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430Valley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax' 509 37
REQUIRED SITE INFORMATION
STREET ADDRESS: / SOD / 3 7
ASSESSOR'S TAX PARCEL NU, BER(S):�
LEGAL DISCRIPTION: 1 / 94 -
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PER DESCRIPTION: e
UILDING PERMIT El CHANGE IN VSE • 0 GRADING .0 MANUFACTURRD HOME
0 RELOCATION Cl SIGN °TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
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OWNER: 0 APPUCANT:
. PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
e CITY,ST ZIP CITY,STATE,ZIP
CI CONTRACT• I 1 d J1 1_%/ I:/ I , Q ARCHITECT:
PHON OA.:
11 i. fr J PHONE: FAX:
ADDRESS: /r a�I✓. , ,.4i./1t/ ADDRESS:
„C ;TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE#1.....&.-&lailtz.x.5..irpi(�//i /� CONTACT:
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PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:_&143
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2ND FLOOR SQ FT:
BUILDING DIMENSIONS:_ CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: / FINISHED BASEMENT: —
NUMBER of BEDROOMS: 3 CRITICAL AREAS: — GARAGE: C19(3
FLANKING SETBACK: CURRENT PROPERTY SIZE: S30 I COVERED DECK:
FRONT SETBACK: / CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE: A A
LEFT SETBACK: 5' CURRENT WELL USE: A A
RIGHT SETBACK: _ IMPERVIOUS SURFACE AREA: .?I J� . _
•i
Spokane •
.0010 alley
ME HANI PERMIT_APPLICATION
PROJECT - _ PERMIT I
ADDRESS: / ` USE:
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS:
• (street) (city/state) -(zip)
CONTR OR: ME
H-E11'� /1t9 Bc .
MAIUNGADaR SS: PHONE#: q8 f ' 46(5-
40 loi
6(5-40ioi 6', q/OW7
(street) (city/state) (zip)
DESCRIPTION OF WORK s OF ONUS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 / X $15 =
2 FUEL BURNWG APPLIANCE, >100,000 X $19 =
3 UNUSTED APPLIANCE(ADDITIONAL FEE) aOR<400,000 X $50 - _
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USED APPLIiWCE(WSEC min.AFUE rating), =ORc400,000 X $50 I.
6 USED APPLUANCE(WSEC mh.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFHIGERATION • 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 - / X , • $10 =
16 MISCELLANEOUS FUEL BURNING APPL - X $10 =
• 17 GAS PIPING(ea.Outlet) - 3 X $1 =
18 DUCT SYSTEMS _ - X $10 =
19 VENTILATING FANS - x $10 =
20 MR 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 U HOOD - 1 X $10 = _
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X .$12 =
26 MR CONDITIONER 3-15 TON / X $20 =
27 AIR CONDITIONER 15-30 TON X $25 =
28 MR CONDITIONER 30-50 TON X $35 =
29 MR 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
0 CASH 0 CHECK 0
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0 - IPLUS PROCESSING
FAXEDPERMITS R WITHFEE
Nr CREDIT CARDFEE $35.00
OF A TOTAL PERMIT FEE
DUE
DATE: EXPIRES:
BANNCARD NUMBER:
AUTHORIZED SIGNATURE:
I"
•
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..„...*Valley
•
PLUMBING PERMIT APPLICATION
ADOJECTDDRESS: / _ D D (7L 34,
/ PERMIT
AUSE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (zip)
C• •CIOR / LICENSE#:
/ /
Woi imp 1�
MAI ' ADDRESS: ONE# .
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_/„.44.2.4„, 4D 7g
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leta/-6
(street) (city/state) (zip)
PLUMBING'FIXTURES
DESCRIPTION _ DETAILS *of wars X �� EQUALS • AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6 IN •
2 URINALS • X $6 =
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 • •
5 SINKS LAVS/BASINS,BAR,FLOOR. X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CUUNARY/MEAT =
6 DISHWASHER X • $6 =
4,4 7 CLOTHES WASHER *-3------ 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 S6 =
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 as
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MSC PLUMBING FIXTURE • X $6 = -
- • - SUBTOTAL .
0 CASH 0 CHECK d JIIMIONIER ❑ '1' PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OF A MAJOR cREDrr CARD FEE
• TOTAL PERMIT FEE
• DUE
DATE: •
BANKCARD NUMBER: -
AUTHORIZED SIGNATURE:
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APPROVED BY ., . ./! . --� BLOCK 5
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1111111111111111111111111111111111111111111111111 flp�--03-6q 2mpson Engvneers, Inc.
I CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323
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