2003, 10-21 Permit: BLD-03-02553 Residence w/Attached GarageSpokane
.000 Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
NEW SINGLE FAMILY RESIDENTIAL PERMIT
Job Address: 428 N ADAMS RD
SPOKANE VALLEY WA 99037
Description: NEW RESIDENCE W /ATTACHED GARAGE - GAS
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
MERTON E BOLLMAN
KEN WILSON CONSTRUCTION
5729 S FERRALL ST
SPOKANE, WA 99223
KEN WILSON CONSTRUCTION
5729 S FERRALL ST
SPOKANE WA 99223
Lot:
Permit #: BLD -03 -02553
Blk: Parcel No: 45144.0844
Phone:
Phone: (509) 448 -3411
Lic No: KENWIC*000KW
Applied:
Issued:
Expires:
Zoning:
09/22/2003
10/21/2003
04/18/2004
THIS IS NOT A RECEIPT
Spokane
.0,I0Valley NEW SINGLE FAMILY RESIDENTIAL PERMIT
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
CLOTHES WASHER
GARBAGE DISPOSAL
FLOOR DRAINS
SEWAGE EJECTOR
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
RANGE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
AIR HANDLER <= 10,000 CFM
TYPE II HOOD
HEAT PUMP /AIR COND 0 - 3 TON
BUILDING HEIGHT TO PEAK
DIMENSIONS
COST OF PROJECT
# OF STORIES
# OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
FLANKING SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY USE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SHOWERS (PER TRAP)
SINKS
DISHWASHER
sfr
158000
1
1
1
1
2
1
1
1
1
1
3
4
1
1
1
20
39 X 78
158000.00
1
3
120
70
50
50
NA
r -3
5 -n
1
RESIDENCE
no
no
2
1
6
1
Permit #:
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
GAS LOG, INSERT, FIREPLACE
RANGE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
AIR HANDLER <= 10,000 CFM
HEAT PUMP /AIR COND 0 - 3 TON
WSBCC SURCHARGE
TOILETS
TUBS
SHOWERS
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
FLOOR DRAINS
SEWAGE EJECTOR
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
Total Calculated:
Deposits /Receipts:
Total Due:
BLD -03 -02553
527.42
1,318.55
10.00
10.00
10.00
10.00
3.00
40.00
12.00
12.00
4.50
12.00
6.00
6.00
36.00
6.00
6.00
6.00
6.00
6.00
12.00
15.00
2,074.47
2,074.47
0.00
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 permi nure to the proper ow r.
22 2 / -4'7
Print Name ure Date
// t)i / S 7 /v
Staff Initials
THIS IS NOT A RECEIPT