2004, 10-15 Permit App: BLD-04-07928 Residence W111O\(
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61)ma BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
ValleY40010* 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: '/?J c E /`i
Assessor's Tax Parcel Number(s):
Legal Description: C`f 1-D I S -�- W o i � 7 '�l� I Z /t' t iC4.47i 4Q f '222'
PERMIT DESCRIPTION:
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
0 Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
X Owner: LM y C r fi inc, ❑ Applicant: l
Phone: 1e13 Fax: c iUo Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
,❑' Contractor: Lam- LJ �� `Mc, ❑ Architect:
Phone: /Oi 3 ax: 443 jC3 Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS.�x #OF STORIES: r-�
4-t G,
MAIN FL OR T SQ. FTG: 2""FLOOR SQ. FTG:3 ' UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: 4Y )N2. DECK/COV. Pl TOSQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: A�a
#OF BEDROOMS: , TOTAL HABITABLE3 ACE: IMPERVI U ACE AREA:
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER 011RiSterSITE SEPTIC
SYSTEM? P vveY
•
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: •Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax: -
Address:
City State Zip
SPECIAL INSPECTIONS
El BOLTING ❑ CONCRETE ❑ REINFORCEMENT El WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check 0 Mastercard
❑ .VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
' MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
Sioniee\INIk
BuildingDivision
Valle 11707 E. Sprague Avenue, Suite1106
40,
Spokane Valley, WAA99206
Phone: (509)688-0036;Fax: (509)688-0037
q7O e- (fir 4-ti FOR INSPECTIONS, CALL(509)688-0054
Project Address Permit Use:
Owner: ��C� k SoC. Phone (Daytime Contact): I1;'it�j
Mailing Address: .0 , 'ex'X • '7 VW.t_n'� ate Zip C de
Contractor: l i„ ` r1 c_ ice a#: Phone#: ‘5.e) --[ 10/3
MailingAddress: ,0 . K ? -ne i 2. Kr e �?'22
State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITSi X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 - 1 _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
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE More than 400,000 X $100.00 =
6 rating)
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 ,_
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $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 =
X $10.00 =
13 RANGE -
14 DRYERX $10.00 =
15 FUEL BURNING WATER HEATER ' X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X _ $10.00 =
17 GAS PIPING(each outlet) X $1.00 =
18 DUCT SYSTEMS A X $10.00 =
19 VENTILATING FANS 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 HOOD X $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 $60.00 =
.
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 El MC
DATE: PROCESSING FEE $35.00
EXPIRES:
CARD#: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
SCIIY� PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
leY 11707 E. Sprague Avenue, Suite 106
4100111 Spokane Valley, WA 99206
� Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: T Permit Use:
Owner: Lim 'N C,00 -Sri(' Phone (Daytime Contact): c''g' I a 13
Mailing Address: x 307'12. v\jc 0/422.3
�d)p j9 VY.6i n (B State Zip Code
Contractor: — o • .License#: • Phone#: 'j p )O/3
Mailing Address: P.Com. Eck 307c1'2 L cKct n
City State Zip Code
*OF TOTAL
DESCRIPTION OF WORK UNITS X COST • AMOUNT
1 TOILETS WATER CLOSET,BIDETS 4 2- x $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 LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL i X $8.00 =
9 WATER SOFTENER X 56.00 =
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, 3 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
Sp
okane (509)688-0195 or Fax(509)688-0037. Any re-
an
inspection will incur an additional $25.00
charge.
le11707 E Sprague Ave,Suite 106
.....0 val
y Spokane Valley,WA 99206
ROW Construction Permit
Permit# ROW 04-813 Issue Date 10/15/2004 Account#
Completion Date Issued by Kcummings Construction Utility
Location of Property Project Description
El El
4705 E 14TH driveway
Comments
EW 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
4705 East 14th Avenue
City of Spokane Valley
County of Spokane,State of Washington
E 47' OF LOT 8, &W 6'OF LOT 9, BLOCK 12,WOODLAND TERRACE
SCALE 1:20 I SEWER&WATER PROVIDED BY CITY OF SPOKANE
ADDRESS:
ZONE:UR 3.5
ROAD WIDTH:60
Pit/
FRONT: FLANKING
P S 3 COMMENTS:
REVIEWED BY:
Iv
+1 ; it K8
41
03110Ulddtl 1d3a TeiNNIfld
The site plan is being submitted for the purpose of
i�
) Obtaining a building permit and is a true and correct
Representation of the proposal. All known property
1v Lines/dimensions,curb lines,structures and easements
Qhave been identified. Also indicted are wetlands,
bodies of water,steep slopes or other critical areas.
\t ,,
53 Lindsey Construction, Inc.