2003, 09-22 Permit Application: BLD-03-02553 Residence w/Attached Garage"pokane
4 __ Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
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: Blk:
Phone:
Phone:
Lic No:
Application #: BLD -03 -02553
Applied:
Issued:
Expires:
Parcel No: 45144.0844
(509) 448-3411
KENWIC *000KW
09/22/2003
03/20/2004
Zoning: •
REVIEWED FOR CODE COMPLIANCE
SPOKANE VALL :a: UI •ING DIVISION
e3
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
Initials / Date
A Building /
- x Planning a l
lic Works adiet
/
10/21/2003. 15:11
5093241567
1J•11 rn
11707 E. Sprague Ave.. Suite 106
Spokane Valley, WA 99208
SRHD EHS
PAGE 01/01
TO 3241567 P.01/02
THIS IS NOT A PI:RMff
Penalties will be asee evd for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
Job Address: 428 N ADAMS RD
SPOKANE VALLEY WA 88037
Description: NEW RESIDENCE WtATTACHED GARAGE - GAS
Subdlvlslon:
Owner.
Applicant
Address:
Contractor.
Address:
MERTON E BOLLMAN
KEN WILSON CONSTRUCTION
5729 8 FERRALL ST
SPOKANE. WA 99225
KEN WILSON CONSTRUCTION
5729 S FERRALL ST
SPOKANE WA 99223
Lot Bile
Phone:
Phone:
LIc No;
Application 11: BLD- 03.02663
Applied: 09/2212003
Issued:
Expires: 03120/2004
Parcel No: 45144.0844 Zoning: •
(509) 448.3411
KENWIC•000KW
OCT 18 2003 15:14
REVIEWED FOR CODE COMPLIANCE
SPOKANE VAi, a1• Ul ' ING DIVISION
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
initials/ pate
Building
Planning
lie Works AO. 04 ,/
ry .
Ffr
thwri
2l
sysj ctrl ,, n ail rrf oxir1ui, ±;..
04 rooms or �;.�r�,,:, ,.Or„ .
UCCUPMGY 114-1.- ALLOWNEO jintif ssy<,t txt
installations has SF - O I( wr)sr,t.
5093241567 PAGE.01
*Wane
.�Va11ey
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
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
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
-SAS PIPING (ea. OUTLET)
VENTILATING FANS
AIR HANDLER <= 10,000 CFM
TYPE II HOOD
HEAT PUMP /AIR COND 0 - 3 TON
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
sfr
158000
20
39 X 78
158000.00
1
3
120
70
50
50
NA
r -3
5 -n
1
RESIDENCE
no
no
2
1
1
6
1
1
1
1
1
2
1
1
1
1
1
3
4
1
1
1
Application #: BLD -03 -02553
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SHOWERS
SINKS
DISHWASHER
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
VENTILATING FANS
AIR HANDLER <= 10,000 CFM
HEAT PUMP /AIR COND 0 - 3 TON
Total Calculated:
Deposits /Receipts:
Total Due:
527.42
1,318.55
4.50
12.00
6.00
6.00
36.00
6.00
6.00
6.00
6.00
6.00
12.00
15.00
10.00
10.00
10.00
10.00
3.00
40.00
12.00
12.00
2,074.47
0.00
CtlyStetel-C-/4..
2,074.47
APPROVED BYE," . # __ _% !.
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1102 1
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688 -0036 Fax: (509)688 -0037
REQUIRED SITE INFORMATION
STREET ADDRESS: \
ASSESSOR'S TAX PARCEL NUMBER(S): !it`H IOvc
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
BUILDING PERMIT
®RELOCATION
S tcC Q‘4c
EI CHANGE IN USE a GRADING
SIGN ® TENANT
® MANUFACTURED HOME
OTHER
OWNER / APPLICANT INFORMATION
® OWNER: MEQi OY( C , 1\r( ■A(\ ® APPLICANT:
PHONE 3D-32y -0(9`1 1 FAX: 3l17 -- Jea-).J- )°`--
PHONE:
FAX:
ADDRESS: ADDRESS:
CITY,STATE, ZIP CITY STATE ZIP
® CONTRACTOR:' C \ V' V \t
PHONE: ctf) FAX: (y
ADD S 3P1 � S • r\ thl \ J .
CITY, STATE; ZIP v
sid
WA ST CONTRACTOR LICENSE # 11 E `V � \� ,1� °cook..
ARCHITECT:
V 1 L-)1 \\
PHONE: 111L-1 —1Cr FAX:
ADDRESS: I , C ONE
CITY, ZIP
CONTACT:
PERMIT /BUILDING INFORMATION
i
COST OF PROJECT: *Is1c)0-0 30% SLOPES ON PROPERTY: Act—
BUILDING HEIGHT TO PEAK: 02.5O OCCUPANCY GROUP:
BUILDING DIMENSIONS:.3Qa 78" CONSTRUCTION TYPE: /(/c
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: /
NUMBER of BEDROOMS: 7
CRITICAL AREAS:
FLANKING SETBACK: CURRENT PROPERTY SIZE:
FRONT SETBACK: /2-0 CURRENT PROPERTY USE: /tile/
REAR SETBACK: O CURRENT SEPTIC USE:
i
LEFT SETBACK: CURRENT WELL USE: /LO.t
/
RIGHT SETBACK: 3 Z IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: /P2-0
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT: /NCO
GARAGE: S
COVERED DECK: /L.v.
DECK: /1 c;
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE /TIME:
WA STATE NON - RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING °CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME:
INSPECTOR(S):
PHONE: FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES, WHICH WATER DIST /IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO
IF YES: ® COUNTY ® CITY
PSSA: 0 YES 0 NO
DATE:
STAFF:
METHOD OF PAYMENT:
CASH CHECK
VISA
BANKCARD #; EXPIRES: VIN #
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD