2003, 11-18 Permit App: BLD-03-03094 Addition Siaanill,e1\II Illmik 0 ° (39 1
.00Valley
PERMIT APPLICATIONw ORK 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
IREQUIRED SITE INFORMATION
STREET ADDRESS: I I I 'i t ` - 14d A '&!
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: NUJ F?ter}' y>+r�yt�•;
EIDUILDING PERMIT aCHANGE IN USE 0 GRADING a MANUFACTURED HOME
0 RELOCATION Q SIGN 0 TENANT CI O FLIER
OWNER / APPLICANT INFORMATION
® OWNER: krr t e-N� U)tJ 1 S- ® APPLICANT: /, Wad J S
PHONE: 5J 3t75,5S FAX: 5 3,- 0 )20 PHONE: 5.39-Sb_S 6 FAX: 5 3/711 Zi)
ADDRESS: cj - ) 37 )3 Q Vll a ADDRESS:
CrCITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: 1,024C,,,.. C ams---. • ® ARCHITECT.:
PHONE: 6 - bg-25 FAX: PHONE: FAX:
ADDRESS: S -)5'7 Op LU -2 ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION 1
COST OF PROJECT: )0,griOr 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHTDTO`� PEAK: )\ OCCUPANCY GROUP: ) 2ND FLOOR SQ FT:
B IU g DtENSIdNS`x zo) CONSTRUCTION TYPE:V-JL) UNFIN BASEMENT:
90 sti.r+
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
FLANKING SETBACK: CURRENT PROPERTY SIZE: JD J Z(j COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: At,s-77 c- DECK:
REAR SETBACK: CURRENT SEPTIC USE: ""--
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME i . 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
1
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
1 SPECIAL INSPECTIONS I
0 BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® 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: ® YES ® NO PSSA: 0 YES 0 NO
DATE: STAFF:
METHOD OF PAYMENT:
0 0 0 r 0
[ stVISA
CASH CHECK y r��■�
BANKCARD#: EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
( art crjj��r *Mrrw, 11707 East Sprag.16 Avenue,Suite 106 509-688-0036•-Phone
i..7poa ne - Spokane Valley,WA 99206 509-688-0037-Fax
.,,. V lley
Plumbing Permit Application .
PROJECT j • PERMIT r
ADDRESS: jj � j� ...,,,e_ USE: J JJi "Vett) SL ,icxP v
OWNER: 7),._/-4
r,--,-7 / �� PHONE(Daytime Contact): 1 — o j
MAILING ADDRESS: /` 7
S - J }j7 )4ow-e 5(rvJZ ..,--,-, 91Z1?___
(street) (city/state) • (Gil')
CONTRACTOR: I,,�`7� n®mss p LICENSE#:
MAILING ADDRESS: J J l r J PHONE#:
•
(street) (city/state) (Gil') '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
I TOILETS WATER CLOSET,BIDETS X $6 -
2 URINALS X $6 -
.: X $6
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 X
3 SIN LAVS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 -
RAY,FOOD;PREP/CULINARY/MEAT
6 DISHWASHER X $6 -
7 CLOTHES WASHER X $6 -
B GARBAGE DISPOSAL - X $6 -
9 WATER SOFTENER X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 -
1] FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 -
12 FOUNTAINS,DRINKING ' X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING REVERSALS. X $6 -
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
•
STEAMER,PROOFER,CARBONATOR, X $6
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM • X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL 'X $6
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL:
THOD OF PAYMENT
MEMa"' X
• ' PLUS PROCESSING FEE $35.00
:ASH 0 CHECK ❑ MOM= 0 _ _ • -
TOTAL PERMIT FEE DUE:
E: EXPIRES:
IKCARD NUMBER:
HORIZED SIGNATURE:
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NEW FRONT ENTRANCE ADDITION
FOR EXISTING HOUSE
11606 E 19TH AVE.
SPOKANE VALLEY, WA. 99206
CONTACT AL WALLS: 928-7928