2003, 02-14 Permit Application: 03000907 Basement Bath & LaundryProject Number: 03000907 Inv: I
Application
THIS.IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 2/14/2003 Page 1 of 3
Project Information:
Permit Use: FINISH BASEMENT BATHROOM & LAUNDRY
ROOM
Setbacks: Front Left: Right: Rear:
Site Information:
Plat Key: 003084 Name: EARLY DAWN 02ND ADD
Contact: BELKNAP PLUMBING
Address: 3414 S ADAMS
C - S - Z: VERADALE, WA 99037
Phone: (509) 921-5913
Group Name:
Project Name:
District:
Parcel Number: 45262.2914 Block:
Site Address: 1921 S AIR PARK DR
VERADALE, WA 99037
Location:: VER
Zoning: UNKN Unknown
Water District:
Area: .00 Acres Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Lot:
Owner: Name:
Address:
MONROY, MILT
1921 S AIR PARK DR
VERADALE, WA 99037
Hold: El
Depth: 0 Right Of Way (II): 50
Review
Plan Review
Released By di (II ,L9
2
Operator: CKF Printed By: CKF
Print Date: 2/14/2003
Project Number: 03000907 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 2/14/2003 Page 2 of 3
Contractor: BELKNAP PLUMBING
Address: 3414 S ADAMS RD
VERADALE, WA 99037
Building Characteristics
Const Category: Remodel
Nbr Of Dwellings:
Bldg W x D: x
Req Parking:
Building Permit
Firm: BELKNAP PLUMBING
Phone: (509) 921 -5913
Group:
Occupant Load:
Building Sq Ft:
Handicap Parking:
Description Type Notes
BASEMENT F R -3 VN PARTIAL
BASEMENT
FINISH
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Totals:
Units
1
1
1
Type:
Building Height: Stories:
Sprinlders:
Critical Materials: 0
This Application: Total Project:
Su Ft Valuation Sq Ft Valuation
0 $1,300.00 0 $1,300.00
0 $1,300.00
Unit Desc
Y OR BLANK
Y OR BLANK
Y OR BLANK
Permit Total Fees:
Mechanical Permit
0 $1,300.00
Fee Amount
$44.00
$4.50
$9.68
$58.18
Contractor: BELKNAP PLUMBING Firm: BELKNAP PLUMBING
Address: 3414 S ADAMS RD Phone: (509) 921 -5913
VERADALE, WA 99037
Item Description
VENTILATING FANS
MINIMUM FEE ADJUSTMENT
Units Unit Desc
11r NUMBER OF
1 Select
Operator: CKF Printed By: CKF
Permit Total Fees:
Print Date:
Fee Amount
$10.00
$25.00
$35.00
2/14/2003
Project Number: 03000907 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 2/14/2003
Contractor: BELKNAP PLUMBING
Address: 3414 S ADAMS RD Phone: (509) 921 -5913
VERADALE, WA 99037
Plumbing Permit
Page 3 of 3
Firm: BELKNAP PLUMBING
Item Description
TOILETSBIDETS
SINKS
SHOWERS
CLOTHES WASHER
FLOOR DRAINS
WATER PIPING - DWV
Notes:
Payment Summary :::::
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Units Unit Desc
1 NUMBER OF
2 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Fee Amount
$58.18
$35.00
$42.00
Permit Total Fees:
Invoice Amount
$58.18
$35.00
$42.00
$135.18 $135.18
Fee Amount
$6.00
$12.00
$6.00
$6.00
$6.00
$6.00
Amount Paid
$0.00
$0.00
$0.00
$42.00
Amount Owing
$58.18
$35.00
$42.00
$0.00 $135.18
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: CKF Printed By: CKF Print Date: 2/14/2003
„A_
Sox SPOIcANE CourY
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509- 477 -3675
SPECIFIC SITE INFORMATION
Street Address:
) 9 I
Assess() s Tax Par Number(s): f p )
Legal escri 'on: � /
Project Description:
❑ Building Permit
❑ Change in Use
O Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New /Change)
O Other
Department Use Only
Water District/Purveyor.
Sewer District /Purveyor
Road width
Setbacks
Front Rcar
Left Right:
School District:
Fire District:
Zoning
OWNER /APPLICANT INFORMATION
IZI Indicate who should be tentacled repardine this broiert
XOwner.
Phone: al e --3 ?
Fax:
❑ Applicant:
Phone:
Fax:
Mailing Address:
icil C 14-1
`
Mailing Address:
2nd floor sq. ft.
City, State, Zip
N%A l`Q
-- (79-0'37
City, State, Zip
Garage sq. ft.
❑ Contractor
Phone
Fax
❑ Architect /Engineer
Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# of stones
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2nd floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
I feat source (electric, gas, etc.)
q 5
Manufactured Home
Sign
Width:
Length:
What is the square footage of the sign
face?
1 low high is the sign?
Year:
Make:
i# of signs
Area of existing signs
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) ❑Yes ❑No
Proposed use
\'.Juc
Relocation
Fire Safety
Firm Name
Previous address
Phone
Fire Sprinkler
Tent
Paint booth Fire Alarm
Fireworks display
_
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) ❑Yes ❑No
Proposed use
\'.Juc
Special Inspections Required?
Non- Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? ❑ Yes O N
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
❑ Yes ❑ No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) ❑Yes ❑No
Are critical or hazardous materials used or stored on site?
❑Yes 0 N
Address
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
❑ Reinforcement
\ddress
ADDITIONAL SITE INFORMATION
Are there structures on the property? ❑ Yes ❑ No
Ifyes, identify at site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ifyes, identify on site plan ❑ Yes ❑ No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
❑ Don't know ❑ Yes ❑ No
Will the site be served by a septic system? ❑ Yes O N
Is any part of the property within a 100 yr flood plain?
Ifyes, identi on site plan
❑ Maybe ❑ Don't know ❑ Yes in No
Are or will there be wells located on the property?
1_ /yes, identib, on the site plan ❑ Yes ❑ No
Are there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, ident/ on site plan ❑ Yes ❑ No
Is there evidence of fill or excavation on the property?
❑ Yes ❑ No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) ❑Yes ❑No
Are critical or hazardous materials used or stored on site?
❑Yes 0 N
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
❑ Yes
O No
Is public sewer available to the site? ❑ Yes ❑ No
Is the property inside the ASA?
in Yes
❑ Yes
O No
O No
Is public water available to the site? ❑ Yes ❑ No
Is the property inside the PSSA?
❑ Yes
in No
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASH ❑ CHECK ❑
0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUB'I'OTAl .
TOTAL FEE
MINIMUM PERMIT FEE IS S35.00PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER