2004, 02-19 Permit App: BLD-04-03587 Residence CITY OF
4\ifilk ,
.00Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
1
STREET ADDRESS: i Zj1 3 / E. • 3 ?II"' L In
ASSESSOR'S TAX PARCEL NUMBER(S): Y
LEGAL DISCRIPTION: LOTS t3 L 1< I I tot. e.DC (C V (06 E
PERMIT DESCRIPTION: 12 5 (kJ- 'rr ()'�
13�!)ILDING PERMIT 13 CHANGE IN USE a GRADING a MANUFACTURED HONE
®-RELOCATION a SIGN TENANT OYttER
OWNER / APPLICANT INFORMATION
D OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
/f/ CITY,STATE,ZIP CITY,STATE,ZIP
.CONTRACTOR: v^- 1 FC SLC't).yl tTZ. ONai ® ARCHITECT:
PHONE: 191-7733 FAX: Pi ( �9L/7/ PHONE: FAX:
ADDRESS:1615-20 E.SEc/ r.:. 4Pe-4240W M4DDRESS:
CITY,.STATE,ZIP 9153'' CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# G' -1 Poe SG/O f /QF CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: //7V.
BUILDING HEIGHT TO PEAK: "(� OCCUPANCY GROUP: 2ND FLOOR SQ FT: 17 3
BUILDING DIMENSIONS: `f Z),.7 CONSTRUCTION TYPE: UNFIN BASEMENT: / 110
NUMBER OF STORIES: Z STRUCTURES ON PROPERTY: FINISHED BASEMENT: --
NUMBER of BEDROOMS:--__3 CRITICAL AREAS:._.. r,a *r_.=•
FLANKING SETBACK: CURRENT PROPERTY SIZE: 7547 COVERED DECK:
FRONT SETBACK: 3c� CURRENT PROPERTY USE: DECK: '19-
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: Si CURRENT WELL USE:
RIGHT SETBACK: 5 IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME ' SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: .. TYPE OF SIGN:
iRELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
iSPECIAL INSPECTIONS
BOLTING ®CONCRETE a REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES ® NO
11-6-AFE
STAFF:
METHOD OE PAYMENT.'
Li EI ® r Li animmer
__
CASH CHECK .._. r 11111111111111111111
i l
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
CIT4 o 401 �rwri, 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
S ,ne Spokane Valley,WA 99206 509-688-0037-Fax
40, Talley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR:0-WI,', M S p LUMB I A)(> LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP) .
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 -
2 URINALS X $6 -
3 TUBS Z X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT ' X $6 -
5 SINKS LAVSBASINS,BAR,FLOOR KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER J X $6 =
7 CLOTHES WASHER X $6 -
8 GARBAGE DISPOSAL 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 J X $6 =
12 FOUNTAINS,DRINKING X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WAS YE,VENT,PLUMBING REVERSALS X $6 -
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 =
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
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:
METHOD OF PAYMENT
Miiiiii 2-27-if.. .
• MA • • flfasI ; PLUS PROCESSING FEE: $35.00
0 CASH 0 CHECK 0 MOM 0 I___.......::-:5.= .
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
SaTc c 11707 East Sprague'Avenue, Suite 106 509-688-0036-Phone
pOKane Spokane Valley,WA 99206 " 509-688-0037-Fax
,,,,,,,.•' Valley For Inspections, call 509-688-0054
-Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: aut pi. „ •‘r• 0�w1„ ,„�,_ LICENSE It:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 ( X $15 =
2 FUEL BURNING APPLIANCE >100,000 X $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) -OR<400,000 X $50 =
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 -
5 USED APPLIANCE(WSEC min.AFUE rating) =or<400,000 X $50 =
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 $28 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 =
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57
11 BOILER/REFRIGERATION +1750M BTU X $95
12 GAS LOG,GAS INSERT,GAS FIREPLACE - I X $10 =
13 RANGE - X $10
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - I X $10 =
16 MISC.FUEL BURNING APPL. - X $10 =
17 GAS PIPING(ea.Outlet) - 3 X $1 =
18 DUCT SYSTEMS
- X $10 -
-19 VENTILATING FANS - 9 X $10 -
20 AIR HANDLER(DOES NOT include ducting) •OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 .
22 EVAPORATIVE COOLERS - X $10 .
23 TYPE I HOOD - X $50 =
24 TYPE II HOOD - I X $10 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 =
26 AIR CONDITIONER 3-15 TON X $20 =
27 AIR CONDITIONER 15-30 TON X $25 =
28 AIR CONDITIONER 30-50 TON X $35 =
29 AIR CONDITIONER +50 TON X $60 -
30 LPG STORAGE TANK - X $10
31 WOOD OR PELLET STOVE/INSERT - X $10
•
32 WOOD STOVE-FREE STANDING - X $25
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
VISA' • ft n TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0 Wi. 0 L...._...;:.72..
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
A
86.48' 65.00' A
I
65.0D'
48P(0:()
CO
...
I- 1 v .
! _
7 kiwi -%. Er_--- 1 9
:
d / // // / J`5_ 1 1 N
( N
o (// / / 0
( (l// r
o
u) 0.0
x igi
D V
03 0
101;
N(n
i 5 y
.
d
tJI
t
r
a
-� 5 3 6 2
------------T-7_ v s.70 v •d d ^ 65.00' . v • •4 a • a • . ,500'
• --a
_ 37TH LANE 75.22'
--� — S 89'45'35"E
PLANNING DEPT. APPROVED
tI 4
BY. P ,L ., •
0 PINS ROCK RIDGE 1ST ADDITION
DATE:0/4 t' ei LOT 8 BLOCK 1
0 10 20 4p Founded 1946
PIIIIIIIIIIIIIIUMMI ® impson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
SEPTEMBER 2003 - PHONE (509) 926-1322 FAX (509) 926-1323