2004, 05-15 Permit App: BLD-04-04366 Residence Y
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 r:. i 136 Fay 509 • • • /037
REQUIREE_ D SITE INFORMATION
STREET ADDRESS:
/. O2J & • �. --.7
ASSESSOR'S TAX PARCEL N BE S):
LEGAL DISCRIPTION: ,_ i ({� Ir / (.,
1- -i-Li _if---c.42 . R
PER DESCRIPTION: (1
m t UILDING PERMIT Cl CHANGE.IN•USE - 0 GRADING OMANUFACTURZ.D HOME
0 RELOCAI f ON [J SIGN Ef TENANT 0 OTHER
1 OWNER / APPLICANT INFORMATION
® OWNER: 0 APPUCANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
,,CITY,ST• E,ZIP CITY,STATE,ZIP
°CONTRACTO-1 L ..4 7L�-
' '�� ' ®
k. ARCHITECT:
PHONE"II ♦." - lin i. • PHONE: FAX:
ADDRESS: ,r -,dil. Alla L./4 ADDRESS:
„CC ,.$TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE!R (� CONTACT:
airmarpi
PERMIT/BUILDING INFORMATION __11
•
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT:/4cc)
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT: fir/3
J
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT. / 0
NUMBER OF STORIES: , :RSTRUCTURES ON PROPERTY -11/4-1.---' FINISHED BASEMENT:
NUMBER of BEDROOMS: ii"-- CRITICAL AREAS: GARAGE: (2C3
FLANKING SETBACK: CURRENT PROPERTY SIZE: /0,0 C-! COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: %aDECK:
REAR SETBACK: CURRENT SEPTIC USE: qii-
LEFT
SETBACK: CURRENT WELL USE: ,iJ `A
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
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: FIRE•6LARM:
PAINT BOOTH: : TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
......... ...mmomminr-INIEnommwm..... . "•mmi
F---ZA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: f-HONE: FAX: -
ADDRESS: CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS: CITY,STATE,ZIP
Ii LINSPECTIONS SPECIAL
0 BOLTING 000NCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY I
•IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY 0 CITY -
0
IS PUBLIC WATER AVAILABLE: a YES NO IF YES.WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ❑ YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES Cl NO PSSA: 0 YES CI NO
DATE: I STAFF: I
METHOD OFPAYMENT.'
T 0 ......
0 O VISA
CASH CHECK ` ---
11
BANKCARD#; __All " . VIN#
AUTHORIZED SIGNATOR .
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
SISOkane
MECHANICAL PERMIT APPLICATION
PROJECT /
3L f6Th 37J/LL % PERMIT
ADDRESS: /i [ / L//_--_ USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
. (street) city/state) •(za))
CO"TT�f ►[� - — /D/D &L)
MAILING ADS SS: PHONE aR _/ 8 - - /:4405— .
1-1-0 I g 6', - 9_g
(street) (city/state) (zap)
DESCRIPTION OF WORK ser vans X COST EQUALS AMOUNT
1 FUEL BURNING APPUANCE =OR<100,000 / X $15 a
2 FUEL RURNING APPLIANCE ---- . _ - >100,000 - $19
3 UNUSTED APPLIANCE(ADDITIONAL FEE) =OR400,000 X $50 -
4 UNLISTED APPUANCE(ADDMONAL FEE) >400,000 X $100 =
5 EDUS PPUANCE(WSEC min.AFUE rating) =OR400,000 X $50 =
6 USED APPUANCE(WSEC min.AFUE rating) >400,000 X $100 a -
7 BOILER/REFRIGERATION 1-100M BTU X $15 • =
8 BOILER/REFRIGERATION • 101-0OM BTU X $28 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 =
10 BOILER/REFRIGERATION 1001-1,750M BTU X S57 =
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) - X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - 'j X $10 a ,
20 AIR HANDLER(DOES NOT include ducting) -0R<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 450 = ,
24 TYPE II HOOD - / X $10 a .
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 no ,
28 MR CONDITIONER 30-50 TON X $35 =
29 AIR CONDITIONER .+50TON X $60 a -
30 LPG STORAGE TANK • - • X •.4•-'_: $10 -_. _
31 WOOD OR PELLET STOVEANSERT V - V X . $10 a
32 WOOD STOVE-FREE STANDING - X $25
- - SUBTOTAL
❑ CASH 0 CHECK 0 MM. ❑ ,' . , PLUS PROCESSING
F,u®PERMITS Swa PTED.nTHPAYI2Exr FEE . $35.00
OF A MAJORTOTAL PERMIT FEE
DUE
DATE: V• EXPIRES:
BANKCARD NUMBER:
_ _
AUTHORIZED SIGNATURE: , •. ,-I c'L
Sf itac ne ,
Walley
• PLUMBIN / PERMIT APPLICATION
/PROJECT / / X5-7
ADDRESS: • ,USE:
OWNER: I MiT
'PHONE(Daytime Contact):
MAIUNG ADDRESS:
(street) (city/state) (zip)
c• •CIOR: / •
LICENSE#:
-p, -imp x cies Kp
MAIio ADDRESS: PONE#: . - rgo 7q
•
1. I 7 61 .2 1__.,/d. iner_471Vc_. . f
(street) / (cciiity/state) (zip)
PLUMBING'FIXTURES •
DESCRIPTION . DETAIL - #OF wars X . _COST
S EQUALS _\..•_AMOUNT
I TOILETS WATER CLOSET,BIDETS X $6 _ •
2 URINALS • X $6 =
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE 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 =
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 j 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
18INTERCEPTORS GREASE TRAP,SAND TRAP, • $6
CHEMICAL HOLDING TANK X _
19 MEDICAL GAS per outlet NITROUS,OXYGEN X •
$6 =
20 MISC PLUMBING FIXTURE X $6 =
. - - _ SUBTOTAL .
• alliAt .-r` '
❑ CASH 0 CHECK ❑- — 0 ...-1-`'?-t PLUS PROCESSING Q
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT PAYMENT $35.00
OF A MAJOR CREDIT CARD FEE
• TOTAL PERMIT FEE
•
• DUE I
DATE: • a..!¢ •
BANXCARD NUMBER •
•
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AUTHORIZED SIGNATURE:
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