2004, 06-03 Permit App: BLD-04-04487 Residence ilk7*Ian . . ...„,,,... . Z
.0001FliaBey PERMIT �
APPLICATION iON WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 5091688-0036 Fax
,�-,. REQUIRED SITE INFORMATION
•
STREET ADDRESS: ! CO .," (2.)I-it ' .
ASSESSOR'S TAX PARCEL UMB-•(S), �„
LEGALDISCRIPTION: _ .4,.i 'MILMARFOr - ,4,,-)_
intingrAte_WAWAIRIW- 4 /
PER DESCRIPTION:
UILDING PERMIT Cl CHANGE IN USE 0 GRADING I]MA1'UFACTURED HOME
0 RELOCATION °SIGN 0 TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
® OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
t
i • CITY,ST• E,ZIP CITY,STATE,ZIP
®CONTRACTO4 4,L - 71.4 -, ® ARCHITECT:
PHONE.' A.. 1. ♦ )% PHONE: FAX:
ADDRESS: _�i 4i.J ADDRESS:
cleC ,.$TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR UCENSE#� /7. y� CONTACT:
i-riPERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: NC) MAIN FLOOR SQ FT: / V2L /
BUILDING HEIGHT TO PEAK:1,'? `// 0ic OCCUPANCY GROUP: 2ND FLOOR SQ FT:
/ X (o
BUILDING DIMENSIONS' CONSTRUCTION TYPE: UNFIN BASEMENT: L/O
NUMBER OF STORIES: _I . STRUCTURES ON PROPERTY: NO FINISHED BASEMENT: /(:
NUMBER of BEDROOMS: iF CRITICAL AREAS: NO' GARAGE: i--- 0
FLANKING SETBACK: CURRENT PROPERTY SIZE: I Vey COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE:VAC, I DECK: /C)
REAR SETBACK: CURRENT SEPTIC USE: A7 A I X IV
LEFT SETBACK: CURRENT WELL USE: ,
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: ,81675X .
4, SIGN
MANUFACTURED HOME -
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: , FIREvALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATEITIME:______---
NWA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
1-HONE: FAX: .
ADDRESS: CITY,STATE,ZIP
PHONE: FAX:
INSPECTOR:
ADDRESS: CITY,STATE,ZIP
I SPECIAL INSPECTIONS I
0 BOLTING CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
0
•IS PUBLIC SEWER AVAILABLE: 0 YES NO IF YES: 0 COUNTY CITY -
IS PUBLIC WATER AVAILABLE: 0 YES NO IF YES,WHICH WATER DISTIIRR:
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
•
DATE: STAFF: '
METHOD OF PAYMENT:
0 0 0 r 0 ....••
I„ .1
CASH CHECK ` -
V/NAS
AUTHORIZED SIGNATUR .
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
o. ,
ley
MECHANICAL PERMIT APPLICATION
PROJECT _ r l PERMIT
ADDRESS: l� t.�' I ✓ ' USE:
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS:
(street) (city/state) •(zip)
CONTR ]jWE /� /1710eta)W
MANG ADDR SS: PHONE#t:
o1(16'- q9 .0
(street) (city/state) (zip)
DESCRIPTION OF WORK #orX COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE I.OR<100,000 / X $15 =
2 FUEL BURNING APPLIANCE - >100,000 - X $19 = - _-_
3 UNUSTED APPUANCE(ADDITIONAL FEE) =OR400,000 X $50 - _
4 UNUSTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100
5 USED APPUANCE(WSEC min.AFUE rating) =OR<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 - ______/____ __L $10 = _
13 RANGE - / X $10 = J
14 DRYER - X $10
15 FUEL BURNING WATER HEATER - 1 f X $10 -
16 MISCELLANEOUS FUEL BURNING APPL - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 =
18 DUCT SYSTEMS - 5*- X $10
19 VENTILATING FANS - X $10 =
20 AIR HANDLER(DOES NOT Include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT kidude ducting) >10,000CFM X 419 =
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 -.4..�- : $10 = • -
31 WOOD OR PELLET STOVE/INSERT - X •, $10 =
32 WOOD STOVE-FREE STANDING - X - $25 •al
- - - �: SUBTOTAL
0 CASH 0 CHECK 0 0 1.. , PLUS PROCESSING
FAXED PERMITS ans. H
ONLYRE ACCEPTED WPTI PAY)AENr $35.00
OFAMAJORCA/MIT CARD • FEE
TOTAL PERMIT FEE
DUE
DATE: • EXPIRES:
BANICARD NUMBER:
• AUTHORIZED SIGNATURE: i'
ars ; ..� .
ane
• PLUMBING PERMIT APPLICATION
PROJECT � 0S 1tL 9
ADDRESS: Lz._ ;7
6:'
esUSE:
OWNER PHONE(Daytime Contact):
-MAILING ADDRESS:
(street) (city/state) (ztp)
c• .CTOR / LICENSE#:
1 618 1P
_ d mom(
MAI r ADDRESS: E ONE#: ,
. &:1 4D 7q
l7D . /flvt 'i. g�i(Ri.
(street) %city/state) (zip)
PLUMVINC'FIXTURES
DESCRIPTION DETAILS #97s 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 LAVS/BASINS,BAR,FLOOR, X $6'
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT (o _ •
6 DISHWASHER X $6 =
7 CLOTHES WASHER ' X $6 =
8 GARBAGE DISPOSAL / - X $6 .-
9
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 '
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 I.
20 MISC PLUMBING FIXTUREX $6 • -
. - - -
} SUBTOTAL
• IS ,
� .
0 CASH 0 CHECK E emuommi 0 - ` I PLUS PROCESSING
FAXED PERMITS Ma ONLY BE ACCEPTED'WITH PAYMENT $35.00
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE: :,.:-x . -
BANLCARD NUMBER: -
AUTHORIZED SIGNATURE: W-
r
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,..,5-4‘.jIrA Via`%/ a1$ plan Is being outward for Wis purpose of
o>, �44e/ obtaining a building permit and is a true and correct
�' representation of the proposal. AN known properly
S�F s. / ones/. _ . ,curb IMns structures moments
�.- ���/ have = •. Also indioalad are wsNands,
••• of
steep or • tribal arras
Date: ' -0
0 PINE ROCK RIDGE 1ST ADDITION
LOT 2 BLOCK 5
Founded 1946
0 10 20 40
P5...■_ 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