1996, 08-28 Permit App: 96007138 Convert to Adult Family HomePROJECT NUMBER= 96007138 APPLICATION..
DATE= 08/28/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT.A PERMIT
SITE STREET= 3511 N ELTON RD
ADDRESS= SPOKANE WA 99212
PARCEL#= 45063.3212
PERMIT USE= CONVERT DUPLEX TO RESIDENCE FOR ADULT FAMILY HOME
PLAT#= 001865 PLAT NAME= ORCHARD AVENUE ADD(TR.1-228)
BLOCK= LOT= ZONE= UR -3.5 DIST#= H
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W= 40
# OF BLDGS= # DWELLINGS= 1 WATER DIST = SPOKANE SUBURBAN
OWNER= ALLEN, RON J
STREET= 3511 N ELTON RD
ADDRESS= SPOKANE WA 99212
PHONE= 509 928 0454 '
CONTACT NAME= RON ALLEN PHONE NUMBER= 509 928 0454
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING PLAN REVIEW REQUIRED
APPROVAL: J SHATTO DATE: 08/28/96
*******************************'.BUILDING PERMIT *******************************
CONTRACTOR= OWNER. PHONE=
NEW= REMODEL= X ADDITION= CHANGE OF USE= X
DWELL UNITS= OCCUP. LD= BLDG HGT= STORIES=
BLDG W X D = X SQ FT= SPRINKLER= N
REQ PARKING= #HANDICAP= CRITICAL MAT= N
DESCRIPTION GROUP TYPE SQ FT VALUATION
ADULT CARE LC VN .00
REMODEL LC VN 220.00
ITEM DESCRIPTION
QUANTITY FEE AMOUNT
RESIDENTIAL VALUATION Y 35.00
STATE SURCHARGE Y 4.50
CHANGE OF USE/SAFETY INSP Y 50.00
RESIDENTIAL SURCHARGE Y 7.70
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 96007138
APPLICATION DATE= 08/28/96 PAGE= 02
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
BUILDING PERMIT 97.20 .00 97.20
97.20
.00 97.20
*******************************************************************************
* PROJECT NOTE: TOPIC = CONDITIONS DEPT = BUILDING *
*******************************************************************************
LICENSED FOR MAX 6 CLIENTS - LEVEL I, II, & III
SECOND COOKING FACILITIES MUST BE REMOVED PRIOR TO FINAL
_INSPECTION.
ADULT FAMILY HOME HAS EXISTED IN BUILDING SINCE 1989
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
******************************** THANK YOU ************************************
APPLICATION -INFORMATION
What is the a JOB SITE address?
ASSESSORS tax parcel number?
357) i x.1-00 ��k� L,)A 9?21L
Legal description as it appears on the property deed
OWNER or OCCUPANT
R0 . - A1(erJ
Mailing address
City, state
Phone
2.2-eLI %
Zip
Who should we contact regarding this project?.
Phone
What work is being done under this permit?
y
Waterdistrict
.......................
......................
......................
......................
......................
Building height
# of stories
Contractor
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Unfinished basement area
Mailing address
2nd floor area
Finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Manufactured Hom€
Sign
Width:
Length:
What is the square footage of
the sign face?
How high is the sign?
Year:
Make:
Installer
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address
Mailing address
Relocation
Fire,Safefy
.:.:..::.::.........::::.:.:...
Previous address
Fire Sprinkler
Tent
Paint booth _ Fire Alarm _ Fireworks display _
VALUE
Contractor
Contractor
WA State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
Fuel Storage Tank
Swimming Pool
(Circle one) Above -ground Underground
Contents of tank(s)
Size / gallons
Size / gallons
Private
Public/semi-private
Contractor
Wa State Contractor license #
Contractor
WA State Contractor license #
Mailing address
Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
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Requirements:
#2. We are licensed for 6 clients.
#3. We care for 2 Level 1's and 3 Level II.