2003, 07-15 Permit App: BLD-03-02049 Residence City of
SPOKANE VALLEY
PERMIT # 3 L X) -03 - c►Z-`�'� ��
BUILDING PERMIT APPLICATION
Box 1 OWNER Qui l<S-k'n (-r:, ie L.Z‘L, JUB LULAtION /OA:
OWNER'S ADDRESS )4/ j J, CITY LjaifthiPHONE �-A1s1;--=5-Fi6cj
i_e„ to
DESCRIBE JOB [ l
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME (a'] e ri S(e (')a 5 t`,r,lr) 441q J NE 52)F-�f s' ;�-519 6
CONTRACTOR'S ADDRESS /I/Z I LAI. w +cr,10( CITY ,tc'toe ri- 1 Z kr` l '4 9qact
Z
CONTRACTOR'S REG.# OO7REF)U G L eD41f R.Q. EXPIRATION DATE I/31/6S-
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT /1-7,v4 PHONE 5-z)c; 72-- -7527;7 ,y/05-
ADDRESS ;lf 2/ Ad. /11 c��-s��Ci ✓wet%t� LAITY L., ix/1--1 /-c3,14-e/ W}4-ZIP 9 got
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY C '(4 c 0-,,i-,
BOX 5 ESTIMATED PROJECT COST$ 414, 4/Oa Cr) EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER 4/SZ cl 1 , 1-1 ( U Q__07-567i
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE(Existing/proposed) 1ST FLOOR f--- / %S 2ND FLOOR "— / 1/33
3RD FLOOR / OTHER — / BASEMENT FINISHED /
BASEMENT UNFINISHED -- / I/74 DECK r - / 30 GARAGE / 4So
CARPORT / '-" TOTAL `` / 1//11 HEIGHT TO PEAK OF BUILDING 2(7 FT.
BOX 8 (›Q SINGLE FAMILY (N<-) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY 5;71/5- SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE- SQ. FT.
BOX 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS,WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL.
BOX 10 Water Service meter size(if known) Also see BOX 4
BOX 11 Septic Tank-Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
BOX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT jii / ,1� �► DATE 7-/5—'t9D (OVER)
I hereby 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
ZONE SETBACKS: FRONT SIDE REAR
HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL
DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DISAPPROVAL
DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL
DATE
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION
STORIES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. �p =
BUILDING SQ. FT. p�
BUILDING SQ. FT. p�
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE RECD
RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE
MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES
AMOUNT DUE
BUILDING DEPARTMENT APPROVAL - BY
DATE
ASSIGNED ADDRESS
ctrr 0.0#\•"...,e
'sky
MECHANICAL PERMIT APPLICATION
PROJECT _ PERMIT
ADDRESS: USE:
OWNER: to64_14-f.ft•,� 1.-L.L. PHONE(Daytime Contact): c _ze- _ *- 0°-
MAILING ADDRESS:
(street) ? (City/state) •(zip)
CONTRACTOR: LICENSE#:
el'C'4""1 P... Ivit c LAC.anc c(:l 601'11 FO PA 3 8 W.C.rz
MAILING ADDRESS: PHONE#:
i I co l t INtL�;. h:t.F.r c f'`IN J� ) a po 14:> t, �-j- 9 ?zO t
(stmt) (city/stat) (zip)
DESCRIPTION OF WORK #OF OMITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 i 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 - I X $10 =
13 RANGE - X $10 =
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER . - 1 X $10 =
16 MISCELLANEOUS FUEL BURNING APPL - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - Z x $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000CFM 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 .+50TON X $60 =
30 LPG STORAGE TANK - X $10 =
31 WOOD OR PELLET STOVE/INSERT - X , $10 =
32 WOOD STOVE-FREE STANDING - X $25 =
- I
. SUBTOTAL
0 CASH 0 CHECK 0 0 PLUS PROCESSING
FAXED PERMITS WILL
WITH PAn�xr $35.00
OP niBE ACCEPTED
FEE
TOTAL PERMIT FEE
• DUE
DATE: EXPIRES:
BANXCARD NUMBER:
AUTHORIZED SIGNATURE:
icy
PLUMBING PERMIT APPLICATION
PROJECT ,/� PERMIT
ADDRESS: 10202 _ /61:- !-i•✓e- USE:
OWNER: atC.Q_14 5 t<%'Ae_ (40,%1 e.-s L.L, cL. PHONEDa
MAILING ADDRESS: PHONE(Daytime Contact): ��r'_�2-�SZ 7 X'16 5-
MAILING /V. PIvs•.L4cY:lw.0('j ZAnL_ L,'6er•1� Lo, iii - g Rc/ -?
CONTRACTOR: (street) "(city/state) r (zip)
LICENSE#:
f Liz,_ eI, �1N�t s Pl �, .°� rJ+4ti�� S P� � Ph;
MAILING ADDRESS: PHONE#:
5-09 -CiZ--(^ `-( t 136
t2, 5-0 -._S L qt-- - lie_vtL�_ t 5'eOV.co. . i FL 9�o3 7
(street) (city/state) (zip) _
PLUMB/NC FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS • AMOUNT
+
1 TOILETS WATER CLOSET,BIDETS Z X $6
2 URINALS • X $6 =
3 TUBS 7- X $6 = •
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 = •
5 SINKS LAYS/BASINS,BAR,FLOOR, X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULWARY/MEAT 3
6 DISHWASHER X $6 =
7 CLOTHES WASHER l X $6 =
8 GARBAGE DISPOSAL , X $6 =
9 WATER SOFTENER X $6 =
10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X $6 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, $6
'
CONDENSATE X =
12 FOUNTAINS,DRINKING X $6' =
13 WATER PIPING/DRAIN-1N INSTALLATION,ALTERATION, X $6
WASTE,VENT, REPAIR,REVERSALS
• PLUMBING REVERSAL =
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 = •
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, X $6
HOSE BIB,STEAMER,PROOFER,
CARBONATOR,SWAMP COOLER 3
16 CROSS CONNECTION VACUUM BREAKER,CHECK X $6
DEVICE VALVE,AND R.P.B.P.D.FOR:
VATS,SUMPS,TANKS,BOILERS
17 SPRINKLER SYSTEM ( X $25 4.
18 INTERCEPTORS GREASE TRAP,SAND TRAP, • $6
CHEMICAL HOLDING TANK X • =
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 at
' 20 MISC PLUMBING FIXTURE X $6 =
-
,--
rT �
0 CASH 0 CHECK 0 0 I PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OF A MAYOR CREDIT•CARD FEE
TOTAL PERMIT FEE
DUE
DATE:
EXPIRES:
BANKCARD NUMBER: .
AUTHORIZED SIGNATURE:
/ OF 16th LANE
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'FAIRMONT RE"
10202 E. 16th AVENUE
SPOKANE,WA. 99203
/ LOT 4A -OF- BLOCK 2
P .. MAN COMMONS
LOe - D IN THE NORTHEAST 1/4 OF
APPROVED // rSE� ION 29,T.25N.,WASHINGTON N.M.
�t _ t.,:,". .,_—.—s WASHINGTON
LOT AREA= 5,245 SF.
SCALE, I" = 20'