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2002, 05-20 Permit App: 02003889 Change of UseProject Number: 02003889 Inv: 1 . Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/20/02 Page 1 of 2 Project Information: Permit Use: CHANGE OF USE TO STAFFED RESIDENTIAL Contact: PETERSON, MERRILL HOME FOR 6 CHILDREN Address: 14523 E 6TH C - S - Z: SPOKANE WA 99217 Setbacks: Front Left: Right: Rear: Phone: (509) 928-7681 Group Name: Site Information: Project Name: Plat Key: 002220 Name: RIDGEMONT ESTATES NO. 2 District: F Parcel Number: 45251.0208 Block: SiteAddress: 1918 S CONKLIN RD VERADALE, WA 99037 Location:: VER Zoning: UR -3.5 Water District: Urban Residential 3.5 Lot: Owner: Name: PETERSON, MERRILL Address: 14523 E 6TH SPOKANE WA 99217 Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Permits: Building Permit Contractor: OWNER Firm: OWNER Phone: Building Characteristics Const Category: Change Of Use Group: LC -1 Type: VN Nbr Of Dwellings: 1 Occupant Load: 6 Building Height: Stories: Bldg W x D: x Building Sq Ft: Sprinklers: Li Req Parking: Handicap Parking: Critical Materials: ❑ Item Description CHANGE OF USE/SAFETY INSP STATE SURCHARGE Units Unit Desc 1 Y OR BLANK 1 Y OR BLANK Operator: JAS Printed By: JAS Permit Total Fees: Fee Amount $50.00 $4.50 $54.50 Print Date: 5/20/02 Project Number: 02003889 Inv: 1 Application THIS IS NOT A PERMIT Date: 5/20/02 Page 2 of 2 Penalties will be assessed for commencing work without a permit Notes: APPROVED AS CATEGORY 8 GROUP CARE FACILITY UNDER LC OCCUPANCY. CLIENTS ARE LIMITED TO LEVEL I EVACUATION CAPABILITY. LICENSEE TO NOTIFY LOCAL FIRE DEPARTMENT FOR FIRE SAFETY VISIT PRIOR TO STARTING OPERATIONS (WAC 388-73-387) ADDITIONAL COOKING FACILITIES LIMITED TO USE BY OCCUPANTS OF HOME. THE HOME CANNOT BE USED OR APPROVED AS A DUPLEX Payment Summary: Peinut Type Fee Amount Invoice Amount Building Permit $54.50 $54.50 $54.50 $54.50 Amount Paid $0.00 $0.00 Amount Owing $54.50 $54.50 1 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, any 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: 5/20/02 SpoKANECOUNUY PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING Sc CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 SPECIFIC SITE INFORMATION Street Address: jet/ii 5 (a, /4 Assessors Tax Tax Parcel Number(s): - 0 z 0 Legal Description: Project Description: Cer )1' -(1.c g4 t_ ( y O Building Permit O Change in Use O Grading 0 Manufactured Home Permit O Relocation O Sign O Tenant (New/Change) Ca-' Other Depai Tient Use Only . Water District/Purveyot Sewer District/Purveyor Phone: ra.: Front Rear teft Right School District Fire District: Zoning OWNER/APPLICANT INFORMATION •a,, a 0 Owner: /1/1`t i.c/t /1 Phone: ). li. 76q,/ 19-6 / t KS o,-1 Fax i 2 1 - /3 C., 3 0 Applicant: Phone: ra.: # i if SP frit Main floor sq. It. Mailing Adj„..„: er /II Mailing Address: 2.A floor sq. ft. Csv,... ( City, State, Zip Garage sq. ft. Deck sq. ft. City, State, Zip I leat source (electric. gas, ctc.) 0 Contractor Phone Fax 0 AcchitectiEngincer Phone Fax Mailing address Mailing address Cny, State Zip 11\ City, State Zip WA Si tC,C011irrIC itlf KeTISC a . ' Contact name: M TION 7../.. Building Information Building height to peak # i if SP frit Main floor sq. It. Unfinished basement sq. ft. Dimensions , l'inal habitable space 2.A floor sq. ft. Finished basement sq. ft. ( kcupancy group Construction type C51 Garage sq. ft. Deck sq. ft. Cost tit- psi -lea I leat source (electric. gas, ctc.) Manufactured Home Length: 'Sign What is the square footage of the sign face? r flow high is the sign? Width: Year Make: # of signs Area of esisting signs Fireworks display _ Are critical or hazardous materials used or stored on site? „, O Yes Ld No Proposed use Relocation Fire Safety Finn Name What is the current use of this property? r Previous address Will the site be served by a septic system? 0 Ycs Li No Paint booth Fire Spnnkler Fire Alami Tent Fireworks display _ Are critical or hazardous materials used or stored on site? „, O Yes Ld No Proposed use Value Special Inspections Required? Non -Residential Energy Code Compliance? Finn Name What is the current use of this property? r Phone Will the site be served by a septic system? 0 Ycs Li No Plans Examiner Phone Inspeciots: Is there evidence of fill or excavation on the property? 0 Ycs 171( No Arc there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( --------%) ❑ Ycs IZl No Are critical or hazardous materials used or stored on site? „, O Yes Ld No Address Inspector Phone O Concrete O N. folding O Bolting O Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? ID Ycs 0 No Ifyer, ideal on rile plan What is the current property sire? (square feet or acres) Is any part of the property within 250 feet of a shoreline? Dyes, ideal on site plan 0 Yes 0 No What is the current use of this property? r is your property in a designated wildlife habitat arca? O Don't know O Ycs © No Will the site be served by a septic system? 0 Ycs Li No Is any part of the property within a 100 yr flood plain? Ifyer, ideedi_fr on site plan 0 Maybe 0 Don't know O Ycs 0' No Are or will there be wells located on the property? If yet. den lify on the site plan 0 Ycs d No Are there any wetlands, streams or ponds within 200 feet of the property? If yes, idenlh on the plan 0 Yes CtI No Is there evidence of fill or excavation on the property? 0 Ycs 171( No Arc there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( --------%) ❑ Ycs IZl No Are critical or hazardous materials used or stored on site? „, O Yes Ld No DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? O Yes O No Is public sewer available to the site? O Yes 0 No Is the property inside the ASA? 0 Yes O No OYcs ONo Is public water available to the site? O Yes 0 No Is the property inside the PSSA? O ,Yes 0 No Is the property located within 1000 feet of a Natural Resource Arca? OYcs ONo Date Reece cd: Staff Itcpn>entan.c: METHOD OF PAYMENT MEM VISA 0 CASI I ❑Citi CK ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARL) 1).\'1•t•:: B.\NK(:.\RD NUMBER: \U'l 10R1 ZED SIGN.V 1'111U s1IBI•(Y1".\L TOTAL FEE MINI MUAI PERAUT FEE IS S3SA7PLEASE 'I\KP. 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