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2002, 10-23 Permit App: 02009383 AdditionProject Number: 02009383 Inv: Application THIS IS 30T A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: GAME ROOM ADDITION Contact: AMERICAN DESIGN & CONSTRUCTIO Address: 10103 N WHITWORTH C - S - Z: SPOKANE, WA 99218 Setbacks: Front NA Left: 17 Right: NA Rear: 34 Phone: (509) 981-6573 Group Name: Project Name: . . . . Plat Key: 001740 Name: MYRON ESTATES #4 District: Date: 10/23/2002 Page 1 of 3 Site Information: Parcel Number: 44042.0812 Block: SiteAddress: 4515 S GILLIS RD SPOKANE, WA 99206 Location:: SPO Zoning: UR -3.5 Water District: Area: 0 Sq Ft Nbr of Bldgs: 0 Review Site Plan Review Urban Residential 3.5 Width: 0 Nbr of Dwellings: 0 Lot: Owner: Name: Address: RAYKOVICH TRUST 4515 S GILLIS CT SPOKANE, WA 99206 Hold: 111 Depth: 0 Right Of Way (ft): 0 Operator: DMD Printed By: DMD Print Date: 10/23/2002 Project Number: 02009383 Inv: 1 Application THIS ISNOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 10/23/2002 Page 2 of 3 Building Permit Contractor: AMERICAN DESIGN & CONST Firm: AMERICAN DESIGN & CONST C Address: 10103 N WHITWORTH DR Phone: (509) 467-6281 SPOKANE, WA 99218 Const Category: Addition Nbr Of Dwellings: Bldg W x D: Req Parking: Description RES ADD Building Characteristics Group: Occupant Load: x Building Sq Ft: Handicap Parking: Grp Type Notes R-3 VN Item Description RESIDENTIAL VALUATION STATE SURCHARGE RESIDENTIAL SURCHARGE Contractor: KTU OF SPOKANE INC Address: PO BOX 28899 SPOKANE, WA 99228-8899 Item Description DUCT SYSTEMS GAS APPLIANCE<=100,000BTU GAS PIPING VENTILATING FANS Contractor: THAISS PLUMBING & Address: 3935 N NAPA ST SPOKANE, WA 99207 Item Description TOILETSBIDETS SINKS SHOWERS DISH WASHERS ELECTRIC HOT WATER TANK Operator: DMD Type: Building Height: Sprinklers: EI Critical Materials: El This Application: Sq Ft Valuation 712 $46,992.00 Totals: 712 $46,992.00 Units Unit Desc 1 Y OR BLANK 1 Y OR BLANK 1 Y OR BLANK Permit Total Fees: Mechanical Permit Units 1 1 1 2 Stories: Total Project: Sq Ft Valuation 712 $46,992.00 712 $46,992.00 Fee Amount $550.00 $4.50 $121.00 $675.50 Firm: K T U OF SPOKANE Phone: (509) 467-4000 Unit Desc NUMBER OF NUMBER OF # OF UNITS NUMBER OF Fee Amount $10.00 $12.00 $1.00 $20.00 Permit Total Fees: $43.00 Plumbing Permit Units 1 2 1 1 1 Printed By: DMD Finn: THAISS PLUMBING & SPRINKLE Phone: (509) 487-2703 Unit Desc NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF Permit Total Fees: Print Date: Fee Amount $6.00 $12.00 $6.00 $6.00 $6.00 $36.00 10/23/2002 Project Number: 02009383 Notes: Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 10/23/2002 Payment Summary::::; ............................. Permit Type Building Permit Mechanical Permit Plumbing Permit Fee Amount Invoice Amount $675.51 $675.51 $43.00 $43.00 $36.00 $36.00 $754.51 $754.51 Amount Paid $0.00 $0.00 $0.00 Amount Owing $675.51 $43.00 $36.00 $0.00 $754.51 Page 3 of 3 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: DMD Printed By: DMD Print Date: 10/23/2002 I 1 Ainik SPOKANT Cour PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 SPECIFIC SITE INFORMATION Street Address: 50 .9515 6../a,/,3 Assessor's Tax Parcel Number(s): „7/I1 i, oS' Legal Description: Project Description: t»t'"me, (a0 ,' Lwagk)1 4 Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit ❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ 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 0 Indicate ttbo cbould be ,oeia ied rreurdiny ih,s prajed -- 0r: _Pho 81tY /01&TPlieraQ Fax: 1171 �n\prp/�Ph4 l/`^ ' ' I as: Mailing Address: 15 G _ 6-1al6 Unfinished bascmet . ft. Mailing Address: habitable space 1/2 City, State, Zip Finished basem t . ft. City, State, Zip Construction type ❑(. ntraett , Phone 4L,, 7 kn e„ ID e � TTVV �.