2004, 10-22 Permit App: BLD-04-08075 Residence Sari'apoka1140,e\Oliii • • - '
. ,01rMilley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
1
STREET ADDRESS: "1 6 7 /" O �I h
1D
ASSESSOR'S TAX PARCEL NUMBER(S): OCT ��rf
LEGAL DISCRIPTION: a3HLE:illk. a 1. °
PERMIT DESCRIPTION: SFC-
OIUILDING PERMIT 0 CHANGE IN USE 0 GRADING a MANUFACTURED HOME
Q RELOCATION O SIGN D TENANT D OTHER
I OWNER / APPLICANT INFORMATION
1
® OWNER: Agd,e,ar elle/a" ® APPLICANT:
PHONE: g--0t 3 FAX: '11-(3 -mi 3 PHONE: FAX:
ADDRESS: /C) i& /l. 3D-27 n'� ST ,� ADDRESS:
CITY, ATE, IP CITY,STATE,ZIP
®CONTRACTOR: 0 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: /Z1?Le
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONSJO UNFIN BASEMENT:
: rMCONSTRUCTION TYPE: ii/��'�
NUMBER OF STORIES: U{n2. STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: T .--DFLANKING SETBACK: CURRENT PROPERTY SIZE: 6,(03O COVERED DECK:
FRONT SETBACK: 25 CURRENT PROPERTY USE: DECK: 1
REAR SETBACK: 4( CURRENT SEPTIC USE:
LEFT SETBACK: I I CURRENT WELL USE:
RIGHT SETBACK: LO IMPERVIOUS SURFACE AREA:2-000)
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:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: YES ® NO IF YES: COUNTY CITY
IS PUBLIC WATER AVAILABLE: a
YES a NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES 0 NO
IDATE: I STAFF:
METHOD OF PAYMENT:
El rT"
Mash-NI:WO VISA
CASH CHECK rrinamo
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
MECHANICAL PERMIT APPLICATION
SEMOl' City of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
4000P°
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
�
FOR INSPECTIONS, CALL(509)688-0054
�
Project Addre : #1 -Y C- /"J Permit Use:
Owner: LEAL( Phone (Daytime Contact):
Mailing Address: State Zip Code
�� J 6,1642..._ CayContractor: License#: Phone#:
Mailing Address:
City State Zip Code
_
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / X _ $15.00 ,=
2 FUEL BURNING APPLIANCE More than 100,000 _ X $19.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(WSEC min.AFUE X $50.00 =
5 rating) Equal to or less than 400,000
USED APPLIANCE(WSEC min.AFUE X $100.00 =
6 rating) More than 400,000
7 BOILER/REFRIGERATION 1-100M BTU , X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTUX $39.00 -_
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 __
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 =
13 RANGE X $10.00 =
14 DRYER - X $10.00 =
15 FUEL BURNING WATER HEATER / X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X _ $10.00 =
17 GAS PIPING(each outlet) 9 2 X $1.00 =
18 DUCT SYSTEMS / _X $10.00 ,, _
19 VENTILATING FANSC X $10.00 =
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 =
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM _ X $19.00 , = _
22 EVAPORATIVE COOLERS X $10.00
23 TYPE I HOODX $50.00 =
24 TYPE II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON / X $12.00 __
26 AIR CONDITIONER 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X , $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 AIR CONDITIONER More than 50 TON X $80.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
EXPIRES:
CARD#: TOTAL PERMIT FEE DUE:
-
AUTHORIZED SIGNATURE:
•
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
40,00-
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address 00? e /y Permit Use:
Owner: r Phone (Daytime Contact):
Mailing Address:
y� City State Zip Code
Contractor: C- I7 License#: Phone#:
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST • AMOUNT
1 TOILETS WATER CLOSET,BIDETS $6.00 =
2 URINALS X $6.00 =
3 TUBS X' $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAVSBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER / X $6.00 =
7 CLOTHES WASHER t' X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Inspections performed 10 days after
scheduled completion to schedule call
gra 91inspwl incur an additional $25.00
Spö1ine charge.
11707 E Sprague Ave, Suite 106
4000 Val ey
Spokane Valley,WA 99206
ROW Construction Permit
Permit # ROW 04-882 Issue Date 10/30/2004 Account #
Completion Date Issued by Kcummings Construction Utility
El D
Location of Property Project Description
4706 E 14TH driveway
Comments_
ANEW DRIVEWAY APPROACH
Trench Dimensions AC Cut Required
Applicant/Contractor Name Licence # Individual Name
Lindsey Construction
Address Contractor Phone #
P.O. Box 30792 509-879-3420
Spokane WA 99223-
Account #
Permit Fee Inspection Fee Total Fees Collected
$25.00 $25.00 $50.00
Permittee Signature Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Credit Card# Expiration Date
Name of Holder Signature
In addition to the permit application fee of$16.00(utility)or$25.00(construction),inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(signed) Date
PERMIT MUST BE KEPT ON SITE
Proposed Plot Plan
4624 East 14th Avenue
City of Spokane Valley
County of Spokane,State of Washington
LOT 2, BLOCK 18, &N. ' OF VACATED ALLEY, WOODLAND TERRACE
SCALE 1:20 I SEWER&WATER PROVIDED BY CITY OF SPOKANE
ADDRESS:
ZONE:UR 3.5
ROAD WIDTH:60
FRONT: FLANKING
COMMENTS:
Ass REVIEWED BY:
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PLANNING DEPT. APPROVED
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The site Plan is being submitted for the purpose of
Obtaining a building Permit and is a true and correct
Representation of the proposal. All known property
Lines/dimensions,curb lines,structures and easements
—
/f7 eirtf ff` have been identified. Also indicted are wetlands,
bodies of water,steep slopes or other critical areas.
51) Lindsey Construction, Inc.