2005, 06-23 Permit App 05002139 Finish BasementBUILDING 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
Street Address:
REQUIRED SITE INFORMATION
19 r it al4./ S 0A
0 - f39
Assessor's Tax Parcel Number(s):
Legal Description: Co En, Cr 04.
PERM )T DESCRIPTION: ict e G1in -e--S'S /4)5
Building Permit
❑ Relocation
❑ Change in Use [I Grading
❑ Tenant Improvement ❑ Fire Safety
S i e-
❑ Manufactured Home
❑ Other
❑ Owner.
Phone:
Address:
City r
AO, 66 oic
e.acc-ew QV! 9
State Zip ode
❑ Contractor:
Phone: Fax:
Address:
Applicant:•
Phone: Fax:
Address:
City
E Architect:
Phone:
Address:
State Zip Code
Fax:
City State Zip Code City
• WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact
State Zip Code
PERMIT/BUILDJNG 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 O PP J�yi
6 t oJ-(9
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM? --.F. mac/ -Pif/
5,
MANUFACTURED HOME
Width:
Length: ``ear:
_Manufacturer:
Pit Set:
RELOCATION
-J
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler.
Tent:
# of ea
Fireworks Display:
Valuation: Above/Underground Storage Tank Size:
Fire Alarm:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner.
Address:
Phone:
Fax:
Inspector: Phone:
Address:
State
Fax:
Zp
City
State
Zip
SPECIAL INSPECTIONS
E 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 L� 647 (/✓ & pj, t Signature Ltwf
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check
Bankcard #:
Authorized Signature:
❑ Mastercard
❑ VISA ❑ Other
Expires: VIN#:
Project Address:
Owner. r-Pa
Mailing Address:
Contractor
Mailing Address:
PLUMBNG PERMiiT APPLIICATiON
Phone: (509) 688-0036; FAX: (509) 638-0037
For inspections, Cali (509) 388=0054
le.ito .E 1`z ti
; O• /22-
/ 1--ed
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact): -2 7i9 - 0 &S5 7
(,0,�, as e 0 / %.
City 'state Zip Code
License #: Phone #: 5 .�j5 (? /)2
City
State
Zip Code
DESCR1PT1ON OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
86.0D
=
2
URINALS
X
86.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
/
X
$6.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KJTCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
/
X
86.01)
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
6
GARBAGE DISPOSAL
X
MOD
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
86.00
=
11
FLOOR DRAINS
AREA CASE, COIL, TRENCH, CONDENSATE
X
86.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.0D
=
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
86.00
=
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:
0 CASH 0 CHECK
DATE
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
F
S "Oboe
Wley
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
City
Contractor. License #:
Mailing Address:
Project Address:
Owner.
Mailing Address:
Phone
State
Zip Code
Ci
State
Zip 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 100,000 •
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 Tess than 400.000
X
S50.00
=
6
USED APPLIANCE (WSEC min. AFUE rating)
More than 400.000
X
S100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
520.00
=
9
501 - 1,000M BTU
X
$25.00
=
BOILER/REFRIGERATION
10
BOILER/REFRIGERATION
1.001-1.750M BTU
X
S35.00
=
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
X
$10.00
=
19
VENTILATING FANS
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 II HOOD
-
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
S20.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TO
X
S35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
33
REPAIR & ADDmONS
X
$15.00
=
34
VENTILATION SYSTEMS'
X
512.00
=
35
VENTILATION MECHANICAL EXHAUST
X
512.00
=
36
INCINERATOR - RESIDENCE
X
$19.00
=
37
INCINERATOR - COMMERCIAL
X
$22.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA ❑ MC
CARD «. "�
DATE:
SUBTOTAL
PROCESSING FEE
$35.0D
_��p1/�1
TOTAL PERMIT FEE DUE:
/,'->ES:
AUTHORIZED SIGNATURE:
A