2005, 08-31 Permit App 05003182 DuplexProject Number: 05003182 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: DUPLEX
Setbacks: Front
Site Information:
Plat Key:
Left: Right: Rear:
Name: RANGE
Date: 08/31/2005 Page 1 of 2
Contact: JAYN COURCHAINE
Address: 17201 E CATALDO
C - S - Z: SPOKANE VALLEY, WA 99016
Phone: (509) 924-3492
Group Name:
Project Name:
District: East
Parcel Number: 55074.1034 Block:
SiteAddress: 18410 E INDIANA AVE
Location:: CSV
Zoning: UR-3.5
Water District:
Urban Residential 3.5
Lot:
Owner: Name: JAYN COURCHAINE
Address: 17201 E CATALDO
SPOKANE VALLEY, WA 99016
Hold: ❑
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information: _ s
Review
Site Plan Review
Released By:
Plan Review
Released By:
Approach / Drainage
Septic System Review
Permits:
Released By:
Contractor: OWNER
Building Permit
Finn: OWNER
Phone: (000) 000-0000
Operator: CJJ Printed By: CJJ Print Date: 08/31/2005
Project Number: 05003182 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 08/31/2005 Page 2 of 2
Notes: m" "R io,,, ..-.: ?,.r : ..sd .sazsaF '. §g:, s .rftkSi m.w eEs??^1 asg §arrt%" 'Aks;wavt.,,,,m., a»_g..wn'# ;;,wa,.,. ;d
Payment Summary: �:*, ,3
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: CJJ Printed By: CJJ Print Date: 08/31/2005
S6I&ne
_.Va11ey
Os .ISZ
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane _ !ley Community Development Department
Building Division
JJ 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
one: (509) 688-0036; Fax: (509) 688-0037
P,
D Jai]
REQUIRED SITE INFORMATION
D
Street Address: pi' � c"
Assessor's Tax Parcel Number(s): Poe ,),44) Q ri 7�/` /0_37
Legal Description: ..:-/-4/-70,21 - 6 4�
PERMIT DESCRIPTION:
Er Building Permit
❑ Relocation
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
0 Other
OWNER/APPLICANT INFORMATION
Owner: I
Phone: 9aygyi„ Fax: 9,4 Qo y/
Address: y J? i l Q�
c_efe-e ix)i9 992/�
City State Zip Code
❑ Contractor:
Phone: Fax:
Address:
City
Applicant: .-) /2,'tc,�:�.�:,:/tv"
Phone: 9,2b acc, e 89 Fax:
Address:47.4o/
t- -nj9
City State Zip Code
Architect: cr �tir."6"
Phone: Fax:
Address:
State Zip Code City
State Zip Code
WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT5TOPEAK:
DIMENSIONS:y�
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
�-
GARAGE SQ. FTG:
`_
DEC COV. PATIOJSQ. FTG:
a'
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURC
# OF BEDROOMS:/
`i -f 2,1, 1
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
2'7/422.
COST OF PROJECT:
30% SLOPES ON PROPERTY:
N 6
SEWER OR ON -SITE SEPTIC
SYSTEM? ar y', /c-
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation:
Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
City
State
Zip
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, CaII (509) 688-0054
Project Address:
Owner. �Co�r C j.✓ r
Mailing Addre6s: ,E
Contractor. License #:
Mailing Address:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):-;oy '1x4/3/9z-
4) 9yo.4 - //9e9.7�ef 0r3
City State Zlp Code
Phone #:
State
Zip Code
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,00D
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.OD
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or Tess 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 - 5o0M BTU
X
$20.00
=
9
BOILER/REFRIGERATION
501- 1,0DOM 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
2,
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
2
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
$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 STOVE/INSERT
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:
❑ CASH 0 CHECK 0 VISA 0 MC
CARD #:
SUBTOTAL
DATE:
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
Project Address:
Owner. 1J Prue -
•
Mailing Address: J / 7&&/
Contractor. 0 Jaic
Mailing Address:
iN P
ty
License #:
Permit Use:
Community Development Department
Building Divi:.ion
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact): sag SaL9 ryyz
.,4JGas 9?0/'
State Zip Code
Phone #:
City
State
Zip Code
DESCRIPTION OF WORK
S OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
V
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KffCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
2—
X
$6.00
=
7
CLOTHES WASHER
2-..
X
$6.00
=
6
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
56.00
=
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
=
16
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
0 VISA 0 MASTERCARD
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: