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2002, 06-18 Permit App: 02004929 AdditionProject Number: 0200-1929 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 6/18/2002 Page 1 of 2 Project Information: Permit Use: 270 SQ FT MASTER BEDROOM ADDITION Setbacks: Front NA Left: 11 Right: NA Rear: 32 Site Information: Plat Key: 005710 Name: CHINOOK NO. 4 (CHINOOK ESTATES) District: H Contact: WAREHAM, JEFFERY & STACEY Address: 4916 N BOULDER RD C - S - Z: SPOKANE, WA 99216 Phone: (509) 922-2687 Group Name: Project Name: Parcel Number: 46364.1114 Block: Lot: SiteAddress: 4916 N BOULDER RD Owner: Name: WAREHAM, JEFFERY & STACEY SPOKANE, WA 99216 Address: 4916 N BOULDER RD Location:: SPO SPOKANE, WA 99216 Zoning: UR -3.5 Urban Residential 3.5 Water District: 999 UNKNOWN Hold: ❑ Area: 12,455 Sq Ft Width: 85 Depth: 125 Right Of Way (ft): 50 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Site Plan Review Plan Review Permits: Operator: DMD Printed By: DMD Print Date: 6/18/2002 Project Number: 02004929 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 6/18/2002 Contractor: OWNER Const Category: Add Nbr Of Dwellings: Bldg W a D: 20 x Req Parking: Description RES ADD Building Permit Page 2 of 2 Firm: OWNER Phone: Building Characteristics ition Group: R-3 Type: VN Occupant Load: 14 Building Sq Ft: Handicap Parking: Grp Type Notes R-3 VN Item Description RESIDENTIAL VALUATION STATE SURCHARGE RESIDENTIAL SURCHARGE Notes: .: Payment Summary: Permit Type Building Permit Building Height: 16 270 Sprinklers: ❑ Critical Materials: ❑ This Application: Sq Ft Valuation 270 $17,820.00 Totals: 270 $17,820.00 Units Unit Desc 1 Y OR BLANK 1 Y OR BLANK 1 Y OR BLANK Permit Total Fees: Fee Amount Invoice Amount $325.36 $325.36 $325.36 Stories: 1 Total Project: Si Ft Valuation 270 $17,820.00 270 $17.820.00 Fee Amount $263.00 $4.50 $57.86 Amount Paid $0.00 $325.36 $0.00 $325.36 Amount Owing $325.36 $325.36 Disclaimer: Submittal of this application certifies the ow ner (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, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: DMD Printed By: DMD Print Date: 6/18/2002 SPoIK Com • PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 SPECIFIC SITE INFORMATION oa- cf92j Street Address: L" [ l / i� U 6,7C Assessor's Tax Parcel Number(s): 1-1 3 (4 Legal Description: Project Description: JPO QA) `77, 4 k'f 577/1* $, Building Permit 0 Change in Use 0 Grading 0 Manufactured Home Permit 0 Relocation 0 Sign 0 Tenant (New/Change) 0 Other Department Use Only Water District/Purveyor. Sewer District/Purveyor Road width Setbacks Front Rear. Left: Right: School District Fire District: Zoning OWNER/APPLICANT INFORMATION u[e u -ho - Yed trpurdi,o thistrojerl vi Owner` .4 -, eirCW/i4LC�f�/-7F AInc 922-,,7 ?r- 2 I EA„ A , 9, /,ipl Fax: �%�f t'C� ❑ Applicant ('hone Fax: Mailing Address: L 9 /6.x You&PL Rte # of stories Mailing Address' Unfinished basement sq. ft. Ctn', State, Zip w/4) 3/6 �jjN6 9 9 (/ C city, State, Zip �„a floor sq. ft 0 Contractor Phone Fax Occupancy roup ❑ Archucct;'I:n nnccr g Phone Fax Mailing address Deck ,y. ft. Mailing address Cin', State Zip City, State Zip \\'A State Contractor license # Contact name. FORMATION Building Information Building height to peak # of stories Main floor sq. ft. Unfinished basement sq. ft. llimer�sion� 1 l t r / ,�( I Total habitable space �„a floor sq. ft I unshed basement sy. t. Occupancy roup Construction type Garage sq. ft. Deck ,y. ft. Cost of project I !cat source (electric, gas, ctc.) Manufactured 1 -come gn What is the square footage of the sin face? f low high is the sign? Width: Length: Year: l\ lake: # of signs Area of existing signs Fireworks display _ Proposed use Value Address Relocation Fire Safety Pine Name Is anv part of the property within 250 feet of a shoreline? If yes. ufentifj• on site plan D Yes 54, No Previous address Is the property located within 1000 feet of a Natural Resource Area? D Yes DNo Paint booth Fire Sprinkler _"_ Fire :\larm __ Tent Fireworks display _ Proposed use Value Address Is there evidence of fill or excavation on the property? D Yes No Special Inspections Required? Non -Residential Energy Code Compliance? Pine Name Is anv part of the property within 250 feet of a shoreline? If yes. ufentifj• on site plan D Yes 54, No Phone Is the property located within 1000 feet of a Natural Resource Area? D Yes DNo Plans Examiner Phone Inspectors: Is any part of the property within a 100 yr flood plain? If yes, ident' on site plan D I\laybe D Don't know D Yes -No Are or will there he wells located on the property? 1f yes, identify on the site plan D Yes No Address Is there evidence of fill or excavation on the property? D Yes No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( °:°) D Yes No Are critical or hazardous materials used or stored on site? D Yes No Impectur Phone D Concrete D Welding D Bolting D Reinforcement AdJres> TION \re there structures on the property. 0 N If yes, ident ' on site plan What is the current property s ` e7 /. f/ (square feet or acres) 51 1 i c-/ e Is the property inside the ASA? D Yes D No DYes 0 N Is anv part of the property within 250 feet of a shoreline? If yes. ufentifj• on site plan D Yes 54, No \\'hat is the c,i rrent use of this property? Q 1 C6 / Pell' Is the property located within 1000 feet of a Natural Resource Area? D Yes DNo Is your property in a designated wildlife habitat area? D Don't know D Yes fa. No Will the site be served by a septic system?17 Yes ptsNo Is any part of the property within a 100 yr flood plain? If yes, ident' on site plan D I\laybe D Don't know D Yes -No Are or will there he wells located on the property? 1f yes, identify on the site plan D Yes No Are there any yvetlands, streams or ponds v thin 200 feet of the property? I/ yes, identify on site plain D Yes O No Is there evidence of fill or excavation on the property? D Yes No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( °:°) D Yes No Are critical or hazardous materials used or stored on site? D Yes No EPARTMENT USE ONLY Is the property in a designated Stom)water Control Area? Cl Yes DNo Is public sewer available to the site? D Yes Cl No Is the property inside the ASA? D Yes D No DYes 0 N Is public water available to the site? D Yes D No Is the property inside the PSSA? D Yes D No Is the property located within 1000 feet of a Natural Resource Area? D Yes DNo Date Received: Staff Repre,em aticr. METHOD OF PAYMENT ❑ (..1SII 0 CIII?CK ❑ ❑ W 0 FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD B.\N KC.\RI) Nl'N1BI R: IORI'/Nl) SIGN.\'PURI .: 1APIRI S: SUBTOTAL TOTAL FEE MINIMUM PERMIT FEE IS 135"00 PLEASE MAINE. CA IECI:s PAYABLE TO SPOKANE COUN`IT PERMIT CENTER 1 f) • 7.1 H ApoRes, ZONE fp-- ROAD WIDTH SZ.) FRONT COMMENTS 72r, REVIEWED EInc_k_ PL -o -r PLAN 6, 442 5CAL —1'401-0" 0