�/�611) Fax 2 -2_s.-- i 1IVV ❑ architccta.nlnnecr Phone Pax Mailing address /D/i).3 li' l,&/"ne_0r'r Mailing address City, State Zip WA 9921 ' (:itc, State /,p WA State Contractor license # AMEk 113 Vii/ )5116" Contact name: PROTECT INFORMATION Building Information Building height to peak /2 # of stones I Main fi >r sq. ft. '7I25C Unfinished bascmet . ft. Dimension„Total 2'24- habitable space 1/2 2"d Boor sq. ft. ari J Finished basem t . ft. Occupancy u • 7- Construction type Garage sq. ft. Deck st . ft. Cost of project I !eat so�e (electric, gas, ctc.) Manufactured Home J ^* Sign • Width: Length: What is the square footage of the sign face? flow high is the sign? Year: Make: # of signs Area of existing signs Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( %) 0 Yes L(No Proposed use Value Relocation Fire Safety Firm Name Previous address Phone Fire Sprinkler Tent Paint booth _ Firc Alarm Fireworks display Is there evidence of fill or excavation on the property? 0 Yes El No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( %) 0 Yes L(No Proposed use Value Special Inspections Required? Non -Residential Energy Code Compliance? Firm Name What is the current use of this property? -- Phone Will the site be served by a septic system? O Yes 0 No Plans t?xaminer Phone Inspectors: Is there evidence of fill or excavation on the property? 0 Yes El No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( %) 0 Yes L(No Are critical or hazardous materials used or stored on site? 0 Yes ill No Address Inspector Phone O Concrete D Welding 0 Bolting O Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? 17 Yes O No If yes, identO, on site plan What is the current property size? (square feet or acres) Is any part of the property within 250 feet of a shorreh ? //yes, identify on site plan O Yes K No What is the current use of this property? -- Is your property in a designated wildlife habitat area? �/ O Don't know O Yes C�' No Will the site be served by a septic system? O Yes 0 No Is any part of the property within a 100 yr flood plain? I./yes, ident� on site plan O Maybe 0 Don't know O Yes No Are or will there be wells located on the property? _/ If yes, identify 0/1 the site plan O Yes IH No Are there any wetlands, streams or ponds within 200jeet of the property? If yes, identifi on site plan O Yes Ma No Is there evidence of fill or excavation on the property? 0 Yes El No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( %) 0 Yes L(No Are critical or hazardous materials used or stored on site? 0 Yes ill No DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? DYes 0 N Is public sewer available to the site? 0 Yes 0 No Is the property inside the ASA? 0 Yes 0 No DYes 0 N Is public water available to the site? 0 Yes 0 No Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area? DYes 0 N Date Received: Staff Representative METHOD OF PAYMENT VISA ❑ c;\sI 1 ❑ c1 n:cK ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD I),\TI?: FXPI121{S: BANKC.V21) NUMBER: 11T110121'/.I 1) SIGNA'1 k]Rl';: SUBTOTAL TOTAL FEE MINIMUM PERMIT FEE IS 535.00PLEASE MAKE CHECKS PAYABLE. TO SPOKANE COUNTY PERMIT CENTER ADDRESS /c�r' (-1'1 11 kc i NE (,it / 3• ) ROAD WIDT FRONTN/A ask.- I G COMMENTS � REVIEWED BY4'�� i�../ . CHAPCO CERTIFIED CONSTRUfXTON E. 10811 - 26th Fins Spokane, Wa 99206 r= rad: Job # 18 Legal Description: Lot 12, Block 1, MYRON ESTATES #4 Sc :d Date -q ierrTt ar.. .•; ect 1r rail r .., erty ci ;r cements e,dae other optica Newt cat tguc r «J12 SCS, FT ( 2-16. l`(NeS -) Q C,p 072 rtt HED Ef,._) 20 tc2T-4 F l�s hs' 6 320 (.16-)F-1 ev;skG� m -(GG(s S Ts