2005, 02-10 Permit App: 05000426 Addition 'F, ,
-i
BUILDING PERMIT APPLICATION WORKSHEET
S Kane City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Vallev Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION1Z—(e'
Street Address: i 3910 f 3 C3071-+ C r;v 12.T
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: Q c 7
Building Permit n Change in Use n Grading n Manufactured Home
1 1 Relocation n Tenant Improvement Fire Safety f J Other
OWNER/APPLICANT INFORMATION
H Owner: PIiuL 0uLt F -To+-ligSo14 I I Applicant:
Phone: Fax: Phone: Fax:
Address: / 3G to E 3Ur2t C r Address:
St'3ok 4 UALLvY Wr1 9W37
City State Zip Code City State Zip Code
n Contractor: / tasT IrAv., C 0Ns:r12,.ec'Tid,v I I Architect:
Phone: 9 -5'2-12 Fax: gag - 612 4 Phone: Fax:
Address: 512 4 /V I,/ST A C r Address:
S Poi/.._A%y �. Go is 9 q2 12.
City State Zip Code City State Zip Code
WA State Contractor License #: %,l�si--w 8,8 6 Contact: ba (,J,2,; LA. c„ ,,,
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
23 i 4 ' ‘A 22.- i
MAIN FLOOR TO SQ. FTG: 2'"' FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
441 6 I 3 140
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: . DECK/COV. PATIO SQ. FTG:
41S Lf,59 "'/n
OCCUPANCY_GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
S NA. k.Z (-,.,,., ,H STtC - vv.. i `
II- ( (2.Av -1 )cx-:,O t-L• i-= N 0 11� Kams
- i G- s
# OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
/ 105.4
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
°9G, c> o,., V-- SYSTEM? : t..,:t c
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
BOLTING CONCRETE REINFORCEMENT I I 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,,IIthe property owner.
Print Name 1 2 t4c `c L r^ t Nvvl N Signature (,�0,t tier � Gl.l,eL1,li1ivLCrM
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
(l Cash Q Check Li Mastercard ❑ VISA fl Other
Bankcard #: Expires: • VIN#:
Authorized Signature:
pre--..„ - -•
54.85'
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SITE PLAN
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This site plan is being submitted for the purpose of `N
obtaining a building permit and is a true and correct 4i / '
representation of the proposal. Alt known property • ,/ A. �, \
lines/dimensions curb lines,structures and easements \ /r `D,,
have been identified. Also indicated are wetlands, '5'.'' t.� 8/ < \a,
N.
bodies of wki r,isteep sloes or her critical areas. • . \
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Signed: � r V \a, �/
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Date: 2-4- om`t 0 6 . /�
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103.0'
siiitne MECHANICAL PERMIT APPLICATION Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
dnalleY
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
r..*
Project Address: i 3 9)0 E 3 L j CT Permit Use:
Owner: 17.1,1_,t c i (Jnut_ To+►wsn,V Phone (Daytime Contact): 921 -6407
Mailing Address:
City State Zip Code
Contractor: )3)=4 c>_o N t-' AT , N G__ License#: Phone#: 9 2 2-co
06
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 l 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 1 X $10.00 =
13 RANGE X $10.00 = ,
14 DRYER j X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 2. X $1.00 =
18 DUCT SYSTEMS it X $10.00 =
19 VENTILATING FANS 2.. 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 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
❑CASH 0 CHECK 0 VISA;ff-MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION Community Development Department
ion AIlaik Building Division
ne Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
de/Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
TH.Project Address: /3g/Q g ,3p— Cy--- Permit Use:
Owner: IA e 4 PAL._ 7,,I n 5 in t4 Phone (Daytime Contact): q7--I G 46 7
Mailing Address: J 39) )E 3 0 C i- Si ,'sU. (4)04 9 g o 3 7
n City State Zip Code
Contractor: , FREE STONE PL OM(314 G License#: ' 1 E s p 19L70 1 Phone#: ago-3-62Z I
Mailing Address: J 2- 6 E. neer)Lisa'' LN Col-fle(?7r 4.20- g9Cr)5
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS J 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 =
• LAYS/BASINS,BAR,FLOOR, KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER l , 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, 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 DISPOSAL/SYS X $20.00 = _
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 = _
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑ CASH ❑ CHECK 0 VISA MASTERCARD $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: