2004, 05-03 Permit App: BLD-04-04247 Residence ' SFolian.
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax. 509 688-0037
REQUIRED SITE_ INFORMATION
STREET ADDRESS: a5, '
ASSESSOR'S TAX PARCE N BER(S): � -', 8L%--(--/Q _I
p i--i- ✓j
LEGAL DISCRIPTION: / /
PER DESCRIPTION: 1;/
IIILDING PERMIT El CRANGF IN USE 0 GRADING Q MANUFAC!UKaD HOME
Q RELOCATION °SIGN °TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
0 OWNER: 0 APPUCANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
1
i CITY,ST• E,ZIP CITY,STATE,ZIP
13CONTRACTO4 L/.:�eL IL' lll-4 -/ ® ARCHITECT.:
PHONE"2 j, - NE' _ A ' PHONE: FAX:
ADDRESS: 1 _..at LIQ,/4 ADDRESS:
er„CC ,.TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE$1/2,74/44,.. .�� TsrA CONTACT:
1 . PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: Ai 0 MAIN FLOOR SQ FT: Q
-I X _ •
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT: Gam'1
BUILDING DIMENSIONS:L 50 CONSTRUCTION TYPE: /� .0_ UNFIN BASEMENT: v
NUMBER OF STORIES: G STRUCTURES ON PROPERTY: M C FINISHED BASEMENT:/,
NUMBER of BEDROOMS: 3 CRITICAL AREAS: k GARAGE: (/ q O
FLANKING SETBACK: CURRENT PROPERTY SIZE: U I I Q\ COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: V A'e AFV f DECK:
REAR SETBACK: CURRENT SEPTIC USE: // 4
LEFT SETBACK: CURRENT WELL USE: r /1
RIGHT SETBACK: IMPERVIOUS SURFACE A 5'�
I.
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:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE•ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
ommasimm=sommommnsimegoimomE7
INA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX -
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS 1
❑ BOLTING CI CONCRETE ❑ REINFORCEMENT ❑ WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
•IS PUBLIC SEWER AVAILABLE: YES 0 NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 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: CI YES 0 NO PSSA: ❑ YES 0 NO
IDATE: I STAFF:
METHOD OF PAYMENT:
0 �.
0 0 ❑ r, VISA
CASH CHECK
BANKCARD#; ' - - .• VIN#
AUTHORIZED SIGNATOR .
*FAXED PERMIT-APPLICATIONS WILL-ONLY_BEACCEPTED WllN MAJOR BANKCARD-__
Sp& ane
Mley
MECHANICAL PERMIT APPLICATION
PROJECT ADDRESS:
/ ? 2"7 �p , S7� PERMIT
USE:
OWNER: 4 PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) •(zip)
CONT OR: s ikrE ft:
/) Jam, �i, J ,
MAILING AD(SR SS: PHONE#: 1464 —. / 40L3
40 I q 6 , e.,ZAAaL 1 4 •
(street) (city/state) (zip)
DESCRIPTION OF WORK s OF UNITS x COST EQUALS AMOUNT
I FUEL BURNING APPLIANCE =OR<100,000 1 X $15 =
2 FUEL BURNING APPLIANCE >100,000 X S19 I =
3UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $50 =
4I UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USED APPLIANCE(WSEC min.AFUE rating) =0R<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 - j X $10 =
14 DRYER - / X $10 =
15 FUEL BURNING WATER HEATER - / X $10 =
16 MISCELLANEOUS FUEL BURNING APPL - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 " _
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - 5 X $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT indude 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 $35 =
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 . =
- . �-; I SUBTOTAL
11111111111. _.„0 CASH 0 CHECK 0 NMI/ 0 -___:._.—:-..1...I PLUS PROCESSING $35.00
FAXED PERMITS WILL ONLY BE AM
ACCEPTED WITH PAYME
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE: EXPIRES:
BANKCARD NUMBER:
.. -
AUTHORIZED SIGNATURE------
S acne
,. ,I." ' ? ey
PLUMBING PERMIT APPLICATION
PROJECT av /i. /1y� PERMIT
ADDRESS: ��i)'/ USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (zip)
C• •CIOR: / • LICENSE#:
C. 4 / _ `mom p x X186 K 40
MAI ADDRESS: ONE#: ,
1�: ? 4D 7ci
176! /1. /flL47t& '
., i`iRi�
(street) (city/state) (zip)
PLUMPING'FIXTURES
DESCRIPTION DETAILS *OF MIS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS ' X $6 - •
2 URINALS / X $6' _
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 = •
5 SINKS LAVSBASINS,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 2
Ja
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 ' _
20 MISC PLUMBING FIXTURE X $6 =
SUBTOTAL
"j
❑ CASH 0 CHECK
HE K Drs sa0c- ::_•ED w'.ii PAYMENT PLUS PROCESSING $35.00
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE: JO•.a• : ,
BANKCARD NUMBER:
Mit Iamm-
AUTHORIZED SIGNATURE:
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37TH SANE
Lexington Homes
12827 E. 37th
PINE ROCK RIDGE 1ST ADDITION
a = LOT 13 BLOCK 1
0 10 20 40 Founded )946
® 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