2005, 04-01 Permit App: 05001050 Finish Basement 05--.../05.-C)
4 BUILDING PERMIT APPLICATION WORKSHEET
CITY OF City of Spokane Valley Community Development Department
po ne Building
Division
11707 E. Sprague Avenue, Suite 106
40000 ValleY Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
_0AssStreet Address: k` 605 E . 2_01-7---
Assessors
essor's Tax Parcel Number(s): LI 5 2 2 1 a 7 V L
Legal Description: Lo4 LI S 11V3YL- (a-+ T J p -- O 2— C3Li
PERMIT DESCRIPTION: c l S IN '---kot4tA --4-
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
6 Owner:TI &Ara_ f k6V - ❑ Applicant:
Phone: (Mg- YS' ' Fax: g13 -D 3 3.2 Phone: Fax:
Address: g7o-/ N. Y�2alvcrttl Address:
Uixi (n CC 14 wif 9 rb2-5
City State Zip Code City State Zip Code
❑ Contractor: ❑ Architect:
Phone: Fax: Phone: . Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR.TO SQ.FTG: :. ,..2m-!FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
y25
0CprNCY GROUP: t- r, CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC.
SYSTEM? S-c-- .0 -C...44-
,
MANUFACTURED HOME 71
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
❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ 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 ' 0 Check .❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PLUMBING PERMIT APPLICATION Community Development Department
Building Division
urn
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E, Sprague Avenue, Suite 106
diVaJIey For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: I 110 5 2 D Permit Use:
Owner. c7CkSC MO-X f 6/VPhone (Daytime Contact): //0 - /T o 0
Mailing Address: -.700 a l V&e-J . AJ'--Jnic i*
City State Zip Code
Contractor. License#: Phone#: '
Mailing Address: • ••• • •
City State Zip Code
DESCRIPTION OF WORK • #OF UNITS X .COST• - TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS' I 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 =
• LAVS/BASINS,BAR.FLOOR,KITCHEN,
5 SINKS 'LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,.PREP/CULINARY MEAT I
6 DISHWASHER X $6.00 =
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 =
'ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 =
•
13 FOUNTAINS,DRINKING X $6.00 = _
WATER PIPING/DRAIN-IN WASTE, NSTALIATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL .REVERSALS X $6.00 = •
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB, •
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP COOLER
• VACUUM BREAKER,CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 ' = _ • •
MISCELLANEOUS PLUMBING •
20 FIXTURE • X $6.00 = • •
21 PRIVATE SEWAGE DISPOSALISYS • X $20.00 = '
INDUSTRIAL WASTE .
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE •
0 CASH 0 CHECK 0 VISA 0 MASTERCARD .$35.00
• DATE: EXPIRES: TOTAL PERMIT FEE DUE:
•
BANKCARD NUMBER:
•
AUTHORIZED SIGNATURE: •
MECHANICAL PERMIT APPLICATION Community Development Departi>rlen
•
sokarie Building Divisiot
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 101
For Inspections, Call (509) 688-0054 Spokane Valley, WA 9920E
Project Address: C I(005 F , 201`" Permit Use:
Owner: .S&.SUYI Yn-0.,tC-,,L(, / 1) t -& Hz5V OL Phone (Daytime Contact):(50 a r- 7
Mailing Address: g7OLf W.--)/11&11/ 12.A/ W.C.-4-0141,24'1. LTJ j,4 LOZ 5
City State Zip Code
Contractor. . License#: Phone#:
Mailing Address:
City - State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X ST2.D0 = .
- 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(WSEC min.AFUE rating) Equal toor less than 400,000 . X $50.00 = -
•
6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X ' $100.00 =
• 7 BOILER/REFRIGERATION 1:100M BTU X $12.00 =
8 BOILER/REFRIGERAT1ON 101-500M BTU X $20.00 = •
9 BOILER/REFRIGERATION 501-1,000M BTU • X , $25.00 =
10 BOILER/REFRIGERATION • 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 =
14 DRYER X $10.00 = •
15 FUEL BURNING WATER HEATER X $10.00 =
• 16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) I X $1.00 =
18 DUCT SYSTEMS I X $10.00 = s.
19 VENTILATING FANS - I 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 515.00 =
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 I 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 . St OM =
_31 WOOD DR PELLET STOVE/INSERT • • X $10.00 =
32 .WOOD STOVE-FREE STANDING X $25.00 =
4
33 REPAIR&ADDITIONS / X $15.00 =
34 VENTILATION SYSTEMS •
X • $12.00 =
35 VENTILATION MECHANICAL EXHAUST . X $12.00, _
36 INCINERATOR-RESIDENCE i X. _ $19.00 =
. .37 INCINERATOR-COMMERCIAL X $22.00 = .
METHOD OF PAYMENT: SUBTOTAL
0 CASH fl CHECK 0 VISA fl MC DATE PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
J,
t_ 1
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I REQUIREMENTS % — ---
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RGENCY EGpt;.SS EQ�RMS I
FROM SLEEPING � 5.7SQUARE FEEL
11 NEAROPENING. b4, 50 SflUARE FEETI
If�t' !`�'''vNI� GfL�JOR OPENING(MAX P 244NCHE5
- 20.INCHES I! f 1
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NET CLEAR OPENING HEIGHT 4 •A DVE FLOOR
NE7 CLEAR OPENNWIDTH THESEPUNS MUST BE KEPT� MAX FINISHED STELHEIGHTHALLBE� i EMERGEI�Cv f'`y�pHE 1NRS��d�E� WITHOUT •j I
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