2003, 11-19 Permit App: BLD-03-03099 Residence stnitanoie\,pp
T
.000Valley
PERMIT APPLICATIONW ORK 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
STREET ADDRESS: 12.20 O3 G. 3 I
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: LOT I I U( 1 PI N e £&C. 1)6 . Pi 156-4 O
PERMIT DESCRIPTION: Y( II)&-)
II :DING PERMIT -.DERANGE IN USE •.El GRADIN.
.a. N FACTURED HOME
RELOCATION e}SIGN Q TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
® OWNER: • APPLICANT:
PHONE: FAX: PHONE: FAX:
17 SS: ADDRESS:
• e-4-
JJ 1 CITY,STATE,ZIP CITY,STATE,ZIP
CONTRACTOR: Ci4-I!�1 .5 C4/yn.t T Z C1)1 . ARCHITECT:
PHONE: !"7% 73 3 FAX: B/ /-7 L/ / / PHONE: •
FAX:
ADDRESS: KO t.S CCR-e_AVVWF gRoae4e_14/4 ADDRESS:
CITY,STATE,
`7(15CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# L/f I'"SLI cf-IF CONTACT: e"-iG
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 11195-.i )
BUILDING HEIGHT TO PEAK:2(i OCCUPANCY GROUP: 2ND FLOOR SQ FT: 51g
BUILDING DIMENSIONS: 5-5x'V7L CONSTRUCTION TYPE: UNFIN BASEMENT: 11-P/5-
NUMBER OF STORIES: Z STRUCTURES ON PROPERTY: . FINISHED BASEMENT: e
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: 5S 4-
FLANKING
FLANKING SETBACK: CURRENT PROPERTY SIZE: (6r)e)3 COVERED DECK:
f
FRONT SETBACK: ZS
L CURRENT PROPERTY USE: &' DECK: /00
I
REAR SETBACK: 1 1 ' CURRENT SEPTIC USE:
LEFT SETBACK: CI CURRENT WELL USE: . -
RIGHT SETBACK: S IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT Or SIGN:'
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON—RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
0 BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY ® CITY -
IS PUBLIC WATER AVAILABLE: 0
YES 0 NO IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ° NO PSSA: ® YES 0 NO
DATE: I STAFF:
METHOD OFPAYMENT.'
® 0 0 r 0 ....i■ .
istCASH CHECK L ar MB
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
SOry/ 11707 East Spraguevenue,Suite 106 509-688-0036-Phone
CITY �laiie Spokane Va11iy,WA 99206 509-688-0037-Fax
4000 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: p u R n£ '/€i 1VN6 LICENSE#:
MAILING ADDRESS: 7� 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 - 1 X $10 -
13 RANGE - X $10 -
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - , X $10 -
16 MISC.FUEL BURNING APPL. X $10 -
17 GAS PIPING(ea.Outlet) - 3 x si -
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - 1 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
MOM TOTAL PERMIT FEE DUE:
❑ CASH El CHECK CIEl .. •-= =4 -
•
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
SOTj/� 11707 East Spragu Avenue,Suite 106 509-688-0036-Phone
cH ne Spokane Valley,WA'99206 509-688-0037-Fax
4000 1calleY 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-)rn Intlc pku el. g 6 LICENSE#:
MAILING ADDRESS: PHONE#:
•
(street) (city/state) (Lu') '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3X $6
2 URINALS X $6 -
3 TUBS Z X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT
I X $6
5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- 6 )( $6 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6
7 CLOTHES WASHER X $6
8 GARBAGE DISPOSAL 1 X $6 i
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 X $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 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
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6 -
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 •.
20 MISC.PLUMBING FD(TURE X $6 -
v1ETHOD OF PAYMENT SUBTOTAL:
NIMMON
CASH ❑ CHECK ❑ PLUS PROCESSING FEE: $35.00
•
TOTAL PERMIT FEE DUE:
)ATE: EXPIRES: ,
1ANKCARD NUMBER:
,.UTHORIZED SIGNATURE:
FROM :NEIL THOMPSON FAX NO. :9249728 Nov. 12 2003 10:52AM P3
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75.22 _ 3 T H LANE
_ PSG DEPT.APPROVED
5 89'45'35"E c1�
BY:
•
N DATE: 11/1q/CS
0 PINE ROCK RIDGE 1ST ADDITION
LOT 9 BLOCK 1
0 10 20 40 Founded 1446
011.111...11111.1 pson Engineers, Inc.
CML ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA„ 99212-2789
SEPTEMBER 2003 P1+ (509) 926-1322 FAX (509) 926-1323