2003, 03-27 Permit App: 03002056 AdditionProject Number: 03002056 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/27/2003 Page 1 of 3
Project Information:
Permit Use: RES ADD/REM-
BEDRM,KITCHEN,2BATHRMS,UTILITYRM,SIDI
NG,ROOFNG,WINDOW
.........................................
Contact: BLYTHE, JAMES
Address: PO BOX 141994
C - S - Z: SPOKANE WA 99219
Setbacks: Front 19 Left: 7 Right: 11 Rear: 80 Phone: (509) 926-4761
Group Name:
Site Information: Project Name:
.............................. .
Plat Key: 000766 Name: FAIRACRES
District: H
Parcel Number: 45092.0724
Block:
SiteAddress: 10811 E GRACE AVE
Spokane, WA USA 99206
Location:: SPO
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Area: ),284.00 Acres
Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: ::.......................... .. ..... ..........
Lot:
Owner: Name: BLYTHE, JAMES
Address: PO BOX 141994
SPOKANE WA 99219
Hold: ❑
Depth: 0 Right Of Way (ft): 40
Review
Site Plan Review
Released By
Plan Review
Released
Landuse/Zoning
Permits:
Released By
Operator: JAS Printed By: JAS
Print Date: 3/27/2003
Project Number: 03002056
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/27/2003 Page 2 of 3
Contractor: OWNER
Building Permit
Firm: OWNER
Phone:
Building Characteristics
Const Category: Addition Group: Type:
Nbr Of Dwellings: Occupant Load: Building Height: Stories:
Bldg W x D: x Building Sq Ft: Sprinklers: El
Req Parking: Handicap Parking: Critical Materials:
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
CARPORT U-1 VN ROOFCOVE 124 $558.00 124 $558.00
R
GARAGE U-1 VN 476 $5,712.00 476 $5,712.00
RES ADD R-3 VN 372 $24,552.00 372 $24,552.00
RESIDENCE R-3 VN REMODEL 0 $1,500.00 0 $1,500.00
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: OWNER
Item Description
VENTILATING FANS
CLOTHES DRYER
Totals: 972 $32,322.00 972 $32,322.00
Units Unit Desc
1
1
1
Y OR BLANK
Y OR BLANK
Y OR BLANK
Permit Total Fees:
Mechanical Permit
Fee Amount
$424.00
$4.50
$93.28
$521.78
Firm: OWNER
Phone:
Units Unit Desc
4 NUMBER OF
1 NUMBER OF
Operator: JAS Printed By: JAS
Permit Total Fees:
Print Date:
Fee Amount
$40.00
$10.00
$50.00
3/27/2003
Project Number: 03002056 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/27/2003
Contractor: OWNER
Item Description
TOILETS/BIDETS
SINKS
TUBS
DISH WASHERS
CLOTHES WASHER
ELECTRIC HOT WATER TANK
WATER PIPING - DWV
Notes:
Payment Summary: >:.......
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Plumbing Permit
Firm: OWNER
Phone:
Units
2
2
1
1
1
2
Fee Amount
$521.78
$50.00
$60.00
Unit Desc
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
Permit Total Fees:
Invoice Amount
$521.78
$50.00
$60.00
$631.78 $631.78
Page 3of3
Fee Amount
$12.00
$12.00
$6.00
$6.00
$6.00
$6.00
$12.00
Amount Paid
$0.00
$0.00
$0.00
$60.00
Amount Owing
$521.78
$50.00
$60.00
$0.00
$631.78
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and fmds 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: JAS Printed By: JAS Print Date: 3/27/2003
SPOKE COUNTY
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: D I
11;a C C
Assessors Tax Parcel Number(s):
Legal I)escription:
1A-/ ttrwL�
Project Description:
AJ c +t 0A cAJ °
❑ Building Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
Department Use Only
Phone: SC/9- C)
"`l-Ct) L -.116 1
Fax:
❑ Applicant
Phonc:
Fax
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front
5eft:
Rear.
Right:
e
School District
Fire District:
Zoning
Ll�Y )
` 3
OWNER/APPLICANT INFORMATION
(� Indh.ale who should be ,ontw7ed rvtardrnE this f rojed
p Owner:
346‘[s bi
Phone: SC/9- C)
"`l-Ct) L -.116 1
Fax:
❑ Applicant
Phonc:
Fax
Mailing Adess:
Mailing Address:
Circ, Stair, hip
Soo k4,,, CA..
r9/Li — ici Li
City, State, Zip
Dimensions
3yx 4t'
❑ Contractor
Phone❑
Fax
nneer
Architect/ I[g
Phone
Fax
Mailing address
Mailing address
City, State Zip
F40'1
City, State Zip
Deck sq. ft.
nib
VCA State Contractor license #
41 Cost of project
fig
Contact name
PROTECT INFORMATION
Building Information
Building height to peak
Iy /1
# of stories
Main floor sq. ft.
I(Lt)
Unfinished basement sq. ft.
N4
Dimensions
3yx 4t'
Total habitable space
I'41Ot1
2"d floor sy. ft.
/ &
Finished basement sy. ft.
NI)-
Occupancy group
Construction tv c
U1/4.L)01
F40'1
Garage sq. ft.
yet s1,
Deck sq. ft.
nib
4111
• A
41 Cost of project
fig
I 5,000
I !cat source (electric, gas, etc.) / �� J
1er r,c C
� V l/
Manufactured Home
Sign
Width:
Length:
What is the square footage of the sign
face?
I low high is the sign?
Year:
Make:
# of signs
Arca of existing signs
Fireworks display
,Are critical or hazardous materials used or stored on site?
0 Ycs 1k'. No
Address
Proposed use
Relocation
Fire Safety
Finn Name
What � is the current use of this property?
4�t'Sx � th-i-
Previous address
Will the site be served by a septic system? O Yes dikNo
Paint booth
Fire Sprinkler
Tent
Fire Alarm
Fireworks display
,Are critical or hazardous materials used or stored on site?
0 Ycs 1k'. No
Address
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Finn Name
What � is the current use of this property?
4�t'Sx � th-i-
Phone
Will the site be served by a septic system? O Yes dikNo
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Ycs No
;Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( O ) 0 Ycs tst No
,Are critical or hazardous materials used or stored on site?
0 Ycs 1k'. No
Address
Inspector
Phone
O Concrete
O Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
:Are there structures on the property? O Ycs O No
flies, identi on site plan
What is the current property size?
(square feet or acres) I SS X 1.. (-
Is any part of the property within 250 feet of a shoreline?
If yes, identify on site plan O Yes '_No
What � is the current use of this property?
4�t'Sx � th-i-
Is your property in a designated wildlife habitat arca?
0 Don't know O Ycs )21._No
Will the site be served by a septic system? O Yes dikNo
Is any part of the property within a 100 yr flood plain?
"[yes, identijj, on site plan
0 Maybe 0 Don't know 0 Ycs (, . No
Are or will there be wells located on the property?
Ifj'es, identifi, on the site plan 0 Yes No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identifi, on site plan 0 Ycs IZ No
Is there evidence of fill or excavation on the property?
0 Ycs No
;Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( O ) 0 Ycs tst No
,Are critical or hazardous materials used or stored on site?
0 Ycs 1k'. No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Arca?
0 Yes 0 No
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 ['SSA? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
0 Ycs 0 No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ (: \sI1 IA(l 1I{(:K 0 um. 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
:SPIRES:
BANKC:VZD NLIMBI':12:
1UI'I R)RI'/,I.:D SIGNA7'URI{:
SUBTO'I'Al,
TOTAL FEE
MINIMUM PERMIT FEE IS $35.00 PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER
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