2005, 07-19 Permit App: 05002434 Residense Project Number: 05002434 Inv: 1 Application Date: 07/19/2005 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE- Contact: HELLER,LARRY
NATURAL GAS Address: 15222 E 4TH AVE
C-S-Z: SPOKANE VALLEY,WA 99037
Setbacks: Front 65 Left: 5.5 Right: 5+ Rear: 43 Phone: (509)928-1880
Group Name:
Site Information: Project Name:
Plat Key: Name: RANGE District: Sout
Parcel Number: 45231.1518 Block: Lot: 3
SiteAddress: 15218 E 4TH AVE Owner:Name: HELLER,LARRY
Address: 15222 E 4TH AVE
Location::CSV SPOKANE VALLEY,WA 99037
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 10,850 Sq Ft Width: 64 Depth: 166 Right Of Way(ft): 20
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review Released By:
batit
UVLielli4L-64171
Plan Review Released By: 1
lot 6 W j,jA,44,4„AA„„) '
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Landuse/Zoning Released By:
7 � ma
Sewer Review _ l
Released By: IL Cry `.L y 4,,a,,,_t,,,_
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Permit l,1.1.-,,2-1 `4 ii 1 '-t,
Operator: K_C Printed By: K_C Print Date: 07/19/2005
•
Project Number: 05002434 Inv: 1 Application Date: 07/19/2005 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Building Characteristics
Group: R-3 Type: VB
Total Area 2552
Building Height 18
Stories 1
Dwelling Units 1
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
BASEMENT U R-3 VB 1,276 $19,140.00 1,276 $19,140.00
COV DECK R-3 VB 187 $2,805.00 187 $2,805.00
GARAGE U-i VB 768 $14,592.00 768 $14,592.00
RESIDENCE R-3 VB 1,276 $95,291.68 1,276 $95,291.68
Totals: 3,507 $131,828.68 3,507 $131,828.68
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $1,172.95
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $469.18
Permit Total Fees: $1,646.63
Mechanical Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00
GAS PIPING 2 #OF UNITS $2.00
VENTILATING FANS 3 NUMBER OF $30.00
CLOTHES DRYER 1 NUMBER OF $10.00
GAS LOG OR GAS INSERT 1 NUMBER OF $10.00
HOOD-TYPE II 1 NUMBER OF $10.00
Permit Total Fees: $74.00
Operator: K_C Printed By: K_C Print Date: 07/19/2005
Project Number: 05002434 Inv: 1 Application Date: 07/19/2005 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Plumbing Permit
Contractor: OWNER Finn: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 3 NUMBER OF $18.00
SINKS 4 NUMBER OF $24.00
SHOWERS 2 NUMBER OF $12.00
TUBS 1 NUMBER OF $6.00
DISH WASHERS 1 NUMBER OF $6.00
GARBAGE DISPOSAL 1 NUMBER OF $6.00
CLOTHES WASHER 1 NUMBER OF $6.00
ELECTRIC HOT WATER TANK 1 NUMBER OF $6.00
FLOOR DRAINS 1 NUMBER OF $6.00
SEWAGE EJECTOR 1 NUMBER OF $6.00
WATER SOFTENER 1 NUMBER OF $6.00
WATER USING DEVICES 1 NUMBER OF $6.00
Permit Total Fees: $108.00
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $1,646.63 $1,646.63 $0.00 $1,646.63
Mechanical Permit $74.00 $74.00 $0.00 $74.00
Plumbing Permit $108.00 $108.00 $0.00 $108.00
$1,828.63 $1,828.63 $0.00 $1,828.63
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 07/19/2005
- BUILDING PERMIT APPLICATION WORKSHEET
�, ealle rg - -
��"- City of Spokane Valley Community Development Department
Building Division
'
11707 E. Sprague Avenue, Suite 106
400,Vale Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: / 2 / t i
Assessor's Tax Parcel Number(s):
Legal Description:
^ ,PERMIT DESCRIPTION: ftL) \Q Ut 0 &v c
El Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
N OWNER/APPLICANT INFORMATION
•
Ej Owner: , ,z-ry y N //e,_'
.t-' Applicant: J5,�,tt
Phone: 9,2 S-f Fax: 12&=/''d C. ,h1, Phone: Fax:
Address: /52 2 z 7E; ` ' a... _ Address:
� Vail �C, 5.'4103'1
CiC State Zip Code City State Zip Code
❑ Contractor: ,Jet or-
Fax: 1 ID(Ai('-- Fax:
Address: ►C c n1 vit,-e
City State Zip Code d N , .ct b State Zip Code
Q
WA State Contractor License#: Mit
IV 6' xi /
S
Spokane Valley Bus. Liscense#: f 0 1
a� �t,ck
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:i DIMENSIONS: #OF STORIES:
/
MAIN FLOOR TO SQ. F ""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
/ z -) L TG: 2 --_---- l2 7 -
FINISHED BSEMENT SQ. FTG: GAWB SQ. FTG: DECK/COV. PATIO SQ. FTG:
7bK /s'7
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
/ -C : 0 r n/c; ,e f z-ii c-
#0 - S: HABITABL E AREA:
f / 71,
COST OFPROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
S�, l� � O SYSTEM? creal6r
MANUFACTURED HOME
Width: Length: Year:
Manufacturer:
Previous Address:
Proposed Use: _
Fire Sprinkler:
Tent:
Valuation:
RELOCATION
FIRE SAFETY
# of Heads: Fire Alarm:
Fireworks Display: Blasting:
Above/Underground Storage Tank Size:
Pit Set:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
city State Zip
Inspector: Phone: Fax:
Address:
city State Zip
Firm Name:
Inspector(s):
SPECIAL INSPECTIONS
❑ CONCRETE ❑ REINFORCEMENT
Fax:
❑ WELDING
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 ki-� - 11�
�` = ! �'` Signature -�
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: c�
®N confidential credit card information which
was redacted pursuant to RCw 19.255.010
and the original document destroyed
Pursuant to SOS DAN GS2014-030.
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PLUMBING PERMIT APPLICATION Community Development Department
Building Division
' Phone: (508) 688-0036; FAX: (609)'6-88-0037 11707 E. Sprague Avenue, Suite 106
$Wky- For Inspections, Call (509) 6188-OGS4 Spokane Valley, WA 99206
Project Address: Permit Use: 1t/ei-
Owner. _ AC2, � �- v /�'� � Phone (Daytime Contact): 52? /fFo :"=°%9g0
Mailing Address: 7 Znokzi iue f'l _/leV A, ar'10s3
City State Zip Code
Contractor. I License # Phone 7X
Mailing Address: s ) ,
city 'Z6—,3.2
State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST .
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
-
2
URINALS
X
$6.D0
-
3
TUBS
X
$6.00
-
4
SHOWERS ER
BATH STAL ON-SITE BUILT
X
$6.00
-
5
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREPICULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.D0
-
7
CLOTHES WASHER
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, CONDENSATE
X
$6.00
-
12
ROOF DRAINSIOVERFLOW
DRAINS
X
$6.D0
-
13
FOUNTAINS DRINKING
X
$6.0D
-
14
WATER PIPING/DRAIN-IN WASTE,
VENT PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
-
15
SEWAGE EJECTOR I
GRINDER, SUMP PUMP
X
$6.DD
-
16
WATER USING DEVICE /
ICE AWOR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
-
19 1
MEDICAL GAS r outlet)
NITROUS, OXYGEN
X
$6.00
-
20
MISCELLANEOUS PLUMBING
FIXTURE
X 1-
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
-
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
-
METHOD OF PAYMENT:
❑ CASH [3 CHECK ❑VISA El MASTERCARD
MASTERCARD
DATE EXPIRES:
SUBTOTAL
FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 638-.0037
For Inspections, Call (509) 688-0054
Project Address:
Owner.
Mailing Address:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
city State Zip Code
Contractor. License #: Phone #:
Mailing Address:
city State Zip Code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS X
COST = TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
E ual to or less than 1 D0,000
X
$12.00 =
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00 =
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 =
5
USED APPLIANCE SEC min. AFUE ratio
E ual to or less than 400,DD0
X
$50.00 =
6
USED APPLIANCE SEC min. AFUE ratio
More than 400.000
X
$100.00 =
7
BOILER/REFRIGERATION
1 -100M BTU
X
$12.00 =
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.DD =
9
BOILERIREFRIGERATION
501 - 1,000M BTU
X
$25.00 =
10
BOILER/REFR)GERATION
1.001 -1,750M BTU
X
$35.00 =
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00 =
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00 =
13
RANGE
X
$10.00 =
DRYER
X
$10.OD
F1714
FUEL BURNING WATER HEATER
X
$10.00
MISC. FUEL BURNING APPLIANCE
X
$10.00
GAS PIPING each outlet
X
$1.00 =
18
DUCT SYSTEMS
X
$10.00 =
19
VENTILATING FANS
X
$10.00 =
20
AIR HANDLER POES NOT include ducting)
E ual to or less than 10,000 CFM
X
$12.00 =
21
AIR HANDLER POES NOT include ducting)
Greater than 10,000 CFM
X
$15.00 =
22
EVAPORATIVE COOLERS
X
$10.00 =
23
TYPE I HOOD
X
$50.DD =
24
TYPE 11 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
30-5D TON
X
$35.00 =
29
AIR CONDITIONER
More than 50 TON
X
$60.DD =
30
LPG STORAGE TANK
X
$10.00 =
31
WOOD OR PELLET STOVE/INSERT
X
$10.00 =
32
WOOD STOVE - FREE STANDING
X
$25.00 =
33
REPAIR 8 ADDITIONS
X
$15.00 =
34
VENTILATION SYSTEMS'
X
$12.00 =
35
VENTILATION MECHANICAL EXHAUST
X
$12.00 =
36
INCINERATOR - RESIDENCE
X
$19.00 =
37
INCINERATOR - COMMERCIAL
X
$22.00 =
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MC
CARD #:
DATE:
EXPIRES'
SUBTOTAL
PROCESSING FEE $35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: