2011, 05-13 Permit App: 11001307 RemodelPrdject Number: 11001307 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Date: 5/13/2011 Page 1 of 2
Permit Use: NEW WALL TO CREATE 3RD BEDROOM
Setbacks: Front
Site Information:
Plat Key: 001641 Name: MIRABEAU RANCH ADD District: Nort
Contact: ENDICOTT, LEE A
Address: 12021 E 34TH AVE
C - S - Z: SPOKANE, WA 99206-5967
Left: Right: Rear: Phone: (509) 928-0883
Group Name:
Project Name:
Parcel Number: 45091.1110 Block: Lot:
SiteAddress: 11721 E BUCKEYE AVE
Location:: CSV
Zoning: R-3 SF Res District
Water District: 026 IRVIN
Area: 12,600 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Review
Building Plan Review
Permits:
Contractor: OWNER
Owner: Name: ENDICOTT, LEE A
Address: 12021 E 34TH AVE
SPOKANE, WA 99206-5967
Hold:
Depth: 0 Right Of Way (ft): 0
[Released By:
Originally Released: 5/13/2011 By: tmelbourn
Building Permit
Firm: OWNER
Phone: (000) 000-0000
This Application: Total Project:
Description Grp Type Notes Su Ft Valuation Sul Ft Valuation
1&2 FAMILY R-3 VB NEW WALL 0 $600.00 0 $600.00
Item Description
RESIDENTIAL PERMIT FEE
WSBCC SURCHARGE
SF PLNS RVW < 7999 SQ FT
Totals: 0 $600.00 0 $600.00
Units Unit Desc
1 SELECT
1 SELECT
1 SELECT
Operator: JD Printed By: jmm
Fee Amount
$69.25
$4.50
$27.70
Permit Total Fees: $101.45
Print Date: 5/13/2011
Project Number: 11001307 Inv: 1
Notes:
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/13/2011 Page 2 of 2
Payment Summary:
Permit Type
Building Permit
Fee Amount Invoice Amount
$101.45 $101.45
$101.45
Amount Paid
$27.70
$101.45 $27.70
Amount Owing
$73.75
$73.75
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: JD Printed By: jmm Print Date: 5/13/2011
' CITY OF
pokne
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenteq@sookanevalley.oro
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
NEW CONSTRUCTION
0 DECK
RADDITION/REMODEL El ACCESSORY BUILDING
OTHER
SITE ADDRESS: 117a1 F. 3
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Kcd-kielo Erc;tI
NAME:kCjittg &djC_Ade
ADDRESS: 1 a0 e.
Cx-ry: 0 KOJAR, IltiLaeJo
PHONE: aS--10.5r(13
CONTACT NAME:
STATE:
FAX:
LO A -
CELL:
ZIP: qqdry,
509,994-1/s34,
PHONE: FAX:
RECEIVED
CELL:
CONTRACTOR NAME:
CSV PEHMI 1 ULN EFi
MAILING ADDRESS:
Cx-ry:
STATE:
'47/Art.7
Project #
Name ZIP:
PHONE:
FAX:
Submittal #
cetu,
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE & PROPOSED USE:
i'LL+ Lup 8 lwrjrcayq ()Jail +klta5a-Tnecyta, a.4 tewtooe d . old kock
\.3 eflcAei-5 wail_ (Atka+ Lo ft -et);
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICAB
E
Heigh to PTX:
Dimensions:
n A
No. of Stories:
Total Hablable
Space: 0
•Pi•
Main FlosoitISQ ET:
Y1
Upper Floor FT:
n
Unfinished Basement SQ
FT: 11 A
Finished B emen
FT: 11 A
Q
Garage F :
n/pc
Deck/Covetg d Patio SQ
FT: 11/ lCk.
Impervious urface
Area:
30% SIops on
Property: A/A
No. of Bedrooms:
Construction Type:
I/
Heat Source: (rg=epo•
r Septic:
DO o
TOTAL COST OF PROJECT: $ (oc) aprox •
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitted and subsequently approved before this application can be processed.
Signature
kcceku gikALf
Date: ,51/
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.orgifilestorage/124/938/210/948/1496/Building_Permit_-_Residential_11-11-11.doc