2003, 12-19 Permit App: BLD-03-03319 Basement sifromall,e\iitk,
4000ValleY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION I
STREET ADDRESS: 5-/// I fp 4044, ""
ASSESSOR'S TAX PARCEL NUMBER(S): 3 5 1�
LEGAL DISCRIPTION: IZ 65'oC1 c G
PERMIT DESCRIPTION: A 5rl 1 ,20 /A) 1-3,4 13,4,7-14 13>im p
�DUILDING PERMIT 0 CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
E]RELOCATION CI SIGN Q TENANT D OTHER
OWNER / APPLICANT INFORMATION
0 OWNER: R u L ( E-5 ® APPLICANT:
PHONE: 5-2-t0 7 FAX: ( PHONE: FAX:
ADDRESS: 5-97/ C /`�� S?9> E u -' ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: 6:26-51))-` 644-S1171^-‘„vpp40C✓oyG«`ys ® ARCHITECT:
PHONE: 2-2.1. " 36,61 FAX: JiBYe�� ' PHONE: FAX:
ADDRESS: 4-Y/5- Ai• r-4v' '-vt-I�� l vq -g19 -J ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# D(-mac i.c.)a 22I'-'- 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: c�
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT: I `
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
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:
I MANUFACTURED HOME SIGN I
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
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON—RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 0 NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 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 ® NO PSSA: 0 YES 0 NO
DATE: I STAFF:
METHOD OF PAYMENT:
0 0 0 0
WSA
CASH CHECK dr-Intel
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
►NA-Non< 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
p0kane Spokane Valley,WA 99206 509-688-0037-Fax
.,•vValley For Inspections, call 509-688-0054
'Mechanical Permit Application
MENIIMENIMIMIIIIIIM 4111111
PROJECT PERMIT
ADDRESS: 1 f t L- /q 77--f USE:
OWNER `�,‘_ J 0-,A_ 5 PHONE(Daytime Contact): c'S-) _5-26 7
MAILING ADDRESS:
5//( C Hat S,-Pol c Lt.)A-
(street) (city/state) (ZIP)
CONTRACTOR: c LICENSE#:
6r;S01.-0 5 CA-4-oto-. u-, muJrn4c- ots,1-lc wc, 7 2- KG
MAILING ADDRESS: V PHONE#: 7-2-61 36 6 9
Sit- ,1./ i-r4r4,-, FI e--.1-1) /Oa(d..,..1-vi LA_Kc: L✓4- i. d�-1---
(street)
'(street) (city/state) (ZIP)
DESCRIPTION OF WORK S OF UNITS 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 +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 - r X $10 - 10,CF0
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 $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: / 09
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
MOS f ` `- TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0 ilinain 0 '__:..'moi_
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
5A -re A Ion t t L.L.
2�4 {' W4u.$
Ex ► $T 1.369.
EffiRg sS
CODE COMPLJANCE
VALLEY 8JJLC DIVISION
k51 -0 -)(if ZS( 4-1. i ki-sERI0wRLA-
i