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2001, 12-03 Permit App: 01010595 Plumbing FixturesI�I HUE Sow CAUI\iv PROJECT .A.r PLICATION WORK SHEET SPOKANE COUNT]' DIVISION OF BUILDING & CODE ENFORCEMENT 1026 \VEST BROADWAY AVENUE SPOKANE, \VA 99260 509-477-3675 SPECIFIC SITE INFORMATION Street Address: 20/-7 N 0•65-5/E I/<J Assessor's Tax Parcel Number(s): Legal Description: Project Description: q-tQWIP A 2/10 n41 -C14" gi Building Permit ❑ Change m Use ❑ Grading ❑ Manufactured 1-lome Permit ❑ Relocation 0 Sign O Tenant (Neu'/Change) O Other Department ;Use Only'; ;:._,-. _ L. 0 Applicant R'vcr D,..Inn/PunElor.:^ - • Setter Disrnct/Puretir:, + /° 'Fire .Itoad width; 1 ft I7--- :_Setbacks Front'. Left'l- - Rear. Right- Schaal Dance -, - ' District:: Zoning- r - OWNER/APPLICANT INFORMATION IEI Indnv e who ihould Ge mn/,+,lerl rc:,tmtrn(! lhi• PmleJ go„,,, 4-v, Y L✓ ID 21 U Phone SO4 4 Z7 —4S14 0 Applicant Phone. Niting,ddresc Sp e , -&+ 1 ft I7--- Mailing Address I' hid basement sg fl. ( Slate, Lip L.nn>Imctlnn It pe (i:Ir.IGc SLI fl faro, Stale, /art Oro or prulecl ❑ Cu or Phone 1'a' ❑ Archnt ct/I nynetr Phone I'as hbdmg Nicht, Mailing "dun, Cu) state %,p (:0 State Zip \\:\ Gave Guilt hcen.e s Contact name: PRO IECT INFORMATION Building Information" Budding ht'I'Ill 1 E 1 peak # of stones \Imn non ey ft Unfinished basun(' ni St1 it I)vnuninne Total habitable apace 2ntl Ilio) >q G. I' hid basement sg fl. Occupancy gn Ip L.nn>Imctlnn It pe (i:Ir.IGc SLI fl 1 )cc k <ti. fl. Oro or prulecl 110.115 ntcc (elcCl nC, ga etc) itilaniifacturedI-Iorrie; :< i` Sign width- Length " , What is the square Gn,tage of the sign face? 11ow high is the sign? Year \lake. # of signs Area of esntahg sign Plan. I-ammer Proposed use Value 0 . No - Relocation.' - • Fire Safety.' Required? Previous address NonTResidential-Energy Code Compliance? fire Sprinkler 'fent Paint booth Fire Alarm Fireworks display _ Plan. I-ammer Proposed use Value 0 . No - Is the property located within 1000 feet of a Natural Resource Area? 'O Yes o No -Spe•cial What is the current property sire? (square feet or acres) Required? . NonTResidential-Energy Code Compliance? Firm Name Is any part of the properry within a 100 yr flood plain? "firs. ldentib 0// site plan 0 Maybe 0 Don't know 0 Yes 0 No Phone Are there any wetlands, streams or ponds within 200 feet of the property? If yes. identft on site plan o Yes o No Is there evidence of fill or excavation on the property? 0 Yes 0 No Plan. I-ammer Phone Inspector. 0 . No - Is the property located within 1000 feet of a Natural Resource Area? 'O Yes o No Address Inspector Phone O Concrete 0 Welding 0 Bolting 0 Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? 0 Yes 0 No I f )'era /dent' on me plan/ What is the current property sire? (square feet or acres) Is any part of the property within 250 feet of a shoreline? If yes. identify on site plan 0 Yes 0 No What is the current use of this property? Is your property m a designated wildlife habitat area? 0 Dont know 0 yes o No Will the site be sewed by a septic system? 0 Yes 0 No Is any part of the properry within a 100 yr flood plain? "firs. ldentib 0// site plan 0 Maybe 0 Don't know 0 Yes 0 No Are or will there he wells located nn the property? I fp's, dent j• on the site plan 0 Yes 0 No Are there any wetlands, streams or ponds within 200 feet of the property? If yes. identft on site plan o Yes o No Is there evidence of fill or excavation on the property? 0 Yes 0 No Are there slopes greater than 3090 on the property? (30 ft rise in 100 ft) ( /°o) 0 Yes 0 No Are critical or haiardous materials used or stored on site? 0 Yes 0 No DEPARTMENT USE ONLY Is the property in a designated Storinwater Control Area? o Yes o No' Is public sewer available to rhe site? 0 Yes 0 No Is the property inside the ASA? - 0 Yes O Yes 0 No O No Is pubhc water available to the site? - 0 Yes 0 No Is the property inside the PSSA> ' 0 Yes 0 . No - Is the property located within 1000 feet of a Natural Resource Area? 'O Yes o No Date Reamed Stan Rtpi-osmium e METHOD OF PAYMENT VISA eir ❑ c\sii ❑ I:I II LK ❑Ett=9❑ ❑ DIICOVER FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD D.VI F I;SPIRTS RANKCARD NUAIItIR ALM IORI/ItI) NI( i \ I URI NUB I O'I'AI TOTAL FEE ,11LVL11U%e PERMIT FEE 15 SJSCtl PI.11ASE 11 UCI:CI HICKS 1'' 1n1.1! 10 SPOKANE IPCN INPERMII CcNitm , Project Number: 01010595 Inv: 1 Application THIS IS NOT X PERMIT Penalties will be assessed for commencing work without a permit Date: 12/3/01 Page 1 of 3 Project Information: Permit Use- BASEMENT BATHROOM (TOILET, SHOWER, Contact: WIDRIG, ANDY SINK) Address: 2017 N BESSIE RD C - S - Z: SPOKANE, WA 99212-2421 Setbacks: Front Left: Right: Rear: Phone: (509) 927-4590 Group Name: Site Information: Project Name: Plat Key: 002874 Name: WEST VALLEY ADD NO.2 District: H Parcel Number: 45074.0330 Block: 3 SiteAddress: 2017 N BESSIE RD Spokane, WA USA 99212 Location.: SPO Zoning: UR -3.5 Water District- Area: istrict Area: 10,500 Sq Ft Nbr of Bldgs: 0 Urban Residential 3.5 Width: 0 Nbr of Dwellings: 0 Lot: 4 Owner: Name: WIDRIG, ANDY Address: 2017 N BESSIE RD SPOKANE, WA 99212-2421 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Information Review Plan Review Released By: C -r 7'r-tT- -Q-6 -3 '4a't Permits: Operator: CKF Printed By: Print Dale: Project Number: 01010595 Inv: 1 Application THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Date: 12/3/01 Page 2 of 3 Building Permit Contractor: OWNER Firm: OWNER Address: 0 Phone: (000) 000-0000 000000, 00 000000 Building Characteristics Const Category: Remodel Group: R-3 Type: VN Nbr Of Dwellings: Occupant Load: Building Height: Bldg W x D: x Building Sq Ft: Sprinklers: ❑ Req Parking: Handicap Parking: Critical Materials: ❑ This Application: Stories: Total Project: Description Grp Type Notes Su Ft Valuation Se Ft Valuation RESIDENCE R-3 VN BATHROO 0 $1,000.00 0 $1,000.00 M REMODEL Item Description RESIDENTIAL VALUATION STATE SURCHARGE RESIDENTIAL SURCHARGE Contractor: OWNER Address: 0 000000, 00 000000 Item Description VENTILATING FANS MINIMUM FEE ADJUSTMENT Contractor: OWNER Address: 0 000000,00 000000 Totals: 0 $1,000.00 0 $1,000.00 Units Unit Desc 1 Y OR BLANK 1 Y OR BLANK 1 Y OR BLANK Fee Amount $35.75 $4.50 $7.87 Permit Total Fees: $48.12 Mechanical Permit Firm: OWNER Phone: (000) 000-0000 Units Unit Desc 1 NUMBER OF 1 Select Fee Amount $10.00 $25.00 Permit Total Fees: $35.00 Plumbing Permit Firm: OWNER Phone: (000) 000-0000 Item Description Units Unit Desc Fee Amount TOILETS/BIDETS 1 NUMBER OF $6.00 SINKS 1 NUMBER OF $6.00 SHOWERS 1 NUMBER OF $6.00 WATER PIPING - DWV I NUMBER OF $6.00 MINIMUM FEE ADJUSTMENT 1 Select $11.00 Operator: CKF Permit Total Fees: $35.00 Printed By: Print Date: Project Number: 01010595 Notes• Inv: 1 Application THIS IS NOTA PERMIT Penalties will be assessed for commencing work without a permit Date: 12/3/01 Page 3 of 3 Payment Summary: Permit Type Fee Amount Building Permit $48 12 Mechanical Permit $35.00 Plumbing Permit $35 00 Invoice Amount $48.12 $35.00 $35.00 Amount Paid $0.00 $0.00 $0.00 Amount Owine $48.12 $35.00 $35.00 $118.12 $118.12 $0.00 $118.12 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 is piof a permit shall not be contrued to be a permit for, or an approval of, any violation of any of the provisions of the epde or o% arh., other state or local laws or ordinances. Signature: Operator: CKF Printed By: Print Date: