2006, 10-03 Permit App: 06003965 WABO Inspect Permit Center
S I ohne 11707 E Sprague Ave, Suite 106 [ ,c PERMIT NUMBER:39
Spokane Valley, WA 99206 -?'
Le) t50
Valley (509)688-0036 FAX: (509)688-0037 PERMIT FEE:
Community Development v,,w.spokanevallev.cra.so1.1
Residential Construction o New Construction o Accessory Bldg
Permit Application ❑ Addition/Remodel o Deck
o Other:
SITE ADDRESS ,//, __9,___k__ ___42 —
ASSESSORS
/,/ 9 E c ___42 —
ASSESSORS PARCEL NO: LEGAL DESCRIPTION:
_
•
Building owner . .Contractor .. .. - _
Name( ,,Z %, ', 3 Name:
Address:j4i5/7 - lic_ Address:
City: kt�e a 7r 9° 40�o City: Zip:
Phon - Phone: Fax:
Lic No: Exp.Date:
Contact Person C icy" Business Lic No:
Name: --- i B
Phone:
I
Describ- the scope of work in detail: Cost of Project:
$
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**************The following MTJST be complete: (write N/A if not applicable)**********************
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ. 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE
FTG: AREA:
FINISHED BASEMENT GARAGE, SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON
SQ. FTG: / `2h0Z . I- Cj 54 P:11' 'TY:
#OF BEDROOMS: CONSTRUCTION TYPE: HEAT SOURCE: SEWS- ,'R SEPTIC?
DISCLAIMER i' ti L
�/
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: min-nces. 6) Plan : ...itiona information may be required to be submitted,and subsequently approved before
this application ►=n be proms
Signatur- ,, ,.,.. !�•
Date tl0- ?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 6/252005
Spt..i 1 E lD �
{arie
\itlley •
11707 E Sprague Ave Suite 106 ♦ Spokane Valley WA 99206
509.921.1000 ♦ Fax: 509.921.1008 ♦ cityhall@spokanevalley.org
Residential Plan Submittal Minimums
❑ Completed Building & Mechanical application with: Accurate address, Parcel
Number and/or Legal Description, description of work, owner and contractor
information, signature, and date.
❑ Two sets of plans including Site Plan, elevations, floor plans, foundation plans •
With details, roof plan, framing plans & details.
❑ Show the height of any proposed buildings or accessory structures.
❑ Floor plan for each floor: Dimension to scale (minimum 1/8") and label each
Room (including sq. footage of house and garage on plans) Show each
level of existing house and square footage of any additions.
❑ All braced wall panel types: show locations and details of installation, including
engineered design.
❑ Egress windows: Provide at least one window or exterior door approved for
Emergency escape or rescue from a basement and in every room for sleeping.
❑ Smoke detector locations
❑ 22" X 30" attic access location
❑ 18" X 24" crawl space access:
❑ One-hour separation detail: between house and garage
❑ Floor framing details: Joist type,size, spacing and installation details
❑ Roof framing plan and details
❑ Furnace and hot water heater location.
. 0 All header locations: type, size, and connections
❑ Foundation plan
❑ Insulation information
APPLICATION AND INSPECTION CHECKLIST - Adult Family Home
Code References: 2003 IBC 310(WAC 51-50)and 2003 IRC 110(WAC 51-51)
APPLICATION NUMBER:
Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed.
SECTION 1- PROPERTY INFORMATION
SITE ADDRESS: "�' _ ASSESSOR'S TAX/PARCEL#: -
SECTION 2-APPLICANT INFORMATION ( ems'
PROPERTY OWNER NAME: , ‘�}7`� DAYTIME PHONE() R3 l—3- eat
.,
LICENSEE NAME(IF DIFFERENT): DAYTIME PHONE:
SECTION 3—FLOOR PLAN
A complete floor plan must include all sleeping rooms, identified by number(#1, #2, #3 etc.) and all components for
exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary)
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SECTION 4—DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and that I am requesting or
I am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I further
certify that I am in the process of making an application to the Department of Social and Health Services for an adult family home license and that I
have also made application to the applicable jurisdiction for the appropriate license(s)to conduct such business at this location. I further agree to
hold harmless the jurisdiction conducting such inspections,at my request,as to any claim(including costs,expenses,and attorneys'fees incurred in
the investigation of such claim),which may be made by any person,including the undersigned,and filed against the jurisdiction,but only where
such claim arises out of a ianc.of the jurisdi. ,.nclu.'•a its officers and employees,upon the accuracy of the information supplied to the
jurisdiction as a part o is apspy•.n.
.1 c 3, �� DATE:
NAME TITLE: �
0 PROPERTY OWNER 11 APPLICANT 0 LICENSEE
SECTION 5 - INSPECTION CHECKLIST
Note: Checklist to be completed by building department in the jurisdiction home will be located.
YES NO
Home licensed (or applying for license) on or after July 1, 2001 El ❑
SLEEPING ROOMS 0 0
Sleeping Room #1 ❑ S ❑ NS1 ❑ NS2
Bedroom door is openable from the outside when locked ❑ ❑
Closet doors are readily openable from the inside 0 El
Smoke alarm is installed in the bedroom 0 0
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ ❑
Sleeping room window has a maximum sill height of 44" ❑ 0
Sleeping Room #2 ❑ S 0 NS1 ❑ NS2
Bedroom door is openable from the outside when locked ❑ 0
Closet doors are readily openable from the inside ❑ ❑
Smoke alarm is installed in the bedroom ❑ ❑
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) El ❑
Sleeping room window has a maximum sill height of 44" ❑ ❑
Sleeping Room #3 ❑ S ❑NS1 ❑ NS2
Bedroom door is openable from the outside when locked ❑ ❑
Closet doors are readily openable from the inside ❑ ❑
Smoke alarm is installed in the bedroom ❑ ❑
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) El El
Sleeping room window has a maximum sill height of 44" ❑ ❑
Sleeping Room #4 ❑ S El NS1 ❑ NS2
Bedroom door is openable from the outside when locked ❑ El
Closet doors are readily openable from the inside ❑ ❑
Smoke alarm is installed in the bedroom ❑ ❑
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) El El
Sleeping room window has a maximum sill height of 44" ❑ ❑
Sleeping Room #5 ❑ S ❑ NS1 ❑ NS2
Bedroom door is openable from the outside when locked 0 ❑
Closet doors are readily openable from the inside ❑ ❑
Smoke alarm is installed in the bedroom ❑ ❑
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) 0 El
Sleeping room window has a maximum sill height of 44" ❑ ❑
Sleeping Room #6 ❑ S ❑ NS1 ❑ NS2
Bedroom door is openable from the outside when locked ❑ ❑
Closet doors are readily openable from the inside 0 El
Smoke alarm is installed in the bedroom ❑ ❑
Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ ❑
Sleeping room window has a maximum sill height of 44" El ❑
GENERAL
Bathroom doors are openable from the outside when locked ❑ ❑
Smoke alarms are installed on all levels of the dwelling ❑ ❑
All smoke alarms are audible in all parts of the dwelling upon activation of a single device ❑ ❑
Access road and water supply approved by Fire Department El ❑
El PASSED ❑ CORRECTIONS REQUIRED ❑ PERMIT REQUIRED
INSPECTOR: DATE:
Application and Inspection Checklist developed by Washington Association of Building Officials(WABO),in
cooperation with Department of Social and Health Services(DSHS)for use by both departments and licensors.