2003, 11-14 Permit App: BLD-03-03067 Residence Sborlialfe\'`
doonalley
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 _
STREET ADDRESS: IL 061 6. 3'0
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: Lo- f o ax. I pmx,, p_o -itD6 L !4t601)
PERM SCRIPTION: /0 fAvc....c,
BUILDING PERMIT CHANGE IN USE - C GRADING ®MANUFACTURED HOME
(RELOCATION ®-SIGN ]-TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
® OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
273ftf SS: ADDRESS:
CITY,STATE,ZIP ., CITY,STATE,ZIP
CONTRACTOR: L A ���uIW ��- �, ARCHITECT:
D (
PHONE: _ 77 33 FAX: a / -11,7/ PHONE: FAX:
ADDRESS: 1 �p cw G . Sidebleitriwi 1,S00411 ADDRESS:
CITY,.STATE,
,�ZIPi we 7 + CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#(.. L IcIi5C/b1/eP CONTACT: ��- qa. 1
r
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: � MAIN FLOOR SQ FT: l I )3
BUILDING HEIGHT TO PEAK: 74, OCCUPANCY GROUP: 2ND FLOOR SQ
BUILDING DIMENSIONS: SDX V I9 CONSTRUCTION TYPE: UNFIN BASEMENT: /! /3
NUMBER OF STORIES: Zj STRUCTURES ON PROPERTY: FINISHED BASEMENT: v
NUMBER of BEDROOMS: L CRITICAL AREAS: GARAGE: S7(2
FLANKING SETBACK: CURRENT PROPERTY SIZE: O ICO, COVERED DECK:
FRONT SETBACK: 30 CURRENT PROPERTY USE: ' ' DECK: /00
REAR SETBACK: 51 CURRENT SEPTIC USE:
LEFT SETBACK: VD CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN I
-
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 I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY T I
IS PUBLIC SEWER.AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY -
IS PUBLIC WATER AVAILABLE: ® YES NO IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 9 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES ® NO
DATE: STAFF:
METHOD OF PAYMENT:
D [] 0 r- -- 0 .w.. .
CASH CHECK
BANKCARD#; EXPIRES; VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
SCT1 c r,�, 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pt k .x].e Spokane Valley,WA 99206 509-688-0037-Fax
4.00%1ley For Inspections, call 509-688-0054
'Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) a (ZIP)
CONTRACTOR: Q) (A peotitk#:
MAILING ADDRESS: PHONE#:
•
(street) (city/state) (ZIP)
DESCRIPTION OF WORK It OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 I 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 - ' X $10 -
13 RANGE - X $10 -
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - I X $10 -
16 MISC.FUEL BURNING ADPL. X $10 -
17 GAS PIPING(ea.Outlet) - 3 X $1 -
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - Li 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 - 1 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
11.111.111 TOTAL PERMIT FEE DUE:
❑ CASH El CHECK El MUM El -- ......_-..1..i
4.
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
(�C7T4 cx +/r 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
►J ne Spokane Valley,WA 99206 509-688-0037-Fax
4000 Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: ,
T I m,,rv..(S pttim,g)+.)G 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 T X $6 -
-
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6
5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 =
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER / X $6
-
7 CLOTHES WASHER 1I( X -
8 GARBAGE DISPOSAL
1 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 ] X $6 -
12 FOUNTAINS,DRINKING 11 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, 3 X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
$6 -
RP.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 FIXTURE X $6 -
vIETHOD OF PAYMENT SUBTOTAL:
CASH ���esPLUS PROCESSING FEE: $35.00
❑ CHECK ❑ ❑ L._ ._.-_
TOTAL PERMIT FEE DUE:
)ATE: EXPIRES:
;ANKCARD NUMBER
AUTHORIZED SIGNATURE:
FROM :NEIL THOMPSON FAX NO. :9249728 Nov. 12 2003 10:52AM P4
65.00' 65.00' 65.00'
PLANNING DEPT. APPROVED
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37TH LANE 312.43'
T S 69'45'35*E
4
PINE ROCK RIDGE 1ST ADDITION
LOT 10 BLOCK 1
o 10 20 40 Founded 1946
. 101. 1.11111111111111111 oira son Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
SEPTEMBER 2003 . PHONE (509) 926-1322 FAX (509) 926-1323