2004, 03-05 Permit App: BLD-04-03699 Reisdence ' •dr\., . ,
SFolane
Milley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax. 509 . :: ,,37
REQUIRED SITE_ INFORMATION
.
STREET ADDRESS: f(i J M 8- c_ 7a/ ,L c% _
ASSESSOR'S TAX PARCEL N MBER(S):_
,� t" ; -----78):4' 3 , .
LEGAL DISCRIPTION: (/tel . )
(Z i t I P:,e4 - ',.,k: fr:,-1(j l'-'1' ( ,,, pc—,/,(D
PER DESCR PTION: f.
ITILDING PERMIT El CHANGE-IN-USE. .•0 GRA!)ING .0 MANUFACTURZD HOME
a RELOCATION D SIGN O TENANT (-OTHER
/ .
OWNER / APPLICANT INFORMATION
CI OWNER: APPUCANT:
PHONE: FAX: PHONE: FAX:
.
ADDRESS: ADDRESS:
/ CITY,ST E,ZIP CITY,STATE,ZIP
•
CONTRACTO jl I/./L/ d 1.41 4 , ARCHITECT:
I I
PHON 41/1. r �. �. I� PHONE:_ FAX
ADDRESS: 1 Lit A 1.4.,./*to, ADDRESS:
edga $TATE,ZIP CITY,STATE.ZIP
WA ST CONTRACTOR UCENSE# z. /,� CONTACT:
tahot,
PERMIT/BUILDING INFORMATION
•
COST OF PROJECT: 30%SLOPES ON PROPERTY: NO MAIN FLOOR SQ FT:g /O
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2N0 FLOOR SQ FT: .:5--: \
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:g.,300
NUMBER OF STORIES: A STRUCTURES ON PROPERTY: 0 FINISHED BASEMENTT:
fI 4, NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE:
1`) 1 FLANKING SETBACK: CURRENT PROPERTY SIZE: .3 {
W5F COVERED DECK:
q ‘t)
i FRONT SETBACK: CURRENT PROPERTY USE:V0,-""'tDECK: 0-- - '�
REAR SETBACK: CURRENT SEPTIC USE: 10/A .
I 4 551
LEFT SETBACK: CURRENT WELL USE: A) Pr p -
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: p5 -
oiro°Fk� 1 .
Spanne
.0,.0«ley
MECHA,NICAL PERMIT APPLICATION
PROJECT � I II [. S
PERMIT
ADDRESS:
S: /a / I � USE:
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS:
• (street) (city/state) j, }�••(zip)
CONTRi OfR: •, / j / _ �E EP-A — iPIO eit
MAILING ADaR SS: PHONE# /484 r ' 4 o 5—
itD i q 6: e,-,,&,,,,,,L
I . GIq 7
(street) (city/state) (zip)
DESCRIPTION OF WORK *ol<UNRS X COST EQUALS AMOUNT
I FUEL BURNING APPUANCE =OR<100,000 / X 615
2 FUEL BURNING APPLIANCE >100,000 • X $19 =
3 UNUSTED APPLIANCE(ADDITIONAL FEE) =OR400,000 X $50 =
4 UNUSTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USED APPUANCE(WSEC min.AFUE rating) =OR400,000 X $50 =
6 USED APPUANCE(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 - f X $10 =
16 MISCELLANEOUS FUEL BURNING APPL - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - l't ' X $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT Include ducting) >10,000CFM X $19 =
22 EVAPORATIVE COOLERS - X $10 =
23 TYPE I HOOD - X $50 =
24 TYPE II HOOD - / 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 635 =
29 AIR CONDITIONER +50TON X $60 =
30 LPG STORAGE TANK - X $10 =
31 WOOD OR PELLET STOVE/INSERT - X , $10 =
32 WOOD STOVE-FREE STANDING - X $25 _
. --re._ I SUBTOTAL
UMW ,Vir52'deiLe.#
0 CASH 0 CHECK ❑ MOM
❑ .- .i PLUS PROCESSING
FAXED PERMITS WILL
ONLY BE ACCEPTED
�PAYMENT FEE $35.00
TOTAL PERMIT FEE
DUE
DATE: EXPPIIR�E`S:
BANKCARD NUMBER: f/
AUTIT'ORIZED SIGNATURE:
Ie
.000'alley
• PLUMBING PERMIT APPLICATION
PROJECT
PERMIT
ADDRESS: /e2 ii
USE:
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS: -
(street) (City/state) (zip)
C• CIOR t� LICENSE*:
Milk I
y ilk ' GTT8"KP
MAll ADDRESS: Jowl —
&,,_;?
7D ,S. inet.4-rti, le/R/-
(street) (city/state) (zip)
•
PLUMING'FIXTURES
DESCRt9T/ON I DETAILS #OF UNITS X COST Ed UALS AMOUNT
1 i OILETS WATER CLOSET,BIDETS x $6 .
2 URINALS - X $6 =
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 4. •
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER / ' X $6 =
7 CLOTHES WASHER X $6 =
8 GARBAGE DISPOSAL � X $6 =
9 WATER SOFTENER X $6 =
10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X $6 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, $6
/CONDENSATE X =
12 FOUNTAINS,DRINKING _. X $6 =
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION, X $6
WASTE,VENT, REPAIR,REVERSALS
PLUMBING REVERSAL
_
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 •
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, X $6
HOSE BIB,STEAMER,PROOFER,
CARBONATOR,SWAMP COOLER 3
. .
16 CROSS CONNECTION VACUUM BREAKER,CHECK • X $6
DEVICE VALVE,AND R.P.B.P.D.FOR:
VATS,SUMPS,TANKS,BOILERS =
'17'SPRINKLER SYSTEM / X ' $25
18 INTERCEPTORS GREASE TRAP,SAND TRAP, • $6
CHEMICAL HOLDING TANK X • _
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 is
20 MISC PLUMBING FIXTURE_ X $6 = _
- - - �-3" SUBTOTAL
..•
a „7.
0 CASH 0 SCK. 0 E _...1i.2.'".! PLUS PROCESSING
FAXED PERMITS 17=ONLYBEWITh PAYM $35.00
OF A CREDIT CARD ENT FEE
TOTAL PERMIT FEE
•
DATE: DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
t
A
Gas/Elec. Property Line 65' N
Sight Distance Easmt. — , _
i. __.__
En Driveway
14' Utility Easmt. ^," 711
I. 3 N
iv
25' BIdg.Se`'5' 3 �`', .. — — — — ,-
1
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5,-3„
/-- — ' Garage
House
�9,,� 40'
�'�Y'; 54'-6"
fi1i-3'
ivfcij ,.-
in
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This site plan'is being submitted for the purpose of�I ro I .
obtaining a building permit and is a true and correct..I la I
representation of the proposal. All known propi*ya 1 Tal I
lines/dimensions.curb lines,structures and eauernerrsl 1 t/1 I
have been i entitied. Also indicated are wetlands,cnI 'a I
bodies of at r, steep slopes ther critical areas m 1 m I
Signed: \/1124 IP �n i n I /� ,�/
Date: ,3"9 b 65' `
aooREss_a L54411• 32
ZONE t • 4
ROAO WIDTH )
FRONT i ' FLANKING
COMMENTS
REVIEWED BY���
Pine Rock Ridge
Lot 2 Block 3 Scale 1 " = 20'
12816 E. 37th