2002, 07-22 Permit App: 02006154 AdditionProject Number: 02006154 Inv: 1
a
Application
THIS IS NOTA PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/22/02 Page 1 of 3
Project Information:
Permit Use: FAMILY ROOM ADDITION W/BATHROOM
Setbacks: Front NA Left: 30+ Right: 10 Rear: 30+
Site Information:
Plat Key: 000000 Name: UNKNOWN
Parcel Number: 45092.0722 Block:
Contact: KEVIN SMITH INC
Address: 1307 E BLACKWOOD LN
C - S - Z: SPOKANE WA 99223
Phone: (509) 448-6043
Group Name:
Project Name:
Lot:
District: H
SiteAddress: 10808 E FAIRVIEW AVE Owner: Name: SKILLINGSTAD, DONALD & BET
Spokane, WA USA 99206 Address: 10804 E FAIRVIEW AVE
Location:: SPO SPOKANE, WA 99206-2601
Zoning: UR 3.5
Water District: Hold: ❑
Area: 20,568 Sq Ft Width: 137 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 2 Nbr of Dwellings: 0
Review Information:
Review
Site Plan Review
Plan Review
Septic System Review
Permits:
Released By:
4 Released By:
Released By: / "J
Operator: CKF Printed By: CKF
Print Date: 7/22/02
Project Number: 02006154 Inv: 1
Application
THIS I$ NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/22/02 Page 2 of 3
Building Permit
Contractor: KEVIN SMITH INC Firm: KEVIN SMITH INC
Address: 1307 E BLACKWOOD LN Phone: (509) 448-6043
SPOKANE, WA 99223
Building Characteristics
Const Category: Addition Group: R-3 Type: VN
Nbr Of Dwellings: Occupant Load: Building Height: 20 Stories: 1
Bldg W x D: 22 x 34 Building Sq Ft: 748 Sprinklers: ❑
Req Parking: Handicap Parking: Critical Materials: ❑
This Application: Total Project:
Description Grp Type Notes Su Ft Valuation Su Ft Valuation
RES ADD R-3 VN 748 $49,368.00 748 $49,368.00
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Totals: 748 $49,368.00 748 $49,368.00
Units Unit Desc Fee Amount
1 Y OR BLANK $577.00
1 Y OR BLANK $4.50
1 Y OR BLANK $126.94
Permit Total Fees: $708.44
Mechanical Permit
Contractor: KEVIN SMITH INC Firm: KEVIN SMITH INC
Address: 1307 E BLACKWOOD LN Phone: (509) 448-6043
SPOKANE, WA 99223
Item Description
VENTILATING FANS
MINIMUM FEE ADJUSTMENT
Units Unit Desc
1 NUMBER OF
1 Select
Fee Amount
$10.00
525.00
Permit Total Fees: $35.00
Plumbing Permit
Contractor: J & J PLUMBING & HEATING Firm: J & J PLUMBING & HEATING
Address: 3515 N BEIGE Phone: (509) 000-0000
SPOKANE WA 99000
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 1 NUMBER OF $6.00
SINKS 2 NUMBER OF $12.00
SHOWERS 1 NUMBER OF 56.00
WATER PIPING - DEIN 1 NUMBER OF $6.00
MINIMUM FEE ADJUSTMENT 1 Select $5.00
Operator: CKF Printed By: CKF
Permit Total Fees: $35.00
Print Date: 7/22/02
Project Number: 02006154 Inv: 1
Application
THIS IS NOTA PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/22/02 Page 3 of 3
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Fee Amount
$708.44
$35.00
$35.00
$778.44
Invoice Amount
$708.44
$35.00
$35.00
$778.44
Amount Paid Amount Owing
$0.00 $708.44
$0.00 $35.00
$0.00 $35.00
$0.00 $778.44
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 coutrued 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: CKF Printed By: CKF
Print Date: 7/22/02
Manufactured Home
Sign
Width:
Length:
I`
What is the square footage of the sign
face?
11ow high is the sign?
Year:
�1 Ike '
# of signs
Area of existing signs
-- 'Tent
Firc
i f
Fireworks display
Relocation
Fire Safety
Firm Name
Phone
Plans I Naminer
Previous address
inspectors:
Paint booth
Fire Sprinkler
Is any part of the property within a 100 yr flood plain?
I_ f yes, identifi, on site plant
❑ Maybe ❑ Don't know ❑ Yes No
-- 'Tent
Firc
i f
Fireworks display
�'/
❑ Concrete �O�C'elding
❑ Bolting ❑ Reinforcement
Addres%
Proposed use ------
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
Phone
Plans I Naminer
Phone
inspectors:
Will the site be served by a septic system? ❑ Yes
Address
Is any part of the property within a 100 yr flood plain?
I_ f yes, identifi, on site plant
❑ Maybe ❑ Don't know ❑ Yes No
Are or will there be wells located on the property?
I f hes, ident/' on the site plan ❑ Yes
i/
Inspector
Phone
�'/
❑ Concrete �O�C'elding
❑ Bolting ❑ Reinforcement
Addres%
ADDITIONAL SITE INFORMATION
Are there structures on the property? i'es ❑ No
Ifyes, identifi, on site plain
What is the current property size?
(square feet or acres)
Is the property inside the ASA? ❑ Yes ❑ No
❑Yes 0 N
Is any part of the property within 250 feet of a sh?
I. Eyes, identifi, on site plan ❑ Yes o=
What is the current use of this pro erty?
', , - /`,i; 7"/
/1--
Is your property in a designated wildlife habitat area?
❑ Don't know ❑ Yes N o
Will the site be served by a septic system? ❑ Yes
N
Is any part of the property within a 100 yr flood plain?
I_ f yes, identifi, on site plant
❑ Maybe ❑ Don't know ❑ Yes No
Are or will there be wells located on the property?
I f hes, ident/' on the site plan ❑ Yes
1S o
Are there any wetlands, streams or ponds within NO fset of the property?
yes, identi on site plan ❑ Yes No
Is there evidence of fill or excavation on the property?
❑ Yes
�yN�
H'o
Are there slopes greater than 30°% on the property? (30 t In 100 ft)
( °%) ❑ Yes ,o
Are critical or hazardous materials used or stored on sit?
❑ Yes , No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
❑Yes 0 N
Is public sewer available to the site? ❑ Yes ❑ No
Is the property inside the ASA? ❑ Yes ❑ No
❑Yes 0 N
Is public water available to the site? ❑ Yes ❑ No
Is the property inside the PSSA? ❑ Yes ❑ No
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date Rccc,vcd:
Staff Rcprescntatirc:
METHOD OF PAYMENT
VISA
❑ cAsI 1 ❑ CHECK ❑MUM❑ .
0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I):\'1'I
EXPIRES:
B.\NKCAR1) NUMBER:
111'l1 I0R1Z1.1) SIGN A'1'URI?:
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS $35.17 PLEASE
MAKE CI IECKS PAYABLE 10 SPOKANE
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