2002, 07-17 Permit App: 02005997 Additioni,A
SpokANE Cowl{
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: %/ / 2. 13c. C..1-
Assessor's
.1
Assessor's Tax Parcel Number(s):
Legal Description:
1-/. q-,'D`rzq
Project Description: / 6, X A D���
if Building Permit
0 Change in Use
O Grading
0 Manufactured Home Permit
0 Relocation
0 Sign
0 Tenant (New/Change)
0 Other 41/A' l—c,
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Rear.
Right:
School District
Fire District:
Zoning
-:- titi .
OWNER/APPLICANT INFORMATION
4ule olio rbn ld Ge art/� [ed i o lydin0 <hi.( jnnje
El Owner
j-ci E .J c'%` ofea/,/C.: l (
Phone:
.6c: 71Z- G-33
ilP Applicant
$41,11e7
Phonc
I•as
Mailing Address-
Ai_ //Z (30-4X'vrv/{
,APP��>o
Dimcnstons
/
lc'xz�i
Mailing Address.
2"t{ floor sq. ft.
� /�
CM, State, Zip
sem,..w,s,, 4.,..A
Occupancy group
City, State, Zip
Garagc sq. ft.Deck
N
/
0 Contractor
PhoncPhone
has
0 Archttcct'P.ngincer
las
Mailing address
Mailing address
City, State Zip
Citt, State Zip
\\A State Contractor license #
Contact name.
MATION
Building Information
Building height to peak
i' t
# of stories
f
Main floor sc. ft.
3 F 7
Unfinished basement sci. ft.
/J(A-
,APP��>o
Dimcnstons
/
lc'xz�i
Total habitable space
�83g4/sq Fi
2"t{ floor sq. ft.
� /�
Finished basement sq. ft.
/(0-
Occupancy group
Constntctton tcpc
�aod z x• (e
Garagc sq. ft.Deck
N
se. ft.
ti/
Cost of project
1 leat source (electric, gas, ctc.)
Manufactured Home
Sign
Width:
Length:
What iF the square footage of Ole sign
lace?
flow high is the sign?
Year:
Make:
# of signs
Arca of casting signs
Fireworks display
Are critical or hazardous materials used or stored on site?
O Ycs p No
Address
Proposed use
Relocation
Fire Safety
Firm Name
What is the current use of this property?
g C-51ry
Previous address
\\'Ilhthe sI be serve by a sepEic systc ?"17 Y�c; No e�
/ � , i �--, `e- J �?ee1
Paint booth
Fire Sprinkler
Tent
Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
O Ycs p No
Address
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
g C-51ry
Phone
\\'Ilhthe sI be serve by a sepEic systc ?"17 Y�c; No e�
/ � , i �--, `e- J �?ee1
Plans Examiner
Phone
Inspectors
Is there evidence of 011 or excavation on the property?
O Ycs a No
\re there slopes greater than 30°/0 on the property? (30 ft rise in 100 ft)
( /o0 O Ycs IF No
Are critical or hazardous materials used or stored on site?
O Ycs p No
Address
Inspector
Phone
O Concrete
O Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATI
Are there structures on the property? ® Ycs O No
If yes, rdenti5i on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
]Eyes, identi_,6, on site plan O Ycs ® No
What is the current use of this property?
g C-51ry
Is your property in a designated wildlife habitat arca?
Don't know O Ycs ® No
\\'Ilhthe sI be serve by a sepEic systc ?"17 Y�c; No e�
/ � , i �--, `e- J �?ee1
Is any part of the property, within a 100 yr flood plain?
IEyes, ident� on site plan
l Mfavbc O Don't know 0 Ycs 111 No
Are or will tee c wells located on the property? �`
1 f per, identify on the site plan O Yes ® No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, ident f on site plan O Ycs ® No
Is there evidence of 011 or excavation on the property?
O Ycs a No
\re there slopes greater than 30°/0 on the property? (30 ft rise in 100 ft)
( /o0 O Ycs IF No
Are critical or hazardous materials used or stored on site?
O Ycs p No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
O Ycs O No
Is public sewer available to the site? O Yes O No
Is the property inside the ASA? 0 Yes O No
OYcs 0 N
Is public water available to the site? O Yes O No
Is the property inside the PSSA? O Yes O No
Is the property located within 1000 feet of a Natural Resource Area?
OYcs 0 N
Date Received-
Staff Representatn-e
METHOD OF PAYMENT
VISA
❑ C..\Sl1 ❑ c1IFCK ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
B;\NKC.\RD NUMI31?R:
EXPIRES:
\UTI 10121%,I?1) SIGN.\TUBI (:
SURTO 1 A1.
TOTAL FEE
MINIMUM PERMIT FEE IS SJ5.AOPI.EASE
MAKE CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER
Project Number: 02005997 Inv: I
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: RES ADD - BEDROOM & BATHROOM Contact: JEROMCHEK, JOE
Address: 112 N BOLIVAR RD
C - S - Z: SPOKANE, WA 99216
Setbacks: Front Left: Right: Rear: 25 Phone: (509) 892-6733
Group Name:
Site Information: Project Name:
Plat Key: 002970 Name: ZIEGLERS SUB
Parcel Number: 45143.2848 Block: Lot:
SiteAddress: 112 N BOLIVAR RD Owner: Name: JEROMCHEK, JOE
SPOKANE, WA 99216 Address: 112 N BOLIVAR RD
Location:: SPO SPOKANE, WA 99216
Zoning: UR 3.5
Water District:
Date: 7/17/02 Page 1 of 3
Hold: Lil
District:
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr ofBldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Plan Review
Permits:
Released By:
Originally Released: 7/17/02 By: jshatto
Released By:
Originally Released: 7/17/02 By: jshatto
Operator: JAS Printed By: JAS
Print Date: 7/ 1 710 2
Project Number: 02005997 Inv: 1
Application ,
Date: 7/17/02 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: OWNER Firm: OWNER
Phone:
Building Characteristics
Const Category: Addition Group: R-3 Type: VN
Nbr Of Dwellings: 1 Occupant Load: Building Height: 13 Stories: 1
Bldg W x D: 24 x 16 Building Sq Ft: 384 Sprinklers:
Req Parking: Handicap Parking: Critical Materials: E
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
RES ADD R-3 VN 384 $25,344.00 384 $25,344.00
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: OWNER
Ttem Description
DUCT SYSTEMS
VENTILATING FANS
MINIMUM FEE ADJUSTMENT
Contractor: OWNER
Item Description
TOILETS/BIDETS
SINKS
SHOWERS
MINIMUM FEE ADJUSTMENT
Totals: 384 $25,344.00 384 $25,344.00
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
Permit Total Fees:
Mechanical Permit
Firm: OWNER
Phone:
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
1 Select
Permit Total Fees:
Plumbing Permit
Firm: OWNER
Phone:
Units Unit Desc
1 NUMBER OF
2 NUMBER OF
1 NUMBER OF
1 Select
Operator: JAS Printed By: JAS
Permit Total Fees:
Fee Amount
$361.00
$4.50
$79.42
$444.92
Fee Amount
$10.00
$10.00
$15.00
$35.00
Fee Amount
$6.00
$12.00
$6.00
$11.00
$35.00
Print Date: 7/17/02
Project Number: 02005997
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/17/02
Notes:
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Fee Amount
$444.92
$35.00
$35.00
Invoice Amount
$444.92
$35.00
$35.00
$514.92 $514.92
Amount Paid
$0.00
$0.00
$0.00
$0.00
Amount Owing
$444.92
$35.00
$35.00
$514.92
Page 3 of 3
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 contrued to be a permit for, or an approval of, an Violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JAS
Printed By: JAS Print Date:
7/17/02
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re
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presertatiort
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