2005, 06-10 Permit App 05001981 BasementSi�Iine
.00fUlley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: iO5bi %ate+
F F
Sew(11,0 . act-Dt
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: 1nu@- / ‘-s ch�n�c--
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation 0 Tenant Improvement ❑ Fire Safety 0 Other
I
OWNER/APPLICANT INFORMATION
®'caner. ('�ls P1� bi,«x�n ❑ Applicant:
hone: a- Mato `Fax: Phone: Fax:
Address: in5ri s e- 1:7e1-
Address:
<„Gioarelv C.,.z !k . CiCtle) .
Cityl State Zip Code City State Zip Code
P ► cN . tA-N.,.LV-.
Contractop tv,i,,zr. ( (_s 0 Architect:
Phone: 341-t5n6 Fax: cut- IIr,rt Phone: Fax:
Address: Lit) i r 4. (k,,L 04 Address:
5 POD QQ 1b4
City ' State Zip Code City
State Zip Code
WA State Contractor License #: PaCg r tact . Contact:
Spokane Valley Bus. Liscense #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
-Pis Liy- .b`'
MANUFACTURED HOME
Width:
Manufacturer
Length: Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler. # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
Inspector(s):
Fax:
❑ 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) 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 permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
�olaca�
Project Address: 1 ol7$ t p.Pt� �) n5.r �l. h 4 _Q4:DE)6
Owner: t- �vMailing Address: 59M 7-
n
bne
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
j14O 5(, I Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
State Zip Code
Contractor. .7;i ,. (fir ns S (Ocact�.'e• •J*>- Cif:46nse #: PACT F nice -A -IV- Phone #: • t5ri(., -tcL(
Mailing Address:
City
Ci
State
ZiD Code
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12.00
=
2
FUEL BURNING APPLIANCE
More than 100,00D
X
$15.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00
=
6
USED APPLIANCE (WSEC min. AFUE rating)
More than 400,000
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
8
BOILER/REFRIGERATION
101 - 5D0M BTU
X
$20.00
=
9
BOILER/REFRIGERATION
501- 1,000M BTU
X
$25.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
$1.00
=
18
DUCT SYSTEMS
67,E tit VC'Vl l
L
X
$10.00
=
19
VENTILATING FANS
tizja..11ASIcC Lib }Vte.o
0
X
$10.00
-
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE 11 HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
$20.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVEJINSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
33
REPAIR & ADDITIONS
X
$15.00
=
34
VENTILATION SYSTEMS
X
$12.00
=
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
=
36
INCINERATOR - RESIDENCE
X
$19.00
=
37
INCINERATOR - COMMERCIAL
X
$22.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #.
SUBTOTAL
DATE:
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
Project Address:
Owner
Mailing Address:
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106.
Spokane Valley, WA 99206
Contractor:
Permit Use:
Phone (Daytime Contact):
City
License #:
State Zip Code
Phone #:
Mailing Address:
City
State
Zip Code
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
.c...i -......„)--,s,1
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
1
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH STALL, ON -SITE BUILT
X
$6.00
=
5
SINKS
LAVS INS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA 0 MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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yI�N�SsPZECTICORRECTIONS
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