2004, 04-16 Permit App: BLD-04-04123 Residence City (9w-003(0
SPO .ANE VALLEY S icaX
PERMIT # I-.
BUILDING PERMIT APPLICATION
Box 1 OWNER \�� � � C - JOB LOCATION \ c=c).: . e.
OWNER'S ADDRESS CITY PHONE
)ESCRIBE JOB
f •
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME –� –�
5c,-.a PHONE\c\')._,- S"N•
CONTRACTOR'S ADDRESS ZS, CITY S
:ONTRACTOR'S REG.#\����SL'��o�o� EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VEFFIED)
BOX 3 CONTACT PERSON OF PROJECT C--�c PHONE
ADDRESS CITY ZIP
BOX4 SEWER AVAILABILITY ( s,�,�� WATER AVAILABILITY N =M=N T=
BOX 5 STIMATED PROJECT COST$ �vwo EXISTING BLDG.VALUATION$ -
i
BOX 6 ROPER-TY TAX ACCOUNT NUMBER —1--"—
-EGAL DESCRIPTION -y
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•
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
• ,=NSUS NUMBER LOT NUMBER
BOX 7 JILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR /\ Th.,\ 2ND FLOOR / •
3RD FLOOR / OTHER / BASEMENT FINISHED / )c
BASEMENT UNFINISHED '" / – DECK / GARAGE / v°\t,
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING \� FT,
30X 8 J ) SINGLE FAMILY (\1) NEW CONSTRUCTION
MULTIFAMILY(NO. OF UNITS ) . ( ) EXISTING STRUCTURE
) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY \ `� I SQ. FT.
) TENANT IMPROVEMENT • IMPERVIOUS SURFACE_ '��p� SQ. FT. •
30X 9 PLUMBING FIXTURES ncluin rou h-ins _,• =--
Id
( g g ) • MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
STEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
l
NN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL '
OX 10 Water Service meter size(if known) Also see BOX 4
OX 11 Septic Tank–Not generally allowed in the City of Spokane Valley. For spacial circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
OX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
/ERIFY JNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRli1E AND
DRREC TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
30VE F REMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
NNER/AGENT DATE 'N•\L,- V (OVER)
• 4
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I .reby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard
---- ---- —_ -- Expiration Date
Print the name of the Holder
Signature
• OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE
ZO'1E SETBACKS; FRONT SIDE
• REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL
• DATE
REMARKS
SE"A: EXEMPT NOT EXEMPT
• i
FIRE DEPARTMEN-ikPPROVAL DISAPPROVAL
' DATE
REMARKS
•
-4
PU _IC WORKS DERARTMENT APPROVAL
DISAPPROVAL DATE
. 1 T
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT
NEW INDUSTRIAL IND.ADD/ALT
NEV, COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY
NO. UNITS
MU. (FAMILY ADD/ALT
TENANT IMP. ROOF OTHER
OC!. JPANCY TYPE OF CONSTRUCTION
STORIES
,f BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ • =
BUILDING SQ. FT. @ _
BUILDING SQ. FT. • @
TOTAL SQ. FT. TOTAL VALUATION.
BUILDING PERMIT NO. PLAN CHECK FEE RECD
RECEIPT NUMBER
PERP.'IT FEE
PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOT.' , FEES WSBCC SURCHARGE • ENERGY SURCHARGE
OTH CHARGES ;I
• AMOUNT DUE
BUILDING DEPARTMNT APPROVAL . BY
DATE
•
ASSIGNED ADDRESS
Smy 11707 East Sprague_Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
....*Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: `\ `\0 r)....:. \"S"x\ USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE I:
MAILING ADDRESS. PHONE I:
(street) (city/state) (
DESCRIPTION OF WORK I OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE •OR<100,000 \ X S15 •
2 FUEL BURNING APPLIANCE >100,000 X $19 -
3 UNLISTED APPLIANCE(ADDITIONAL FEE) •OR<400,003 X $50 -
4 UNLISTED APPLIANCE(ADDRIONAL FEE) >400,000 X $100 •
5 USED APPLIANCE(WSEC min.AFUE rating) .or<400,000 X S50 •
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 •
7 BOILER/REFRIGERATION 1-100MBTU X $15 -
8 BOILER/REFRIGERATION 101.500MBTU X $28 -
9 BOILER/REFRIGERATION 501-1,000Mam X S39 -
10 BOILER/REFRIGERATION 1001-1,750M BTU X . $57 •
11 BOILER/REFRIGERATION +1750M BTU X 595 •
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 -
13 RANCE - X 510 •
14DRYER - X $10 -
-
15 FUEL BURNING WATER HEATER - \ X $10 •
16 MISC.FUEL BURNING APPL. - X 510 •
17 GAS PIPING(ea.Outlet) - X 51 •
18 DUCT SYSTEMS - X $10 •
19 VENTILATING FANS - A X $10 •
20 AIR HANDLER(DOES NOT include ducting) •OR<10,000CFM X $12 •
21 AIR HANDLER(DOES NOT Include ducting) >10,000 CFM X $19 •
22 EVAPORATIVE COOLERS - X 510 •
23 TYPE I HOOD - X 550 •
24 TYPE II HOOD - X $10 -
25 HEAT PUMP/AIR CONDITIONER 0.3 TON X S12 •
26 AIRCONOITIONER 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:
AET )D OF PAYMENT PLUS PROCESSING FEE $35.00
11211111111111111
VISA , ;e;skv-r TOTAL PERMIT FEE DUE:
❑ C .5;-I 0 CHECK ❑ rECESig 0 ...__.--.:1-- .J
DATE: EXPIRES:
BANKCARD NUMBER:
M'7", -r-n cl'•'' ^
SScITY on. '°"�� 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
-Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: \\��-� C \-.. ..\\...... USE:
OWNER: C PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE I:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP) •
PLUMBING FIXTURES
DESCRIPTION DETAILS IC OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 7.- X $6 -
i 2 URINALS X $6 -
3 TUBS \ X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT \ X S6
5 SINKS LA VS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR PHOTO,X- X 16. -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER ` X $6 -
7 CLOTHES WASHER ` X $6 -
8 GARBAGE DISPOSAL X $6 -
9 WATER SOF I EVER X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6
•
r 11 FLOOR DRAINS AREA,CASE,COIL„TRENCH,CONDENSATE , X $6 -
! 12 FOUNTAINS,DRINKING X S6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING REVERSALS X S6 -
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
SI LAMER,PROOFER,CARBONATOR, 3 X $6 -
SWAMP COOLER
6 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X S6
17 SPRINKLER SYSTEM X $5 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6 -
19 MEDICAL CAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FLVIURE X S6 -
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LET O D OI kYMENT SUBTOTAL:
.I
MEMIElil
PROCESSING FEE: $35.00'-] CASY. _, CHECK O O L-._- z..
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
LNKCARD NUMBER:
UTHORIZEI` ""GNATURE:
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