2003, 10-21 Permit App: BLD-03-02839 Residence sio"
,
.0,0Vall " PERMIT
APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIV/S/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax:(5091688-0037
REQUIRED SITE INFORMATION `
STREET ADDRESS: l el 005 &`J ' k3
a'-'71-1---...""
ASSESSOR'S TAX PARCELNUMBER(S): 0A 41 4.
LEGAL DISCRIPTIO / e -' 6 1'6/11Z ''-" P,W, /'
PER DESCRIPTION:
MIMING PERMIT 0 CHANGE IN USE 0 GRADLNG .0 MANUFACTURED HOME
RELOCATION D SIGN °TENANT Q OTHER
OWNER / APPLICANT INFORMATION
I] OWNER: 0 APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
11/ CITY,STATE,ZIP CITY,STATE,ZIP
C �
CONTRA TOR: _ I 0111E55 ARCHITECT:
PHONE: MI I I FAX: 1Q 1 (+
Ie i PHONE: FAX:
ADDRESS: rO rl X I'(plq * 4-`ct11e ADDRESS:
CI ,.STATE ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# l 'i CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: NO MAIN FLOOR SQ FT: /`1 /
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT: /3/7
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: NO FINISHED BASEMENT: 7-
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: 7& O
FLANKING SETBACK: CURRENT PROPERTY SIZE: IDI ft COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE:VA64 1 DECK:
REAR SETBACK: CURRENT SEPTIC USE: J/A
LEFT SETBACK: CURRENT WELL USE: /IA
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: ,.I -(,I)
0
I _
MANUFACTURED HOME , . SIGN1
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIREALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
- STATE NON-RESIDENTr -- ENERGY CODE
1
PLANS EXAMINER: PHONE: FAX: -
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
0 BOLTING °CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
•IS PUBLIC SEWER AVAILABLE: 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO
I
DATE: 1 STAFF:
METHOD OF PAYMENT:
0 s..�■
0 0 0 . ,: VISA
CASH CHECK ' .anims
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
cxrt ,
ley
PLUMBING PERMIT APPLICATION
PROJECTPERMIT
ADDRESS: O05 L . 314 /AfaUSE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (zip)
CONTRACTOR: . LICENSE#:
J1mm y'o PlAinm81 i( � m p t C75 KP
MAILING ADDRESS:
2 - 407(31'
n 3 r yr ✓` S o 'cc n� , GUI' 6167 . 10
(street) (city/state) (zip)
PLUMBING FIXTURES •
DESCRIPTION DETAILS #Of UNITS 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 A X $6 =
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD,
Iv
PREP/CULINARY/MEAT =
6 DISHWASHER I/ X • $6 =
7 CLOTHES WASHERX $6 =
8 GARBAGE DISPOSAL 1 , 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 =
20 MISC PLUMBING FIXTURE_ X $6 2, -
- _ SUBTOTAL
0 CASH 0 CHECK 0FAXED PERMITS WILL ONLY as0ceP�DcvtrftPAYMENT PLUS PROCESSING $35.00
OF A AOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE: 4,..MIS: /--
BANKCARD NUMBER:
n _
AUTHORIZED SIGNATURE:
#Or ,
s crrt°' e -
4�Wl
MECHANICAL PERMIT APPLICATION
PROJECT t�, PERMIT
ADDRESS: 1 l.! / • TI 1 USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
HSATit\Itti—
(street) (city/state) y� •(zip) /CON TO• Tr: lit FT1l — I Dec 15 0..)
MAI IN AD RESS: PHONE#:
14 '' // 5'
4011 • C N Y\b . 5 kin NEI/. J q 0 7
(street) (city/state) (zip)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPUANCE =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 APPUANCE(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 - / 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 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 . =
—
. _. . , 1` t SUBTOTAL
WS1• ;past �:
0 CASH 0 CHECK 0 0 PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OF A MAJOR CREDIT CARD 1 FEE
TOTAL PERMIT FEE
DUE
DATE: EXP I' •
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: id,
Call 24 hours before inspection required
S
����e Phone 509.688-0036 Fax 509.688-0037
_ Valley DEPARTMENT OF PUBLIC WORKS
Anticipated start date 11/ 1 /63 Permit # PW
APPROACH PERMIT
APPLICATION ��, ��- � � ��,� �� ,
Location of property CO -
Address/- =rcel #, if availa•g-)
Applicant Nam."-__24L, - - A..r*-:rt ;:_,,,ti� 7 z6 , ,.
,
� �Address06 H! q f P �ci`� " �
Contractor's Name /`
• e4 /Jiiii ' :4- 641 ' "1/ .:,?,,.4:1
»
Address 0 ` ' A... .,,W — bne.
Contractor's Reg# CPA 16'' .G 7 ✓//', °Expires
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway Commercial/Industrial Driveway
Existing Curb & Gutter Rural Road Section
Culvert Installation Sidewalk Repair/Construction
Other conditions
See construction requirements and details on reverse. Bond/insurance certification must be on
file with the City.
SPECIAL CONDITIONS:
PERMIT FEE $ Inspection Fee$
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Signature _
Fees Paid$ Date snit
.. .. tn:'.. I I1-7 lr..J.1. W. ..LCJ ,.1 .�./\ ...All"l. u:a.. . _ ,_y.,.nt - ..y ....)...•F r....'•: .�.,- ' '
1I,' :-r
... , t. ; i
S P O K .. N E .1 f ge-14 � '-V'" C O LJ r T Y
UTILITIES DWISION Na A DIVISION OF THE PUBLIC WORKS DEPARTMENT
N.Bruce Rawls,P.E,Utilities Director Gary Ober6.Director
• GENERAL FACILITIES CHARGE(GFC)
PAYMENT OPTION SELECTION RECORD
PLEASE NOTE Form must be filled out accurately and in its entirety,and signed,or a permit will not be issued.
Date: /%w/ 3
Plat Name: ()VA-Lf-#-'6"', ,.-- Lot No s): /
Block No(s): ( Q
Site Address(es):
.' 00.5– I A
41—(:; # ilfr 1t .Parcel No(s):
Owner Name: OR Builder Name: LEV---/A/&2-- -/ fabM&Sv filC•
PRINT Owners Name PRINT Builder's Name
Payment Option Selected(Check One):
1. ( ) GFC payment received at issuance of Sewer Connection Permit by
Division of Utilities
2. ( X) GFC to be paid at closing,at the GFC rate in effect at the time of closing.
3. ( `) GFC payment in 24 equal monthly payments upon establishment of Sewer Billing Account.
Complete one of the following statements.
a. Owner's Statement: I, , understand that I will be
billed for the applicable GFC amount in 24 monthly installments. The monthly GFC installments will be added
to my monthly sewer service charges.
b. Builder's Statement I, . understand that because I
am selecting this option for payment of the GFC, that the purchaser of the home wilt be responsible for
payment of the applicable GFC in 24 equal monthly installments. I agree to formally disclose to potential
buyers of the property that the GFC charges will be added to the monthly sewer service billings as soon as
billing commences.
Special Conditions: ) No ( ) Yes –Se etr -e.:e Side of Form
1)A\I N "K
County, GFC Payment Option Form
Spokane
Division of Utilities Revised 03/06/00
1026 W,Broadway • Spokane, WA 99260-0180 • (509)477-3604 FAX: (509)4774715 TDD: (509)324-3166
RPR 18 2003 12:57PM SPOKANE COUPiTY -
477 .7179
atswrt�wl�t�r.1.1tVNY&JinnA'APYLIC:A'TIONFORM • ' h � �
• • PLEASE NOTE: This application.form.
must beaaauatelg t entirety, signed, pernsit Also lsota
felted out aaydin itsandOr• wiII eat be�•`"�.- "'�- 5J»�-'j";,":••
that sewerpecmira are valid for 12 mouths form the dace of issuance.No extensions will be granted.•A separate rigbt.of.wyy pcx is--•
required for any work performed-in or from the county right-of-way. - - • - . • -
PRO INFORMATION
Job Address:/3005 (37-a,
` t
/ Owner's-nom= v//Y 6
-16
A)
65 risky, •
Parcel Number: Lou / Block [Q
Project Namer6+ � �� ��aJnOKV
! WA—
CHECK APPLICABLE BOXES •
�,(i J p
Regular Residential X.New Zip` S r 4 r /
0 Dry Sewer C7 Commercial 0 New Plto '? — L `L — 1s /
O Repair Cl Temporary '
O' Addition
❑ Abandonment •
•
* FIRST TIME CONTRACTORS OR HOME OWNERS PERFORMING THE INSTALLATION MUST FIRST CONTACT THE
U ILI'fFS DIVISION BEFORE PERMIT(S)CAN BE ISSUED.
•
SIGNATUR}OF UTILITIES DIVISION PERSON CONTACTEC:
• C°zIrnic—.°1127
k0 X CR v a
Business addsnm L— ' l ?p r!0/ a _ _ g Conteh Name
C.tty/Stare:\) RT) f Pr{J zip: II iX -V 1 0-1 9 rn
Phone Number: 'I — I' 00._ •
INTERIOR PLUMBING ALTERATIONS? - 401 circle one• -
EU our the information r the table below¢appy . •,
•
• Contractor(if different from above): Phone:
Business Address City/State/Zip
•
"Forphembing reversal feeiii ormation,.rer ieoastsfde of.'2fjoetrx •
FEE INFORMATION
Number of Buildings connecting to sewer / X(times)$100(per bldg)—$ /OO' Q + $10.00—
manr Or WAY minim
For i •resdmoal ank one pernit is required;
• Foeeoodocaisiuw,townhouse,tapeta,trip4x ov fonrpiet with separate ownership(as determined by lot inn)separate Worn ted separate stub.ore permit is required per
.ddres.per aids
• For a voile WadiK dupla.nipinc or fourplet with sink orr.ea>tbip,one permit is reqs rad
• Multiple bwldsp kartme tss iedusniel awn arse')with single:orser:lip,one permit respired per butting mnuhecting to tie sewer.
(POR SITUATIONS POT COVERED HERE,CALL ME COUNTY DIVISION OF UI'ILIYTES AT 477-3604)
Is any of the work to be performed in o •. the •• -; : '-way CI Yes d No
APPLICANT SIGNATURE: �'_ DATE:
11007::74V/M311. _ Wif4W.w
Method of Payment:
L7 Cash LI Check El Visa Q MasterCard. .EI Discover Card
- • •Date • • - Expires:
Bankcard Number: - •
• . Authorized Signatun::
Spokane County Division of Building be Code Enforcement •
1026 West Eroadway.Avmue•Spokane WA 99160 •
TeL Vo.(509)477-3675*Fax No.(509)477-7198•7DD No.(509)477-7133
20.0C' 85.85' 7.„),
III
- I
• i 50' //
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APP OVED B :.c.,.. c�ti � '
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443 I house ,'
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ii
10
In
N • 5' 58' S8 �,N _r
Z . is - 1 I •
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. �, of i
z
garage•
of ' water �' f
• , I ;`5' 25 Bldg
° -- sewer ' Setback
-4/
0., , __ i - .
•
:;. ��� 4414,— r G I 25 _ / 4�+'\U t i n y
4�Qt � -a �7'� _ / Easement
1 55.o 2 . /
/ 1
11.13' / I \
I
0 13005 E. 37th Lexington Homes
PINE ROCK RIDGE 1ST ADDITION
LOT 1 BLOCK 6
Founded 1946
0 10 20 40
piiiimimmimmil 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