2004, 12-15 Permit App: 04009398 Remodel Project Number: 04009398 Inv: 1 Application Date: 12/15/2004 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW BATHROOM IN BASEMENT Contact: GIESBRECHT,BRIAN
Address: 12818 E 31ST AVE
C-S-Z: SPOKANE VALLEY,WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509)928-4924
Group Name:
Site Information: Project Name:
.....................................................................................
Plat Key: Name: HILL VIEW EST District: Sout
Parcel Number: 45273.1920 Block: Lot:
SiteAddress: 12818 E 31ST AVE Owner: Name: BEYER,BRIAN R&ANN M
Address: 2111 S PINES RD
Location::CSV SPOKANE VALLEY,WA 99206
Zoning: UR-7 Urban Residential-7
Water District: Hold: ❑
Area: 12,508 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 2
Review Information: »>;:.;:.;.<.:
Review
Plan Review Release('By:
. !SWA /i, LW, 1
P
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
This Application: Total Project:
Description Grp Type Notes Si Ft Valuation Sq Ft Valuation
RESIDENCE R-3 VB REMODEL 0 $1,000.00 0 $1,000.00
Totals: 0 $1,000.00 0 $1,000.00
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $69.25
STATE SURCHARGE 1 SELECT $4.50
Permit Total Fees: $73.75
Operator: K_C Printed By: K_C Print Date: 12/15/2004
.
Project Number: 04009398 Inv: I Application Date: 12/15/2004 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Mechanical Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
VENTILATING FANS 1 NUMBER OF $10.00
Permit Total Fees: $10.00
Plumbing Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 1 NUMBER OF $6.00
SINKS 1 NUMBER OF $6.00
TUBS 1 NUMBER OF $6.00
Permit Total Fees: $18.00
t s:
Noe
a ment
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Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $73.75 $73.75 $0.00 $73.75
Mechanical Permit $10.00 $10.00 $0.00 $10.00
Plumbing Permit $18.00 $18.00 $0.00 $18.00
$101.75 $101.75 $0.00 $101.75
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: K_C Printed By: K_C Print Date: 12/15/2004
J
BUILDING PERMIT APPLICATION WORKSHEET
SaSan'OU City of Spokane Valley Community Development Department
ne Building Division
11707 E. Sprague Avenue, Suite 106
4100°V
a e Spokane Valley, WA 99206
Y Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: \ ( i -;; ... ; i r' 1 °. •. -- „,i) , p, ,_ic . Jr. -i, ,.. 1
Assessor's Tax Parcel Number(s): L ?,)-V) / D )
Legal Description:
PERMIT DESCRIPTION: t;,..: : .,
(Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
El Owner: ( .i it E 1 c i„.. y,`-:i ..- ,IX Applicant:(4 V ./, _ , ( , ;
Phone: Sr, i -<}`t.`13 Fax: '‘:,1Phone: 1 ' (1' , Fax:
Address: E i ) . i Address: < ,---- :.—
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: 2N0 FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
'?" t 0 --n SYSTEM?
.
MANUFACTURED HOME
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
F-1 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 ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PLUMBING PERMIT APPLICATION Community Development Department
,,,,, Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
4, [,alley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
00
Project Address: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
City State Zip Code
Contractor: License#: Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK N OF UNITS X COST = TOTAL AMOUNT
( "O V
1 TOILETS WATER CLOSET,BIDETS I X $6.00 = V
2 URINALSX $6.00 =
3 TUBS I X $6.00 = (9- 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 lJ v
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENERX $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, 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 DISPOSALJSYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL Jl/lJ�
METHOD OF PAYMENT: (
PROCESSING FEE `'�,�
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD ykat
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
,
1
A.*kat MECHANICAL PERMIT APPLICATION Community Development Department
Building Division
^J 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: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
C ty State Zp 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 -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) X $1.00 =
18 DUCT SYSTEMS X $10.00 = /�
19 VENTILATING FANS ( X $10.00 = (Y O .O
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 X $10.00 =
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 (0 ,00
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEED
CARD# EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: