2004, 10-01 Permit App: 04007824 AdditionSpokane
,�,,►'+c
Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
RESIDENTIAL ADDITION/REMODEL PERMIT
Job Address: 1028 N ELLA RD
SPOKANE WA 99212 -
Description:
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
720 SQ FT ADDITION TO RESIDENCE - MASTER BEDROOM, BATH, MUD ROOM
AND ENTRY WAY
STORIE, DAN & SANDI
STORIE, DAN & SANDI
1028 N ELLA RD
SPOKANE, WA 99212 -
Lot:
Permit #:
Blk: Parcel No: 45182.0808
Phone:
Phone:
Lic No:
(509) 928-0093
Applied:
Issued:
Expires:
BLD -04-07824
10/01/2004
10/01/2004
03/30/2005
Zoning:
General Information:
VALUATION
REROOF
NON -HEATED
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
# OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
FLANKING SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SINKS
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
53770
N
N
18
20 X 38
1
1
55
N/A
20+
25
20+
r-3
5-n
1
82'6"X145
no
no
1
1
1
1
1
1
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SINKS
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
Total Calculated:
Deposits/Receipts:
Total Due:
268.70
671.75
4.50
6.00
6.00
6.00
10.00
1.00
10.00
983.95
983.95
0.00
THIS IS NOT A RECEIPT
Spokane
�"�MtHey
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
RESIDENTIAL ADDITION/REMODEL PERMIT
Permit #: BLD -04-07824
Disclaimer:
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of
Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued
Print Name
Staff Initials
rmit inure to the property owner.
Signature
THIS IS NOT A RECEIPT
////�/
Date
Spokane
Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
Job Address:
Description:
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
1028 N ELLA RD
SPOKANE WA 99212 -
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
RESIDENTIAL ADDITION/REMODEL
720 SQ FT ADDITION TO RESIDENCE - MASTER BEDROOM, BATH & ENTRY
WAY
STORIE, DAN & SANDI
STORIE, DAN & SANDI
1028 N ELLA RD
SPOKANE, WA 99212 -
Lot:
Application #: BLD -04-07824
Applied:
Issued:
Expires:
Blk: Parcel No: 45182.0808
Phone:
Phone:
Lic No:
(509) 928-0093
Zoning:
10/01/2004
10/01/2004
03/30/2005
General Information:
VALUATION
REROOF
NON -HEATED
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
# OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
FLANKING SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SINKS
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
53770
N
N
18
20 X 38
1
1
55
N/A
20+
25
20+
r-3
5-n
1
82' 6" X 145
no
no
1
1
1
1
1
1
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SINKS
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
Total Calculated:
Deposits/Receipts:
Total Due:
CITY OF SPOKANE VALLEY
t t' ROV,ED FOR SUBMITTAL
Initials / Date
Building
Planning
Public Works_ZaCa 4'1/-.,
268.70
671.75
4.50
6.00
6.00
6.00
10.00
1.00
10.00
983.95
0.00
983.95
THIS IS NOT A RECEIPT
S61.000Valley
• BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
• Spokane Valley, WA 99206
Phone: (503) 688.0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION - • .
a
Street Addrees:
Assessor's Tax Parcel Number(s): VS -47,2A 2J',2 3
Legal Description: iijes� / y.5— feet e)( Lit 7 fee %/; A0cil o j
-:7 '/¢ ;pf ,Z—
PERMIT DESCRIPTION: -
El Building Permit n Change in Use nGrading n Manufactured Home
fl Tenant Improvement fl Fire Safety n Other
❑ Relocation
OWNER/APPLICANT INFORMATION
Owner: JEAN cri_ S- / S7-7
Phone: - 9 4-007.3 Fax: •
Address: , o X may . e-7 c.. 4 g 9
o/A-€ 1/2 //e`''
Gty / State Zip Code
❑ Contractor:
Phone: Fax:
Address:
City
State
WA State Contractor License #:
0
Applicant:
Phone: Fax:
Address:
City
El Architect:
Phone: Fax:
State Zip Code
Address:
Zip Code City
Contact:
State Zip Code
PERMIT/BUILDING INF.ORMATIO.N
•
t-IEIGHT TO PEAK / v 1 - -
0
DIMENSIONS: 0, X D
3f.
# OF STORLES:
MAN FLOOR TO SO. FTG: r o
----a` -t- (Q9 v
2""-' FLOOR S0_ FTG: _
0
-UNFIt4 BASEMENT SO. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ: FTG: •
- DECK/COV. PATIO SQ. FTG: Q
OCCUPANCY GROUP:
CONSTRUCTION TYPE:/7-7 ��
HEAT SOURCE: /-/y1::-A.-
3 S t
A
# OF BEDROOMS:
/
TOTAL HABITABLE SPACE:
l aa -F'
IMPERVIOUS SURFACE AREA:
-
COST OF PROJECT: •
-
30%SLOPES O[ PROPERTY:SEWER
OR ON-SITE SEPTIC
SYSTEM?SZ w E'er
• RELOCATION A//
MANUFACTURED HOME ,i/4
Width.;
Manufacturer: .
Length:
Year:'
Pit Set:
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: J Paint. Booth:
Tent:
Valuation: - Above/Underground Storage Tank Size:
Fireworks Display: Blasting: •
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone: Fax:
City
Inspector: Phone: Fax:
Ad d ress:
State
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
Firm Name: Phone:. Fax:
Inspector(s):
❑ -WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water: 2) Ownership of this City of Spokane Valley Permit inure to- the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) Ail construction is to. be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of?Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)_
n Cash ❑ Check ❑ Mastercard - 0 VISA 0 Other
• Bankcard #: Expires: VIN#:
Authorized Signature:
Wkane
Dalley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuifdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: ito07 A)row rif CL 1 7Zc cP Permit Use: 4y[r 2* 2c 1-7vAJ
Phone (Daytime Contact): � —CC) 23
CSO/1-4�/, I -'/I is i/ is-c-'� 7'z Z
City 7' State Zip Code
Contractor: License #: Phone #:
Mailing Address:
Owner: 7 ,t'
Mailing Address: J .4'4 t
City
State
Zip Code
METHOD OF PAYMENT:
D CASH E3 CHECK
DATE:
BANKCARD NUMBER:
0 VISA
EXPIRES:
E3 MASTERCARD
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF -
UNITS
1
X '
COST
-
-
TOTAL
1
TOILETS
WATER CLOSET, BIDETS
i
X
56.00
=
// --AMOUNT
V At I-
2
URINALS
l
X
56.00
=
3
TUBS
X
56.00
=
CC..- CC
' 4
SHOWERS (PER TRAP)
BATH. STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR. PHOTO, X-RAY. FOOD,
PREP/CULINARY/MEAT
1
I
X
56.00
=
p
i cam kP
_ lJ -
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
B
GARBAGE DISPOSAL
X
56.00
=
` 9
WATER SOFTENER
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56,00
=
11
FLOOR DRAINS -
i
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
=
I
Y SR_nrr 1 = I
12
ROOF ORRINS/OVERFI OW ORCINS
13
FOUNTAINS, DRINKING
X 56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X 56.00
=
GRINDER, SUMP PUMP
X 56.00
=
15
SEWAGE EJECTOR
16
WATER USING DEVICE
(CE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
X
56.00
=
CARBONATOR, SWAMP COOLER
VACUUM BREAKER. CHECK
VALVE, AND R_P_B.P.D_ FOR
X
56.00
=
17
CROSS CONNECTION. DEVICE
VATS TANKS BOILERS
- GREASE TRAP, SAND TRAP,
X 56.00
=
18
INTERCEPTORS
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
X$6.00
=
MEDICAL GAS (per outlet)
19
20
MfSCELLANEOUS PLUMBING FIXTURE
X ' 56.00
METHOD OF PAYMENT:
D CASH E3 CHECK
DATE:
BANKCARD NUMBER:
0 VISA
EXPIRES:
E3 MASTERCARD
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
*Wane
.0001/alley
Project Address:
Owner:
Mailing Address:
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Corr inanity Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
- Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
Contractor: License #:
Mailing Address:
City
State
Phone #:
Zip Code
C
State
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS-
X
TOTAL
COST AMOUNT
1
FUEL BURNING APPLWNCE
Equal to or less than 100,000
X
$15-00
-2
-FUEL BURNING -APPLIANCE
Mara than 100.000
X
51500 =
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00 =
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
5100.00 =
5
USED APPLIANCE (WSEC min. AFUE
rating2
Equal to or Less than 400.000
X
550.00 =
6
USED APPLIANCE (WSEC min. AFUE
rating)
More than 400,000
X
5100.00 =
7
BOILER/REFRIGERATION
1 - 100M BTU •
X
515.00 =
• 8
BOILER/REFRIGERATION
101 - 500M BTU
X
528.00 -
9
BOILERIREFRIGERATION
501 - 1,000M BTU
X
539.00 =
10
BOILER/REFRIGERATION
1,001 -1,750M BTU
X
557.00 =
-Pt
BOILERYREFRIGERATION
More than 1,750M BTU
X
595.00 -
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
510.00 =
13
RANGE
X
510.00 =
14
DRYER
X
510.00 = _.
15
FUEL BURNING WATER HEATER
(
X
510.00 = ()-- Z 0
16
MISC. FUEL BURNING APPLIANCE
X
510.00 -
. 17
GAS PIPING (each outlet)
X.
51.00 =
18
DUCT SYSTEMS
X
$10.E I =
19
VENTILATING FANS
X
510.00
=
20
AIR. HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
519.00
= "
22
EVAPORATIVE COOLERS
X
510.00
-
23
TYPE 1 HOOD
,
X
550.00
-
24
TYPE It HOOD
X
510.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512.00
=
26
' AIR CONDITIONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
30
LPG STORAGE TANK
X
510.00
=
31
WOOD OR PELLET STOVE!INSERT
X
510.00
=
32
. WOOD STOVE - FREE STANDING
X
525.00
=
METHOD OF PAYMENT:
DATE:
SUBTOTAL
PROCESSING FEE
535.00
D CASH 0 CHECK D VISA 0 MC
#: EXPIRES.
TOTAL PERMIT FEE DUE:
CARD
AUTHORIZED SIGNATURE:
Zip Code