2004, 02-04 Permit App: BLD-04-03694 Residence 68g-6)(0-5 ,L
City of
F,4)( b FS c C 37
SPOKANE VALLEY
PERMIT# .g Lo -c._,\-f -- ( J'-L C r i
BUILDING PERMIT APPLICATION
Box 1 OWNERC&L PF S CAM t TL CATV5r JOB LOCATION 12'7 31 f. 3112-s
OWNER'S ADDRE�,ppS E SCtLC wc-Y G'c.^a ome qqq 7 7 3 3
DESCRIBE JOB II I eS /OC.ci e-e.
THIS PROPERTY IS OWNED BY:SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY .
CONTRACTOR'S REG.# C1.(F�SC4b 1 R-F EXPIRATION DATE it o J 'Zoo'(
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT f,1..A p-r-- PHONE 997- 733
ADDRESS SA-Y►'Ne--- CITY ZIP .
—
BOX 4 SEWER AVAILABILITY 5 WATER AVAILABILITY f5
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG.VALUATION$
BOX 6 PROPERTY TAX ACCOUNT NUMBER LO'-j- 7 64,k 1 PI N I Q bac et o (Sr p-oo
LEGAL DESCRIPTION
(IF NECESSARY,PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
l:tNbUb NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE proposed) 1ST FLOOR 1303 / 2ND FLOOR Jo S %
3RD FLOOR / OTHER - - / BASEMENT FINISHED /
BASEMENT UNFINISHED1$J30$ DECK //O / GARAGE 5,0/ �/
CARPORT "-- / TOTAL �p?p / HEIGHT TO PEAK OF BUILDING Z 7 FT.
BOX 8 ("INGLE FAMILY ( �EW CONSTRUCTION
( ) MULTIFAMILY(NO.OF UNITS ) ( ) EXISTING STRUCTURE d
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY 7 Z 1'1 Z SQ.FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ SQ.FT.
BOX 9 PLUMBING 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,
LAWN SPRINKLER SYSTEMS,BACK FLOW PREVENTERS,ET AL.
BOX 10 Water Service meter size(if known) /17 Also see BOX 4
BOX 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)
BOX 12 Street use may require a"Street Use Permit"for sewer,water,sidewalks,curb cuts.Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PER4 RY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY N� ' OP
o e A FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO /E r /O' E n/' F f A ICH THE APPLICATION IS MADE. '
OWNER/AGENT -�J JI J DATE�1 ie)y (OVER)
/Mk
I
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard _ Expiration Date
IPrint the name of the Holder Signature
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
OFFICE USE OW-PLEASE DO NOT WRITE BELOW THIS LME
--------------
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT •
FIRE DEPARTMENT APPROVAL DISAPPROVAL• DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYPE 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
OCCUPANCY 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
OTHER CHARGES
AMOUNT DUE
BUILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
Received
San 11707 East Sprague Avenue,Suite 106 509-688-0036 Phone
py Kane ' Spokane Valley,WA 99206 509-688-0037-Fax
4•000lleY
a _
Plumbing Permit Application
PROJECT PERMIT
•
ADDRESS: USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR (n-volit 5 Ka, i A)G LICENSE/:
MAILING ADDRESS: `'J PHONE I:
(street) (city/state) (ZIP) '
PLUMBING FIXTURES
DESCRIPTION DETAILS S OF UNITS % COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6
2 URINALS X $6 -
3 -N9S X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I X $6 -
5 SINKS LAVSSBASINS,BAR,FLOOR,KITCHEN, -
LAUNDRY,UTILITY,JANITOR,PHOTO,X-
5 .
X $6 _
RAY,FOOD,PREP/CULINARY/MEAT `�
6 DISHWASHER I X $6
7 CLOTHES WASHER IX $6 -
8 GARBAGE DISPOSAL I 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 IX $6 -
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
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, 3 X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6 ..
