2004, 01-20 Permit App: BLD-04-03419 Addition ary or odge\....,
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206 ..
Phone:(509488--0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: %7 a /`7
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: 1 /6taik4vd7C��2 •i
PERMIT DESCRIPTION:
CI EUILDING PERMIT a CHANGE.IN USE a GRADING D MANUFACTURED HOME
-RELOCATION• ®SIGN D TENANT E.OH1ER...
{ OWNER / APPLICANT INFORMATION
® OWNER: ./. CGtq CO PSI-- ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP . CITY,STATE,ZIP
®CONTRACTOR: a ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: r` PAc E:
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: ., TYPE OF SIGN:
iRELOCATION FIRE SAFETY 1
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE
i
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS j
CI BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY -
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES 0 NO
11-15AfE7------1
STAFF:
METHOD OF PA YMF_NT,'
O 0 ® r .
CASH CHECK L.1471 "1�_.
SANKCARD#; EXPIRES: VINE`
AUTHORIZED SIGNATURE::
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
oT4 ,/� 11707 East Sp;ague Avenue,Suite 106 509-688-0036-Phone
1S ,ne Spokane Valley,WA 99206 509-688-0037-Fax
4000 Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: /71 g /31-47 USE:
k//
OWNER: 'iC r1 C/TG'r e1.- PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP) '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6 =
2 URINALS X $6 -
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6 =
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- / X $6 =
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6 =
7 CLOTHES WASHER X $6 =
8 GARBAGE DISPOSAL X $6 -
9 WATER SOFTENER X $6 =
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 -
12 FOUNTAINS,DRINKING X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING REVERSALS X $6
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 =
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 =
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MISC.PLUMBING FIXTURE X $6
SUBTOTAL:
METHOD OF PAYMENT
VISA- !Vase-f... PLUS PROCESSING FEE: $35.00
0 CASH 0 CHECK ❑ ❑ '-.-- -
- ,._
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
K-
l3TT of 11707 East Sprague Ate;nue,Suite 106 509-688-0036-Phone
n� �► Spokane Valley,WA 99206 509-688-0037-Fax
4000VdlleY For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 9 OF tm/ITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 X $15 -
2 FUEL BURNING APPLIANCE >100,000 X $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $50 =
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USED APPLIANCE(WSEC min.AFUE rating) =or<400,000 X $50 =
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFRIGERATION 101-500M BTU X $28 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39` _
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 =
11 BOILER/REFRIGERATION 4-1750M BTU X $95 -
12 GAS LOG,GAS INSERT,GAS FIREPLACE — X $10 =
13 RANGE — X $10 =
14 DRYER — X $10 =
15 FUEL BURNING WATER HEATER — X $10 -
16 MISC.FUEL BURNING APPL. — X $10 =
17 GAS PIPING(ea.Outlet) — X $1 =
18 DUCT SYSTEMS — X $10 -
19 VENTILATING FANS — ( X $10 = I co wt.)20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 = I
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 =
22 EVAPORATIVE COOLERS — X $10 =
23 TYPE I HOOD — X $50 =
24 TYPE II HOOD — X $10 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 =
26 AIR CONDITIONER 3-15 TON X $20 =
27 AIR CONDITIONER 15-30 TON X $25 =
-
28 AIR CONDITIONER 30-50 TON X $35 =
29 AIR CONDITIONER +50 TON X $60 =
30 LPG STORAGE TANK — X $10 =
31 WOOD OR PELLET STOVE/INSERT — X $10 -
32 WOOD STOVE-FREE STANDING — X $25 =
SUBTOTAL:
METHOD OF PAYMENTPLUS PROCESSING FEE: $35.00
ginilii _
VISA } TOTAL PERMIT FEE DUE:
ElCASH ❑ CHECK ❑ iiiiiinit ❑ _
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: