2005, 01-28 Permit App: 05000267 AdditiontIII04 G
Spokane
40##Va1 Iey
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707E Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: a 011 U - e Ss No—
Assessor's Tax Parcel Number(s)
Spoka? L iCLU e u� �� a-a'v
Legal Description: e'
PERMIT DESCRIPTION: `iI atkek X a4 (d,t42,;
Building Permit
Relocation
Change in Use ( I Grading
Tenant Improvement n Fire Safety
Manufactured Home
Other
OWNER/APPLICANT INFORMATION
Owner: lOac,q
Phone: J Fax
Address: 0o11 f'- 6ess-e--
5d(cre 110UeBacke
Qt
State Zip Code
Contractor: ac\ti.k.\--Os'1 Cpn4
�
oY&&Li Phone Ic%-ot30 Fax: 27-N(o(r
0- Address '?,t) aux /r7V
rt'lnra w n- g,49-/
State Zip Code
city
WA State Contractor License #./1/Q,el(.Cq(e3k�
Applicant:
Phone
Address.
Fax:
City
Architect.
Phone.
Address.
State Zip Code
Fax
City
Contact.
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS: # OF STORIES
I
MAIN FLOOR TO SQ FTG
2 °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' m�w
�()(J
30% SLOPES ON PROPERTY'
SEWER OR ON-SITE SEPTIC
SYSTEM?
Project Number: 05000267 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 01/28/2005 Page 1 of 2
Project Information:
Pcnnit Use: ADD 28 SQ FT DINING ROOM BUMP -OUT
Setbacks: Front N/A Left: EX Right: EX Rear: 12+
Site Information:
Plat Key: 002874 Name: WEST VALLEY ADD NO 2 District: 1-1
Contact: SMART CONCEPTS INC
Address: PO BOX 1178
C - S - Z: MEAD, WA 99021
Phone: (509) 927-0130
Group Name:
Project Name:
Parcel Number: 45074.0330
SiteAddress: 2017 N BESSIE RD
Location:: CSV
Zoning: UR -3.5
Water District.
Block: 3 Lot: 4
Urban Residential 3.5
Area: 1,500.00 Acres Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information: --------------------------
Owner: Name: WIDRIG, ANDY
Address. 2017 N BESSIE RD
SPOKANE VALLEY, WA 99212-24
Hold: D
Depth: 0 Right Of Way (ft): 0
Review
Plan Review
Permits:
ReleaSeci
Operator: K_C Printed By: K_C Print Date: 01/28/2005
Project Number: 05000267 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 01/28/2005 Page 2 of 2
Building Permit
Contractor: SMART CONCEPTS CONST LLC Finn: SMART CONCEPTS CONST LLC
Address: PO BOX 1178
MEAD, WA 99021
Phone: (509) 927-0130
Building Characteristics
Group: R-3 Type: VB
Total Arra 28
This Application: Total Project:
DescriptionGrp Type Notes Sq Ft Valuation Sq Ft Valuation
RES ADD R-3 VB BUMP -OUT 0 $4.000.00 0 $4,000.00
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
Notes:
Payment Summary_:
Permit Type •
Building Permit
Totals: 0 $4.000.00 0 $4,000.00
Units Unit Desc Fee Amount
1 SELECT $97.25
1 SELECT $4.50
I SELECT $38.90
Permit Total Fees: $140.65
Fee Amount Invoice Amount Amount Paid Amount Owing
$140.65 $140.65
$140.65 $140.65
$0.00 $140.65
$0.00 $140.65
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 he 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: K_C Printed By: K_C
Print Date: 01/28/2005
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