2004, 05-11 Permit App BLD-04-04334 PoolA
SpacArT Cowry
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DEPARTMENT OF BUILDING AND PLANNING
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: -01 x i40d ,NL i96D
O Building Permit
O Change in Use
0 Grading
O Manufactured Home Permit
O Relocation
O Sign
El Tenant (New/Change)
O Other
Department Use Only
Water District/Purveyor
Sewer District/Purveyor
Road width
Setbacl�s
Front Rear.
Left Right:
School District
Fire District
Zoning
OWNER/APPLICANT INFORMATION
Q Indicate who should be contacted reeardrn2 this t'rrnect
0 Owner. Phone.
SONI) QL�1 .1C� Fax:
?�
92Z.— VX_ qU I
0 Applicant
Phone:
Fax:
Mailing Address:
I (, D,1I /L
Mailing Address:
City, State, Zip /j `� ,,�s
ece 6,e- ,i/f��e vi t (,✓4
l O 7�
City, State, Zip
❑ Contractor ^ /. / ' /Phone
/106- Wd to ( Fax
��( %�^
92- `` z. V 3—
❑ Architect/Engineer
Phone
Fax
Mailing address �/ £ !Q� ,
/327 'ni(1`____
Mailing address
City, State Zip
5,w.,(9/1)._ l/4u,r/y t-
( 6
City, State Zip
WA State Com or license #
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2^d floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc.)
Manufactured Home
Width:
Length:
What is the square footage of the sign
face?
How high is the sign?
Year.
Make.
# of signs
Area of existing signs
Relocation
Fire Safety,
Previous address
Fire Sprinkler _
Paint booth _ Fire Alarm _
Tent
Fireworks display
Proposed use
Value
Special Tnspeciions Reglixed_?
Non Residential Energ . c qde Gomphance?'
Firm Name
Phone
Plans Examiner
Phone
Inspectors:
Address
Inspector
Phone
0 Concrete • 0 Welding 0 Bolting 0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
If yes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
If yes, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
• O Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
Ifyes, ident ' on siteplan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells Located on the property?
Ifyes, identij on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identify on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( -%) OYes ONo
Are critical or hazardous materials used or stored on site?
OYes ONo
DEPARTMENT USE ONLY
Tts;tEt zo1erty`i&a Bestgnated Stortmvate5 Coa4col Area? !
1 - tl d f Y .; 4
_ �: Yes O� No;
' Ts^pnbiu sSa. iTvai1aMe to'..... sites ` r O ;.Yes
.
is thepsoperyt msldcdhe,(aSA'o r j LZ Yes,, O' No. r {
� c. z
yrs'pnbJsc wa available to the to + ' r ��0 Yes"'irk.No ts"
IsthepropedymsadPi. xltcPSSA? t Q Yes 0 No -
Is the pro localedga•thm1U00feeio"3,Na'tli}alResoUrceAt& "t
Date Received:
Staff Representative:
METHOD OF PAYMENT
MEM
❑ CASH ❑ CHECK ❑
O
!IC&VE:.
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL
!OT7lL FEE'.;
MAKEcotsfypAY�c CIi'NIfl . ;
. ,•. COUN'�'%YL'1iMTirCCNt�jk '. ..
MECHANICAL PERMIT APPLICATION
PROJECT /
ADDRESS: L � �.LL /7v1"q -
-
PERMIT
USE: S�-l'� x'441"44
�/
Ae'C'
OWNER: IC�,(-� ��un�� -
PHONE (Daytime Contact):
MAILING ADDRESS:-
9^(.X//
Street
Ci /State
01
CONTRACTOR: pba,
LICENSE:
MAILING ADDRESS:
PHONE:
Street -
Ci /State
Z
DESCRIPTION OF WORK
# OF n+uLn
UNITS Pero
COST/
UNIT
AMOUNT
EOUALS
FUEL BURNING APPLIANCE
= OR <100,.000
X
$12
= $
FUEL BURNING APPLIANCE
>100,000
X
$15
= $
UNLISTED APPLIANCE (ADDITIONAL CHARGE)
= OR <400,.000
X
$50
= $
UNLISTED APPLIANCE (ADDITIONAL CHARGE)
>400,000
X
$100
= $
USED APPLIANCE (Must meet WSEC's min. AFUE rating)
= OR <400,.000
X
$50
= $
USED APPLIANCE (Must meet WSEC's min. AFUE rating)
>400,000
X
$100
= $
BOILER/REFRIGERATION
1-100M BTU
X
$12
= $
BOILER/REFRIGERATION
101-500M BTU
X
SO
= $
BOILER/REFRIGERATION
501-1,000M BTU
X
$25
= $
BOILERIREFRIGERATION
1,001- 1,750M BTU
X
$35
= $
BOILER/REFRIGERATION
+1,750M BTU
X
$60
= $
GAS LOG, GAS INSERT, AND/OR GAS FIREPLACE
-
X
$10
= $
RANGE
-
X
$10
= $
DRYER
-
X
$10
= $
FUEL BURNING WATER HEATER
-
X
$10
= $
MISCELLANEOUS FUEL BURNING APPLIANCE
-
X
$10
= $
GAS PIPING (ea. Outlet)
-
X
$1
= $
DUCT SYSTEMS
X
$10
= $
VENTILATING FANS
-
X
$10
j $
AIR HANDLER (DOES NOT include duct systems)
= OR <10,000 CFM
X
$12
= S
AIR HANDLER (DOES NOT include duct systems)
>10,000 CFM
X
$15
= $
EVAPORATIVE COOLERS
X
$10
= $
TYPE HOOD
-
X
S50
= $
TYPE II HOOD
X
$10
= $
HEAT PUMP/AIR CONDITIONER
0-3 TONS
X
$12
= $
AIR CONDITIONER
3-15 TONS
X
$20
= $
AIR CONDITIONER
1530 TONS
X
$25
= $
AIR CONDITIONER
30-50 TONS
X
$35
= $
AIR CONDITIONER
+50 TONS
X
$60
= $
LPG STORAGE TANK
-
X
$10
= $
WOOD OR PELLET STOVE/INSERT
-
X
$25
= $
METHOD OF PAYMENT
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD ❑ DISCOVER
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES:
BANKCARD NUMBER:
SUBTOTAL
PLUS: PROCESSING FEE
SUBTOTAL: MINIMUM PERMIT FEE
IS $35.00
PLUS: 16% REGIONAL PLANNING
SURCHARGE
$ 25.00
AUTHORIZED SIGNATURE:
TOTAL PERMIT FEE DUE
Spokane County Division of Building & Code Enforcement
1026 West Broadway Avenue' Spokane, WA 99260-0050
Telephone No. (509) 477-3675' Fax No. 477-7198' TDD No. (509) 477-7133
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