2004, 06-01 Permit App: BLD-04-04498 Residence City o f (� ' 003
SPOKANE VALLEY frx)( 0037
PERMIT # _
BUILDING PERMIT APPLICATION
Box.1 OWNER JOB LOCATION E.
OWNER'S ADDRESS CITY PHONE
DESCRIBE JOB SF
I-HIS PROPERTY IS OWNED BY: SINGLE/MARRIED
'ARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS S. `3\Z, c.cc CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VEf IFIED)
BOX 3 ONTACT PERSON OF PROJECT C.�c ' � PHONE
,DDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY C \ WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ �� ��� EXISTING BLDG.VALUATION$ ! T
BOX 6 PROPERTY TAX ACCOUNT NUMBER Qc«z\ ��� �� \t\-\2==\ N = ���
EGAL DESCRIPTION I-,,
\41'5% •%\\ W\
•
F NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) ,f .
• r:
CENSUS NUMBER LOT NUMBER
--_-- --------
BOX 7 i;'JILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR / 2ND FLOOR /
UD FLOOR / OTHER / BASEMENT FINISHED /
zASEMENT UNFINISHED / DkAc DECK / \bQ GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING ti' " FT. •
30X 8 (1) SINGLE FAMILY ( � NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) . ( ) EXISTING STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY \\1SQ. FT.
) TENANT IMPROVEMENT • IMPERVIOUS SURFACE ! SQ. FT. •
3OX 9 f ..UMBING 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,
t.AWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL:
OX 10 Water Service meter size(if known) Also see BOX 4
OX 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)
OX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts.Contact the Public
Works Department. S
/ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRIJE AND • •
DRREC TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
30VE F" EMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
Nr:ER GENT DATE <y- QC (OVER)
I reby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
N'= 'i Mastercard
--- ---- ---- ---- Expiration Date
Print the name of the Folder
Signature
OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE
Z( IE SETBACKS: FRONT SIDE
REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL
DISAPPROVAL DATE
REMARKS
SE. A: EXEMPT NOT EXEMPT
FIF.L= DEPARTMENT' APPROVAL
I DISAPPROVAL • DATE
REMARKS
•
PUP LIC WORKS DEPARTMENT APPROVAL
DISAPPROVAL DATE
TYP= 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
OC( IPANCY • TYPE OF CONSTRUCTION
• STORIES
BUILDING SQ. FT.
BUILDING SQ. FT. @ _
BUILDING SQ. FT.
BUILDING SQ. FT.
TOTAL SQ. FT. TOTAL VALUATION.
BUILDING PERMIT NO. PLAN CHECK FEE REC'D
RECEIPT NUMBER
PERMIT FEE
PLAN CHECK FEE PLUMBING FEE
MECH. FEE
TOTAL FEES WSBCC SURCHARGE • ENERGY SURCHARGE
OTH Z CHARGES I
___ AMOUNT DUE
BUIL_ 'NG DEPARTMINT APPROVAL . 'BY
DATE .
•
ASSIGNED ADDRESS •
••
••
Sa1'o # 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
'Dalley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: \\')_\.-� \--\. .\,%,... USE:
OWNER: 'PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE I:
MAILING ADDRESS: PHONE#:
(street) (city/state)
PLUMBING FIXTURES
DESCRIPTION DETAILS I'OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6
2 URINALS X $6
3 TUBS
Z X $6
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT •� X $6
5 SINKS LA VS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- ik X 46'
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6
r 7 CLOTHES WASHER , X $6
8 GARBAGE DISPOSAL X $6 -
9 WATER SOFTENER X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6
11 FLOOR DRAINS AREA,CASE,COIL„TRENCH,CONDENSATE X $6
r 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 .-
I SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6 -
7 SPRINKLER SYS I EM X $25 -
.8 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X
.9 MEDICAL GAS per outlet NITROUS,OXYGEN X $6
.'0 MISC.PLUMBING FIXTURE X $6 -
IETHOD OI,PAYMENT SUBTOTAL:
• visA PLUS PROCESSING FEE: $35.00
] CASH ❑ CHECK ❑ EMS= El L_.
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
1NKCARD I' "OBER:
UTI-OFJZEI GNATURE:
SCITYt 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: \\Z1/4. .\_ \--\IX\c-, USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE I:
MAILING ADDRESS: PHONE I1:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK I 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) •w<400,000 X $50 •
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 •
7 BOILER/REFRIGERATION 1-100MBTU X $15 •
8 BOILER/REFRIGERATION 101-500MBTU X $2B •
9 BOILER/REFRIGERATION 501-1,000MBTU X $39 •
10 BOILER/REFRIGERATION 1001.1,750MBTU X . $57 -
11 BOILER/REFRIGERATION +1750M BTU X $95 •
12 GAS LOC.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 — K X $10 •
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 S50 - r
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:
:DIET: ID" OF PAYMENT PLUS PROCESSING FEE : $35.00
YISA' , nrl`,,I..;1cKO TOTAL PERMIT PEE DUE:
C -1 ❑ CHECK ❑ inalani 0 :__:..._:t'..
DATE: EXPIRES:
BANKCARD NUMBER:
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