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL:
iTHOD OF PAYMENT
Rier PLUS PROCESSING FEE: $35.00
CASH 0 CHECK 0 =MI= 0 • _ ..i
TOTAL PERMIT FEE DUE:
TE: EXPIRES:
I
VKCARD NUMBER
IHORTZED SIGNATURE:
Silc��� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
ane Spokane Valley,WA 99206 509-688-0037-Fax
....*Valley For Inspections, call 509-688-0054 `
-Mechanical Permit Application
PROJECT • PERMTT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state)
(ZIP)
CONTRACTOR: 611 G �Di.. Fkar
LICENSE t:
MAILING ADDRESS:
PHONE S:
(sleet) (city/state) (ZIP)
DESCRIPTION OF WORK _t OF EMITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 I X $15 •
2 FUEL BURNING APPLIANCE >100000 X $19 =
3 UNLISTED APPLIANCE(ADDMONAL FEE) =OR<400,000 X 550 -
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X 5100 -
5 USED APPLIANCE(WSEC min AFUE rating) .of<400,000 X 550 =
6 USED APPLIANCE(WSEC min AFUE rating) >400,000 X $100 -
7 BOILER/REFRIGERATION 1-100M BTU X $15 -
8 BOILER/REFRIGERATION 101-500M BTU .X 528 •
9 BOILER/REFRIGERATION 501-1,0001x4 BTU _ X $39 =
10 BOILER/REERIGERATLIN 1001-1,F i BTU X 557 =
U BORFR/REFRIGERATI N +1750M BTU X $95 -
_12 GAS LOG,GAS INSERT GAS FIREPLACE - 1 X $10 -
13 RANGE - X $10 -
14 DRYER - X 510 -
15 FUEL BURNING WATER HEATER - ' X 510 .
16 MISC FUEL BURNING ADPL. - X 510 -
17 GAS PIPING(ea.Outlet) - 3 X $1 -
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - 3 X $10 -
20 AIR HANDLER(DOES NOT include ducting) •OR<10,000CFM X 512 -
21 ATR HANDLER(DOES NOT i tdude ducting) >14000 CFM X 519 -
22 EVAPORATIVE COOLERS - X $10 -
-
23 TYPE I HOOD - X 550 •
24 TYPE II HOOD - I _ X $10 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 -
26 AIR COND IO NTR 315 TON X $20 -
27 AIR CONDITIONER 15.30 TON _ X $25 -
28 AIR CONOTI1ONER 30-50 TON X $35 -
29 AIR CONDITIONER +50 TON X 360 -
30 LPG STORAGE YANK - X510 -
_
31 WOOD ORMUT STOVE/INSERT - X 310 -
_
32 WOOD STOVE-FREE STANDING - X 525 -
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE $35.00
MMEMMO TOTAL PERMIT FEE DUE
0 CASH 0 CHECK ❑ 711111111111 0 • •----
DATE: EXPIRES:
BANKCARD NUMBER:
ADDRESS
7nMF /tK
ROAD WIDTH 30
FRONT `__FLANKING
86 -8' COMMENTS 65_0o'
(� REVIEWED BY !��
i
• .tio 1
. ._
_ _
---- __ _
N
J
N_
T w
4:
ire-
^ V� „,
O
).,
op,„..„, _
ivi- .--
N 0 VVV /i� This site is being Submitted
`= rn `y obtaining a iidin9 permN the purpose �f
otb 0- co N'''-
o
representati. of the pr a � d C�reCt
repredimeAsi oposeI. All k
b ..__ – have been i, t curtrii�,� ��and easemen rs
\- \ bodies ofd ' are wetlands.
• r /� �
Signed: r ,� ��'i �►itical areae.
r _ - b-� - Date: ,;: ��;'�
3or
5 3.6 2 •
.70 . a• • 65.00' .
loom -- - ..
•
w 75.22.
—
S 89'45'35"E
—
Gj.-----.---- 37Th LANE.
0 PINE ROCK RIDGE 1ST ADDITION
LOT 7 BLOCK 1
0 10 20 40 Fpunded 1946
1111.1.="mmmil 9mpson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789 •
SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323