2005, 08-08 Permit App: 05002982 Pole BldgOS-- 2 BUILDING PERMIT APPLICATION WORKSHEET
ane `` QJLy of Spokane Valley Community Development Department
%, )9a, 1 Building Division,
n 11707 E. Sprague Avenue, Suite 106
�� !l Spokane valley, WA 99206
_le 7: 11 i �.
dns: (509) 688 -0034, Fax: (509) 6 83-0087
Street Address:
%R ED T NFORMATION
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Assessor's Tax Parcel Number(s): cSC� - . Ub`J
Legal Description: 6tti-144
PERMIT DESC RIPTION: 7e Gj
� Building Permit ❑ Change in tis' ❑ Grading
1 1 Relocation ❑ Tenant Improvement ❑ Fire Safety
[1 Manufactured Home
n Other
OWNER/APPLICANT INFORMATION
❑ Owner. ;k1 n 7;14/0/
Phone: 410 -yld 8' F"ax:
Address: i7v21 6. &it:
S k�ii
State
City
❑ Applicant:
Phone: Fax:
{y /pt. Address:
Clog,
2p Code City State Zip Code
[1 Contractor: 1-6`) S 8115 Sly/ix
Phone: Fax:
Address:
city
) State
Zip Code
WA State Contractor License #:
Spokane Valley Bus. Liscense #:
❑ Architect:
Phone: Fax:
Address:
City
Contact:
Contact:
State Zip Code
PERMIT /BUILDING INFORMATION
HEIGHT TO PEAK: /0 j
DIMENSIONS:
# OF STORIES:
MAIN FLoopg. TO pa FTG: L
2 "u 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 OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR -SITE SEPTIC
SYSTEM? 5-11 C,
08/18/2005 09:32 5093241567
61iSe
Valley
Street Address: / 7
SRHD EHS PAGE 01/01
TO 3241567 P.01/02
— 41.1.0 a111•=, a ■1 N•••• II • • •r
City of Spokane Valley Community Development Depar nan,
Building D/vislor,
(t; ,�. ��� 11707E Sprague Avenue, Suite 106
Spokane Valley, WA 99206
mine: (509) 688 -0036; Fax: (609) 633 -0037
154-JItI;JiI'uz MATION
EI/
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: d�
Building Permit
Relocation
8 Change In ❑ Grading ❑ Manufactured Home
Tenant Improvement ❑ Flre Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑
.Owner:
Phone:
Adt Tess:
City
❑ Contractor.
Phone: Fax;
Address:
caty
State
WA State Contractor License #:
Spokane Valley Bus. Llscense #:
Zip Code
❑ Applicant:
Phone: Fax:
Address:
city
❑ Architect:
Phone:
Address:
State Z+p Code
Fax:
City
Contact
Contact:
State Zip Ccde
PERMIT/BUILDING INFORMATfON
•
ncwM I TO PEAK: /0
DIMENSIONS:
2 "FLOOR SQ. FTG:
# OF STORIES:
UNF1N BASEMENT SQ. F7G:
GARAGE SQ. FTG:
DECK/GOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
# OF BLSROOM3:
CONSTR CTION TYPE:
TOTAL HABITABLE SPACE:
COST Or -ROJECT: 30% SLOPES ON PROPERTY: SEWER OR -SITE SEPTIC
SYSTEM ?{�Tl (�
IMPERVIOUS SURFACE AREA:
AUG 18 2005 10:44
5093241567
PAGE.01
MANUFACTURED HOME
J /idth: Length: Year
Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
=ire Sprinkler. # of Heads: Fire Alarm: Paint Booth:
rent: Fireworks Display: Blasting: Date/Time:
Valuation: Above /Underground Storage Tank Size:
WASHINGTON STATE NON- RESIDENTIAL ENERGY CODE
Plans Examiner.
kddress:
Phone: Fax:
City State Zip
nspector. Phone: Fax:
kddress:
City
State Zip
SPECIAL INSPECTIONS
1 BOLTING I 1 CONCRETE ❑ REINFORCEMENT ❑ WELDING
=irm Name: Phone:
nspector(s):
Fax:
)ISCLA!MER
he permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
!welling, the dwelling is /will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
)roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this
ransaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
eferenced 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.
)wnership of resulting development rights granted by any issued permit in
Print Name 96/#41 b Signature
.10 the • •pe o •-
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Cash ❑ Check ❑ Mastercard 0 VISA ❑ Other
tankcard #:
authorized Signature:
Expires:
VIN #:
Project Number: 05002982 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 08/18/2005 Page 1 of 2
Project Information:
Permit Use: 24 X 24 DETACHED POLE BUILDING
Setbacks: Front 243 Left: 8 Right: 68 Rear: 143
Site Information:
Plat Key:
Name: RANGE
Contact: ZIEGLER LUMBER
Address: 620 E HOLLAND
C - S - Z: SPOKANE, WA 99218
Phone: (509) 467 -4958
Group Name:
Project Name:
District: East
Parcel Number: 55073.1803 Block: 1
SiteAddress: 17422 E BALDWIN AVE
Location:: CSV
Zoning: UR -3.5
Water District:
Area: 41,000 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Urban Residential 3.5
Review Information:
Lot: 3
Owner: Name: TAYLOR, S D & J I
Address: 17422 E BALDWINN AVE
SPOKANE VALLEY, WA 99016
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
Site Plan Review
Released By:
Plan Review
Originally Released: 08/17/2005 By: cjjanssen
Released By:
Sewer Review
Permits:
Originally Released: 08/17/2005 By: cjjanssen
Released By:
FAXED TO COUNTY HEALTH 8/17/05
OK PER LANCE AT COUNTY HEALTH
Originally Released: 08/18/2005 By: cjjanssen
laMagcgieffiM
Operator: CJJ Printed By: CJJ Print Date: 08/18/2005
Project Number: 05002982 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 08/18/2005 Page 2 of 2
Building Permit
Contractor: ZIEGLER LUMBER COMPANY Firm: ZIEGLER LUMBER COMPANY
Address: 4220 N MARKET ST Phone: (509) 489 -8760
SPOKANE, WA 99207
Building Characteristics
Total Area 576
Building Height 10
Stories 1
Dwelling Units 0
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
GARAGE U -I VB DETACHED 576 $10,944.00 576 $10,944.00
GARAGE
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
Notes:
Payment Summary:
Permit Type
Building Permit
itIMEMEINEI
Totals: 576 $10,944.00 576 $10,944.00
Units Unit Desc
1 SELECT
1 SELECT
Permit Total Fees:
Fee Amount
$195.25
$4.50
$199.75
Fee Amount Invoice Amount Amount Paid Amount Owing
$199.75 $199.75 $0.00 $199.75
$199.75 $199.75
$0.00 $199.75
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: 08/18/2005
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