2004, 06-16 Permit App: BLD-04-04617 Residence .,„#\
*lane ..
galley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509 688-0036 Fax: 509 • ;: #137
REQUIRED SITE INFORMATION
:-
STREET ADDRESS:_13 ,,/ i l) ,
, g--/-_-/J 1J
ASSESSOR'S TAX PARCL N SEWS):_ /j
1C `� L , ' �
LEGAL DISCRIPTION:1' �1i ) / 1'`\ (_/-
PER DESCRIPTION:
IIILDING PERMIT El CHANGE-IN USE -- :1]GRADING CI MANUFACTURED HOME -
0 RELOCATION (I SIGN °TENANT 0 OILIER
reme..........,................._____ __
OWNER / APPLICANT INFORMATION 11
0 OWNER: 0 APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
t •
' CITY,ST• E,ZIP CITY,STATE,ZIP
®CONTRACT°-7I. ,,,,j A
�- �'^� ARCHITECT:
PHONE"' A.' / , A PHONE: FAX:
ADDRESS: _At 1 A,-.14 ADDRESS:
eth ,E./��TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
I
COST OF PROJECT: 30%SLOPES ON PROPERTY: N0 MAIN FLOOR SQ FT: / lig(i)
BUILDING HEIGHT TO PEAK: _ O"CCUPANCY GROUP:_ 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:/e:71 7
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: Al 0 FINISHED BASEMENT:
NUMBER of BEDROOMS: . / CRITICAL AREAS: GARAGE: LI-q4
FLANKING SETBACK: CURRENT PROPERTY SIZE:,\W
/F7O1 5-r COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: V NT- DECK:
REAR SETBACK: CURRENT SEPTIC USE: ) - / I
LEFT SETBACK: CURRENT WELL USE: ;r A. _
RIGHT SETBACK: _ IMPERVIOUS SURFACE AREA: _) / -
iiiS
i MANUFACTURED HOME IGN -- --
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: , , FIRE4kLARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE -11
PLANS EXAMINER:
PHONE: FAX:"_
ADDRESS: CITY,STATE,ZIP
INSPECTOR:
PHONE: FAX:
ADDRESS: CITY,STATE,ZIP
SPECIAL INSPECTIONS
❑ BOLTING ❑CONCRETE ❑ REINFORCEMENT ❑ WELDING
FIRM NAME:
PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
Il
•IS PUBLIC SEWER AVAILABLE: 0YES NO IF YES: 0 COUNTY 0 CITY -
IS PUBLIC WATER AVAILABLE: 0 YES ❑ 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 0 NO •PSSA: 0 YES 0 NO
•
IlDATE: II STAFF: 11
METHOD
OF PAYMENT:
0 0 ❑ r ❑ ....IIII -
, WSA
CASH CHECK
. - - VIN#
BANKCARD#; W-
AUTHORIZED SIGNATUR .
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
SFOI.ane
x,00 Valley
• PLU MING PERMIT APPLICATION •
PROJECT
/ OjI 6' PERMIT
ADDRESS: / ` USE:
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS:
(street) (city/state) (ziP)
• CIOR: / LICENSE#: t�Q�_
jai
i _ 4 t p
r r , limp/ x .535"
W P
MA10r ADDRESS: ( PHONE#: . '
&I;? — 4,0 7g
17614 jd: waif
(street) l' (city/state) (zip)
PLUMSINC FIXTURES
DESCRIPTION _ MAPS #OF UNITS X DOST EQUALS_. ' AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6 _ •
2 URINALS - x $6 _
3 TUBS r X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT ---- X $6 = '
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6'
KITCHEN,LAUNDR.',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 .
a
16 CROSS CONNECTION VACUUM BREAKER,CHECK • , X $6
DEVICE VALVE,AND R.P.B.P.D.FOR:
VATS,SUMPS,TANKS,BOILERS =
11 SPRINKLER SYSTEM / X $25
18 INTERCEPTORS GREASE TRAP.SAND TRAP, $6
CHEMICAL HOLDING TANK X • a
'
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MISC PLUMBING FIXTURE X $6
- SUBTOTAL
•
❑ CASH p CHECK CI 0 -- =`'' PLUS PROCESSING
FAXED PERMITS'7ILLONLYBEACCEPTED WITH PAYMENT $35'00
OFA MAJOR CREDIT CARD FEE
• TOTAL PERMIT FEE
DUE I
DATE: :
BANgCARD NUMBER
AUTHORIZED SIGNATURE:
•
,e,,.*Milky
' MECHANICAL PERMIT APPLICATION
PROJECT ) " � .�.L1�I,/j`-J, -pERMfT'
ADDRESS: / USE:
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS:
(street) city/state) -(ziP)
CO OR 1 WE
�-_
acia-p, - , 11110 46LO
MAILING ADD SS: PHONE it
1 q 6'400 , , / - 9
(street) (city/state) !,) 7
DESCRIPTION OF WORK s or eNn X COST EQUALS AMOUNT
I FUEL BURNING APPLIANCE -OR<100,000 / X $15 =
2 FUEL BURNING APPLIANCE >10%000 .__ .. X ' $19 .
3 UNLIS(tU APPLIANCE(ADDITIONAL FEE) -OR400,000 X $50 - -
4 UNUSTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USW APPLIANCE VSEC min.AFUE rang) -OR<400,000 X $50 -
6 USED APPUANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M SRI 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 S1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - if 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 I.
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 MR 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 ( --
•
Ir:.; I SUBTOTAL
,Va cfr-rtt.
0 CASH 0 CHECK 0 0 ,.` PLUS PROCESSING
PAREDPERMITS VILLOMXBEACCEPTEDonTHPAYI Nr $35.00
OFAMAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
• DUE
DATE: • EXPIRES:
BANKCARD NUMBER: CC/)-- .. .
AUTHORIZED SIGNATURE:
Ftt a-
4
- Luu.
2001 WSEC Residential Compliance Form
t1 .
r 1 Prescript-arc(Chapter 0,Options for all R Oc._uN1ncK�.Clunate Zinc
licst;o:cccc: Al L
3-".: SPOICANECIATTYDIVSIONOFBUILDING bcCAliEENFORC_CMEN
1026VPISTBROADWAY AVENUE
I SPOKANE.�'A 99260
1 C(x.k' 1 5Q•477-3(,75 �, �
gufraira •ER'�tI• NO. DATE:SITE ADDRESS f,
INSTRUCTIONS
epartment staff can
j) Your ou witht will general questions about this form. You building must match the smore efficiently if you provide all of the iequested elect d option ince tts WithOui
1 help ja:3
exceptions or substi:tctiocts.
1 2) Glazing percentage deteorinec which option to choose. Complete the lotieN'ing glazing area calculation before
Iproceeding to the option table below.
GLAZING AREA CALCULATION: q�
- B /0
t i TOTAL 1IN : �pPF -EFLOOR`) ;:JI'GLAZING ING
NOTE: L•se rou?,ir opening(R/O)for window area. Include all half-lite and full-lite door glazing in this
calculation
CAN'T COMPLY? If
Irfi ` tetonaacceptable, systems
(Chr4)or,Co oflrnteorn e{aapter)Apprccach Tha�antage istlexibigty too iu gle
individual 1)l
imce
-
factors(R-values)as longmaximum
as an overall a"i^nu ren7rnu.'Gticulalions may deu. be Ferlormed byte that the band ornty�requirements sccepwhle
are p less software
than the PrescrHelpful
q p; /
/Jwww.er.ergy.wsu.edu/
ust �n accep
computer software pro;rani. Helpful forms and other resources can be dor.nloadcd at htt /_- gy z
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1 Below I
1 P I - -- - __Rin R -1�
q.21R r 1
G 20 R-38 I j kir ( F27 i 30 i
- 1'1< t 040 (i SC R.30 --1------1--------4
❑ r-- i i2 14 t R-21 R-t2 R�0 R-10! in
Z 0-40 059 I O O t R-3°. , R-3` f?-5` —
E.
1 ►�t — 4---4-- R38 R30 R r9 R-21
t7 12 . F f�tU
CD ❑i f7L • 17% 037 058 0. i------4---- A 5' -.- -i !
i i bbd ! (i-27 R-2 i , R-12 R-3U ! R-10 ,
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' Group R3 • 0 1 058 020 i P.-a5 R'0 'rel'
[_..J_______!--- -___i_____i_________L____I---'—____I—L_______..:._________
•I 0 0. t,bmina R-vakxzs are tor wood frame assermfi only or asserreti s britt in ac ed. ratio f0 Cie oon6uoned floor area dill,C
for each opfan feMd For examde.U a;.roposed design ha'a oto Sr a oeni moot flo r ars
C`J a Mrnain te scCthe15% tr+neC(c titled. Proposed tunaarnaN wO ccrsatipsCode
V ,giro i d cis rotes option aboae,nay ai�gs 'PG5 de .4cc s Advanced Frarrod Cog
2. PapiBtatdscores bAcalms >
irgle railed'or W
r� *pooriy io si je ratter or}1st vaulted oafirgs• d Frio.Crm the irtsta to 4�e sal 1 as waits aix,ae
01.4 4. t + C be iiei/attrd
installed either on to adola b loNgracb to a rtir irttm told aduad for its blended use.and installed
d 4. tk�a+r4fade r,�s shall be a water te�start ttrt�7R,traratf
Tack fydeifor trowlon ions. SaeSrxaontom.
y� G • �r�orcJygblhemax;ladtrc�ssf-'ed t��U� b
�+ F xqd vier tb pe spaces is voter 1.manila lured for its/mended use,and waning t-�t ig f. ( ,Gtir<dslfiperirnaler insulations
r coda;ures specifications. ac. �,+itli s triry u au fzi irutiaGon
7. r&(brutes sem`'d�16in'+tesoncerRervithheader avity n isRSforminautan3
3. maw(iuci.'�,01;ec,dot&1 is R19 atilt front Tate 10.6,- .
*tee irg area
trial be as tecr
9 V`Yrs. arra is listed.the total ca75rg area(ourt4nod vcxti !Fs mart340)as a posit d gross
area
;C+. Wive t a less ton
r expli ,Mlh doctors U�40 a less is rd.rodded in riaviw reca linin r'u s.
suit be tey<ttan or ad nave
a thatd:vvatic.tec'iOveded i;ari•K.7' atth ITRC 100 or m spe'afind in Sider;02.15.
1
1. i at► gid i stmt love ty{a ai det9c t e ..in idoeacaveonce
12. t o9 and slid timber wadi with a rticiatvm average
Cr 3S•are exenpt kmt tf-. hs ration rrAulr or d;
f0.-n 5-05080 -7.001 RcsiA-n<ia: Comp Fort
4 . •
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5etbock -This
sNe Plan is being g1bnHlNd for the purpose of /
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representation a atio thePemMt and ism: hue and correct / // _
P oposat. AN know y //
lines/di ns,curb ti / ------
haw • ratified. nes.strUctWq and ea emmeents / ;R 14 U t�I;t y /
Also a ,,..--
bodies
of • steep slopes or : wallahs• / may'. >> Easement/ '
critical areae _
Sate: • ®,/II A A 4+`•� f . , .F -= p,4• J / �,
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Garage
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^`O �`�/ Patio /' ��
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/ Fnd wall lin '
til/ ' ”' Note:
/ ;� s ; o Il i Property line
'i G ; to k I 50'from center
/ ` i ', , of cul-de-sac.
/ , Housetuippr \
' 1�
+ ti
// / 3'5\ ' A>QDRESS ` �•
/ I Fnd.Wall line \
ZONE • -:_a.
/-) , ROAD WIDTJ1 _?j►'
.`, , , COMMENTS /1♦l►.f♦ !.-
/. y.; / REVIEWED : t tf/t�I.I1���...,
\-Yi\ $ `�� Qin/ — , \ ,� 1 11i r' -,
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0 PINE ROCK RIDGE 1ST ADDITION
LOT 3 BLOCK 6
Founded 1946
0 10 20 40
m.r --- ,,,,N�,,,,,,,� impson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
PHONE (509) 926-1322 FAX (509) 926-1323
SEPTEMBER 2003