2005, 08-22 Permit App: 05002961 Addition Project Number: 05002961 Inv: 1 Application Date: 08/22/2005 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: 31 X 24.6 ADDITION TO RESIDENCE Contact: HENDERSON,DUANE
Address: 11306 E 25TH AVE
C-S-Z: SPOKANE VALLEY,WA 99206
Setbacks:Front Left: Right: Rear: Phone: (509)927-8537
Group Name:
Site Information: Project Name:
Plat Key: 001393 Name: KOKOMO TOWNSITE(FEES) District: F
Parcel Number: 45283.3214 Block: Lot:
SiteAddress: 11306 E 25TH AVE Owner:Name: HENDERSON,DUANE
Address: 11306 E 25TH AVE
Location::CSV SPOKANE VALLEY,WA 99206
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review Released By:
PER M.HARNOIS
Originally Released: 08/19/2005 By: cjjanssen
Plan Review Released By:
Originally Released: 08/19/2005 By: TMELBOU
Sewer Review 11 Released By:
Originally Released: 08/22/2005 By: cjjanssen
Permits:
Operator: CJJ Printed By: CJJ Print Date: 08/22/2005
Project Number: 05002961 Inv: 1 Application Date: 08/22/2005 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
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
RESIDENCE R-3 VB 759 $56,682.12 759 $56,682.12
Totals: 759 $56,682.12 759 $56,682.12
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $692.75
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $277.10
Permit Total Fees: $974.35
Mechanical Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
GAS PIPING 1 #OF UNITS $1.00
VENTILATING FANS 1 NUMBER OF $10.00
GAS LOG OR GAS INSERT 1 NUMBER OF $10.00
Permit Total Fees: $21.00
Plumbing Permit
Contractor: JIMMY'S PLUMBING Firm: JIMMY'S PLUMBING
Address: 1702 S MAMER Phone: (509)928-8991
SPOKANE,WA 99216
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 1 NUMBER OF $6.00
SINKS 2 NUMBER OF $12.00
SHOWERS 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
WATER SOFTENER 1 NUMBER OF $6.00
URINAL 1 NUMBER OF $6.00
Permit Total Fees: $54.00
Operator: CJJ Printed By: CJJ Print Date: 08/22/2005
Project Number: 05002961 Inv: 1 Application Date: 08/22/2005 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $974.35 $974.35 $0.00 $974.35
Mechanical Permit $21.00 $21.00 $0.00 $21.00
Plumbing Permit $54.00 $54.00 $0.00 $54.00
$1,049.35 $1,049.35 $0.00 $1,049.35
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: CJJ Printed By: CJJ Print Date: 08/22/2005
CBUILDING PERMIT APPLICATION WORKSHEET
Spolcane ` , �tCypokana Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
_ = Valley �' ' Spokane Valley, WA 99206
- � �1 - 4 �ne: (509) 683-0036; Fax: (509) 688-0037
i-3-)_ E c is_,
,1 ) .
iEYbUIRED SITE IN/; P. MATION
Street Address: //:31,_ 24 5isj u- , t,
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: a-tM -' T r. ,
(q B-uilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
1 OWNER/APPLICANT INFORMATION
❑ _Owner A �4 ,✓ ❑ Applicant: ; , ' •
Phone: ax: Phone: 9-ft-/e '3 Ewe
Address: j/3o& T. 0sr-�-t,-t- Address:Joss'. ,4y,..e,_ z-
Citel� ' 4),4.1 4gio . L L? �� taei,pi
State Zip Code C State Zip Code
❑ Contractor: , 1G..Jyl,rA ; .,( / ,,— ❑ Architect:
Phone: F • Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
• WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense#: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: - #OF STORIES:
.z.iti 3i'x• .2et 1 " 2.
2.
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
757 4OX -cA % w /0
FINISHED BBASEMENT SQ.FTG: GARAGE SQ. FTG A DECK/COV. PATIO SQ. FTG:
--)7/g 73-9 56-3/9c = 7 q s
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
i/L iC Alea0,v A�/701c_ ,/'ec
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF ‘ROJECT: 30%SLOPES ON PROPERTY: C47.W OR ON-SITE SEPTIC
MANUFACTURED HOME
%Width: Length: Year. Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
'fans Examiner. Phone: Fax:
kddress:
City State Zip
nspector. Phone: Fax:
address:
City State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone: Fax:
nspector(s):
)1SCLAIMER
The perrnitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
!welling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
)roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
eferenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
'ermit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
)wnership of resulting development rights granted by any issued permit inure to the property owner.
'rint Name . %/,,, 57 € ,5L g Signature .<./..Z
4ethod of Payment: (Faxed permit applications will only be accepted with major bankcard)
1 Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
;ankcard#: Expires: VIN#:
uthorized Signature:
PLUMBING PERMIT APPLICATION Community Development Department
Nra Building Division
Phone: (509) 688-0036; FAX: (509') 688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: //3O� �. Z ' .w Permit Use:
Owner. /[7,z,..e.---1.."-- Ate,—"c-&.r--tom... Phone(Daytime Contact):
Mailing Address: /1'30‘ £ .... -3.---2 ?--O2-c"-e— _j/po-4' V Ve—
City State .Zip Code
Contractor -�� __J.." - .
I __„ - License#: Phone#:
Mailing Addre : I
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST . = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00 =
2 URINALS / X MOD = 6 -6'4'
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 X $6.00 = Q i
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 = / O v
X-RAY,FOOD,PREP/CULINARY MEAT
6 DISHWASHER / X $6.00 = ,
7 CLOTHES WASHER j X $6.00 = 4i
8 GARBAGE DISPOSAL / X $6.00 =
9 WATER SOFTENER / X MOD = (9 6
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, NSTALLATION,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 DISPOSAUSYS X $20.00 =
INDUSTRIAL WASTE •
22 INTERCEPTOR X $15.00 = .s --
SUBTOTAL
'
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: i )-r.,-)4-*- „ e--1 6--
l
MECHANICAL PERMIT APPLICATION Community Development Department
sykne Building Division
" ' Phone: (509) 688-0036; FAX: (509) 6811-0037 11707 E. Sprague Avenue, Suite 106
,INIalk
For Inspections, Call
(509) 688-0054 Spokane Valley, WA 99206
Project Address: /� /j 6 L • /.c'�T;'t z''- Permit Use:
Owner. .ai,z-..r /42--e---,.........../.4 ,___-,....-1 Phone (Daytime Contact):
Mailing Address:
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 $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(WSEC min.AFUE rating) Equal to or 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/REFRIGERATION 101-5DDM BTU X $20.00 =
9 BOILER/REFRIGERATION 501-1,00DM 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 = /p_i
13 RANGE X $10.00 = C
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) / X $1.00 = / C v
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS /r 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 $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD .--/"-'"R- ' $10.00 1.--.
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 30-50 TON X $35.00 =
29 AIR CONDITIONER More than 50 TON X $60.00 =
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&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: SUBTOTAL 3 f
❑CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#. EXPIRES: TOTAL PERMIT FEE DUE: ik 0°
AUTHORIZED SIGNATURE: