2003, 10-17 Permit App: BLD-03-02805 Residence Soniundll""e\liwak 0 Milley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:1509 688-0036 Fax: 509 688-0037
JREQUIRED SITE INFORMATION t
STREET ADDRESS: Ian gL/I /7_67:: -
ASSESSOR'S
ASSESSOR'S TAX PARC L d . BER(S):
LEGAL DI PTION:?Ai / I 1
7y
s
PERM SCRIPTION: 1r' � sCi: irei-Z1_ !!`1'..1
UILDING PERMIT 0 CHANGE IN USE 0 GRADING a MANUFACTURED HOME
Q RELOCATION a SIGN Q TENANT Q-OTHER
OWNER / APPLICANT INFORMATION
0 OWNER: 0 APPLICANT:
PHONE: FAX: PHONE: FAX:
ADO SS: ADDRESS:
/ 3 CI ,STATE,ZIP CITY,STATE,ZIP
���CCONTRACTO/I // . .ILait, "—J to-.:mm.,.......-. ARCHITECT:
_. ® ARCHITECT:
I ',/
PHONE. /I.� , �� / E PHONE: FAX:
ADDRESS:1114 i a �►�.�..��i -`41.--.-ADDRESS:
CITY,.� ZIPAT CITY,STATE,ZIP
WA ST CONTRACTOR UCENSE# / CONTACT:
PERMIT/BUILDING INFORMATION f
COST OF PROJECT: 30%SLOPES ON PROPERTY: J']0 MAIN FLOOR SQ FT/43 3
BUILDING HEIGHT TO PEAK:/5/4u
U4 OCCUPANCY GROUP: 2N0 FLOOR SQ FT:
BUILDING DIMENSIONS61WDD CONSTRUCTION TYPE: UNFIN BASEMENT:/3 20
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: 67 FINISHED BASEMENT:
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: '173
FLANKING SETBACK: CURRENT PROPERTY SIZE: cg I V/ COVERED DECK:
FRONT SETBACK: d 3 CURRENT PROPERTY USE:Vim.- ` ° DECK: /620
REAR SETBACK: 10 CURRENT SEPTIC USE: a
LEFT SETBACK: s CURRENT WELL USE: A A-
RIGHT SETBACK: 6 IMPERVIOUS SURFACE AR •: ..Stell 5F
LMANUFACTURED 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: FIR 'ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
❑ BOLTING °CONCRETE ❑ REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
•IS PUBLIC SEWER AVAILABLE: 0 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: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ❑ YES ❑ NO PSSA: 0 YES 0 NO
IDATE: I STAFF:
IF
METHOD OF PAYMENT:
0 0 ❑ r 0
CASH CHECK
BANKCARD#; / EXPIRES: VIN#
AUTHORIZED SIGNATU• .
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
QTY
sow
.0000Valley
PLUMBING• PERMIT APPLICATION
PROJECT ) / /�,/A'Z (f/ 37iki� PERMIT
ADDRESS:
OWNER: P ONE(Daytime Contact): 6bw--- s"I6/
MAILING ADDRESS: ir ,
(s et) ( ity/state) (zip)
CONT' •R; LICENSE#:
WI ; ,)t,.�,: ,b'72?I .-L, ria,--- I 101M 0 10 50" q5? t\ t-'
MAILING le-ESS: 't PHONE#:
76 A /IdrhLi- 7'YJA7,Y �4fitc --L4 1�N.
(street) ci /state) (zip)
PLUMBING FIXTURES
•
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 5 X $6 a
2 URINALS - X $6 =
3 TUBS 3 X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 a
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD, l!/
PREP/CULINARY/MEAT =
6 DISHWASHER / X $6 a
7 CLOTHES WASHER / X $6 a
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 GP!NDER,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 a
20 MISC PLUMBING FIXTURE_ X $6 is
_ _ - _ SUBTOTAL
CI CASH 0 CHECK p � ❑ ``- I PLUS PROCESSING $35.00
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT FEE
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
DATE: ...sa:- ,I .
BANKCARD NUMBER: --
'` _~_
AUTHORIZED SIGNATURE: o
b�
MEC ANICAL PERMIT APPLICATION
' --iPERMIT
ADDRESS:PROJECT 665 j 2 " USE:
OWNER: PHONE(Daytime Conttaact)).
MAILING ADDRESS: 1/416b /�� 1 j 1 v t1 q ,L �r %( qq;;c ti'
treet") 1 J (city7state) (zip)
CONTRA Ri � ' r#4-ep-
/ir b0
MAILING RES : PHONE*:
L1 Oji _. II-05
a , 641.1-146 ,,, ; . „ e, GAJ A- 90(9 7
(street) (city/state) / (zip)
DESCRIPTION OF WORK #OF UNm 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<4(10,000 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 - S 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) - 1-K X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - 8.IX $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 $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 =
`z I
I SUBTOTAL
WS( ,-.as: `;
0 CASH 0 CHECK 0iiiiiin 0 PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OFA MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE: r i•.:..:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: MO,
•
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APPROVED = _ _
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0 PINE ROCK RIDGE 1ST ADDITION
LOT 14 BLOCK 1
Founded 1946
0 10 20 40 61impson
Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323