2002, 09-16 Permit App: 02007967 RemodelProject Number: 02007967 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 9/16/02 Page 1 of 2
Project Information:
Permit Use: FINISH FAMILY ROOM & BATHROOM IN Contact: O'CONNELL, JOHN M
NORTH HALF OF DUPLEX (@ 624) Address: 5511 S CREE DR
C - S - Z: SPOKANE, WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509) 928-5203
Group Name:
Site Information: Project Name:
Plat Key: 000636 Name: DOBRAVEC ADD District: F
Parcel Number: 45174.1209 Block: Lot:
SiteAddress: 622 N HERALD RD Owner: Name: O'CONNELL, JOHN M
SPOKANE, WA 99206 Address: 5511 S CREE DR
Location:: SPO SPOKANE, WA 99206
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Hold: ❑
Area: 0 Sq Ft Width: 89 Depth: 140 Right Of Way (ft): 40
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information: ; N
Review
Plan Review
Permits:
Operator: CKF Printed By: CKF
Print Date: 9/16/02
Project Number: 02007967 Inv: 1 Application Date: 9/16/02 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Const Category: Remodel
Nbr Of Dwellings:
Bldg W x D: x
Req Parking:
Building Permit
Firm: OWNER
Phone:
Building Characteristics
Group:
Occupant Load:
Building Sq Ft:
Handicap Parking:
Description Grp Type Notes
BASEMENT R R-3 VN
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: OWNER
Item Description
VENTILATING FANS
MINIMUM FEE ADJUSTMENT
Notes: .;a:dna,.. moa .,zty
Type:
Building Height: Stories:
Sprinklers: ❑
Critical Materials: ❑
This Application: Total Project:
SCI Ft Valuation Su Ft Valuation
476 $2,137.24 476 $2,137.24
Totals: 476 $2,137.24 476 $2,137.24
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
Permit Total Fees:
Mechanical Permit
Firm: OWNER
Phone:
Units Unit Desc
1 NUMBER OF
1 Select
Permit Total Fees:
Fee Amount
$75.50
$4.50
$16.61
$96.61
Fee Amount
$10.00
$25.00
$35.00
Payment Summary: ,. , ..vve,..•. r ;. . 1;r
Permit Type
Building Permit
Mechanical Permit
Fee Amount Invoice Amount
$96.61 $96.61
$35.00 $35.00
$131.61 $131.61
Amount Paid
$0.00
$0.00
$0.00
Amount Owing
$96.61
$35.00
$131.61
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: CKF Printed By: CKF Print Date: 9/16/02
I 1
SPoxAKE COUNJY
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 \VEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
Y &L j\167AZ
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: R jP4 g 4 Tisia OM IA' 6 45cratZT
Ail 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 Inl/ ah win should be , onlaeled n eardinmjed
-PrOwner.
�.I 011.v e- r).4-(7nneil
Phone: CI C/ y,- 6733 0
tax:
❑ :Applicant
Phone:
tax:
Mailing Address:
Dimensions
Mailing :Address:
20 floor sq. ft.
City, State, Zip
6, (ck,
L4,4 I'll
cr' q , 6 g
Cite, State, Zip
Deck sq. ft.
❑ C ntractor
I Icat source (electric, gas, etc.)
PhonePhone
Fax
❑ Architectilin}nnccr
Fax
Mailing address
Mailing address
Cid', State Zip
City, State Zip
W.1 State Contractor license #
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement s9. ft.
Dimensions
Total habitable space
20 floor sq. ft.
Finished basement set ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
511 ()f j()
I Icat source (electric, gas, etc.)
Manufactured Home
Sian
Width:
Length:
What,is the squ ;re footage of the sign
face?
I low high is the sign?
Year:
Make:
# of signs
Arca of existing signs
Tent
Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
❑ Yes 43 No
Relocation
Fire Safety
Firm Name
What is the current use of this property?
Previous address
Will the site be served by a septic system? ❑ Yes pr No
Paint booth
Fire Sprinkler
Tent
Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
❑ Yes 43 No
Address
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? ❑ Yes pr No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
❑ Yes ® No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/ °'o) ❑ Yes Q No
Are critical or hazardous materials used or stored on site?
❑ Yes 43 No
Address
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
❑ Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? ❑ Yes ❑ No
Ifyes, identi/ on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
If yes, ident,5 on site plan ❑ Yes RI No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
❑ Don't know ❑ Yes 41 No
Will the site be served by a septic system? ❑ Yes pr No
Is any part of the property within a 100 yr flood plain?
Ifyes, idenlij, on site plan
❑ Maybe ❑ Don't know ❑ Yes xt No
Are or will there be wells located on the property?
I_ fyes, identij, on 1/7e se/e plan ❑ Yes Ir,. No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identifi, on site plan ❑ Yes 0 No
Is there evidence of fill or excavation on the property?
❑ Yes ® No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(/ °'o) ❑ Yes Q No
Are critical or hazardous materials used or stored on site?
❑ Yes 43 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
❑Yes
❑ No
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 0 N
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
0 CASI 1 0 CHECK 0 MEMO 0 � , 0
1C11V1 <
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I :XPIRFS:
B.\NKC:\R1) NUMBI?R:
\U111OR1/,I?D SIGN;ATURI::
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS $35.00 PLEASE
\L\KE CI IECKS PAYABLE TO SPOKANE
COUNTY PERMIT CISNrER