2003, 10-27 Permit App: BLD-03-02909 Residence ••"\..., .
SP6kane
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fay 509 688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: / -� / 7 <J 7 `� ' sy ' ,H-- "- '
ASSESSOR'S TAX PARCEL `•MBER(S):
LEGAL DISCRIPTIO 41.iff* (T '
_ . /1� �hof _-i A-....4 —.rte
PER DESCRIPTION:
II1LDING PERMIT El CHANGE IN USE D GRADING 0 MANUFACIU1Z:+,D HOME
QRELOCATION DSIGN 0TENANT 0-OTHER
OWNER / APPLICANT INFORMATION
0 OWNER: 0 APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
j • CITY,ST ,ZIP CITY,STATE,ZIP
DCONTRACTO i1 ',/4.114i_14/ 1,;/ a , 0 ARCHITECT.:
PHON /A. — NE: lifIMx. ,11 PHONE FAX:
ADDRESS: / iii. 1i.,444„d, ADDRESS:
C4^C ..$TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# �/�; r� /,� {p CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: 7/1,64‘--1---- MAIN FLOOR SQ FT: lb g&
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ Fl:_i_ (
BUILDING DIMENSIONS:&& X 51C CONSTRUCTION TYPE: UNFIN BASEMENT:- ' 7 2
NUMBER OF STORIES: I f G�-iuA �-. STRUCTURES ON PROPERTY: / FINISHED BASEMENT: —
NUMBER of BEDROOMS: -__SCRITICAL AREAS: GARAGE: 554
FLANKING SETBACK: CURRENT PROPERTY SIZE: `/,3,.00 COVERED DECK:
FRONT SETBACK: 3 / CURRENT PROPERTY USE: V Q%C•2-- DECK: /070
REAR SETBACK: Wo CURRENT SEPTIC USE: WA
LEFT SETBACK: CURRENT WELL USE: A) A
RIGHT SETBACK: CJ IMPERVIOUS SURFACE AREA: 3 U/$ I •
S1 okane
,."' Valley
MECHANICAL PE IT APPLICATION
APROJECT / / ,p + 3 t- 0� PERMIT
ADDRESS: J USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
• (street) (city/state) •(zip)
CONTWf: ♦ Li` E#�EAA _ Ill Ord
MAILING AD6R SS: PHONE#:
1464 ' 465
4D Ig 6': ql,w 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 APPUANCE(ADDITIONAL FEE) =OR<400,000 X $50 =
4 UNLISTED 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 =
6 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 =
, i
15 FUEL.BURNING WATER HEATER - X $10 =
16 MISCELLANEOUS FUEL BURNING APPL - X $10 =
17 GAS PIPING(ea.Outlet) - tk
4 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 . =
// , I SUBTOTAL
0 CASH 0 CHECK 0 0 .` ' PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT FEE $35.00
OFA MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: C --4)--...‘ . -
Sa e
,,.00" ' ley
• PLU/MBINGJPERMIT APPLICATION
PROJECT /,_9(.1/ ✓JF -yL-d �� USE:ADDRESS: / C7�`-,
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (�3Q•
y
i (zip)
itio x
4 a
MAI ADDRESS: , ONEF#:�.
- 40;1 — 4a 7q
I7U id. Meui-nut__ Wa/- 0
(street) (city/state) (zip)
PLUMBING'FIXTURES
DESCRIPTION DETAILS S OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS GA X $6 = •
2 URINALS • X $6 =
3 TUBS A 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, 6,..--
PREP/CULINARY/MEAT =
6 DISHWASHER X $6 a
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 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 s'
• - „ SUBTOTAL
'a �
❑ CASH 0 CHECK 0 iminom 0 -i•. ! ! PLUS PROCESSING
FAXED PERMITS QOIIS.ONLY BE ACC,EPYED WITH PAYMENT $35.00
OF A MAJOR CREDIT CARD FEE
• TOTAL PERMIT FEE
• DUE
DATE: •
.
BANKCARD NUMBER: •
AUTHORIZED SIGNATURE:
. , ,
/. ./01 .1_____ Fax
Transmission
. .../#111:94, DATE: /6( /0-:
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Number of pages including covcrahcct
FROM:
TO: Dave / Brian / Josh J Julann '"ari
Lexington Homes Inc.
COMPANY:
PHONE: (509) 924-1519
PHONE:
• FAX #: (509) 8924208
FAX #: f
Remarks:
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0- PINE ROCK RIDGE 1ST ADDITION
LOT 5 BLOCK 6
Founded 1946
0 10 20 40 „'
Wil' vmpson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323
13017 E. 37th Lexington Homes