2002, 09-09 Permit App: 02007747 Perm RelocationProject Number: 02007747 Inv: I Application Date: 9/9/02 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
ProiectInformation:
Permit Use: PERMANENT RELOCATION OF RESIDENCE ON Contact: RUBERT, MIKE
BASEMENT Address: PO BOX 29
C - S - Z: SPANGLE, WA 99031
Setbacks: Front 25 Left: 30+ Right: 30+ Rear: 30 Phone: (509) 448-2720
Group Name:
Site Information: Project Name
�`.@V41R�. i116P,"ROhvVI!;k t4.s ...,. ILI �'�'r91r�"-.�',��F".F,,;:,: '.. .. :.:=..:"••,`s:^V1u9","s°d,,....._.k,IZYl e1v�`irx.,..�."fifl�v'.'::.9PoI�Gi�I�+; " •
Plat Key: 006229 Name: CHRISTIN'S HADD District: H
Parcel Number: 45092.0719 Block: 1 Lot: 5
SiteAddress: 2810"JOHNSON RD Owner: Name: RUBERT, MIKE
SPOKANE, WA 99206 Address: PO BOX 29
Location:: SPO SPANGLE, WA 99031
Zoning: UR 3.5
Water District: Hold: ❑
Area: 11,453 Sq Ft Width: 0 Depth: 92 Right Of Way (ft): 36
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:.
Review
Site Plan Review
Released By:
Plan Review
Released By(%t
Special Reviews Released By'
--
Approach / Drainage Released By:
Sewer Review elease By:
------------------
V -
1
Operator: CKF Printed By: CKF Print Date: 9/9/02
Project Number: 02007747
Permits:
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 9/9/02 Page 2 of 3
Contractor: OWNER
Const Category: New
Nbr Of Dwellings:
Bldg W x D: x
Req Parking:
Description
BASEMENT U
Building Permit
Firm: OWNER
Phone:
Building Characteristics
Group: Type:
Occupant Load: Building Height: Stories:
Building Sq Ft: Sprinklers: ❑
Handicap Parking: Critical Materials:
This Application: Total Project:
Sp Ft Valuation Sp Ft Valuation
725 $8,917.50 725 $8,917.50
Totals: 725 $8,917.50 725 $8,917.50
Grp Type Notes
R-3 VN
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: OWNER
Item Description
GAS WATER HEATER
GAS APPLIANCE<=100,000BTU
GAS PIPING
VENTILATING FANS
CLOTHES DRYER
Contractor: OWNER
Item Description
TOILETSBIDETS
SINKS
TUBS
FLOOR DRAINS
MINIMUM FEE ADJUSTMENT
Operator: CKF
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
Fee Amount
$150.50
$4.50
$33.11
Permit Total Fees: $188.11
Mechanical Permit
Units
1
1
2
2
1
Firm: OWNER
Phone:
Unit Desc
NUMBER OF
NUMBER OF
# OF UNITS
NUMBER OF
NUMBER OF
Permit Total Fees:
Plumbing Permit
Firm: OWNER
Phone:
Units Unit Desc
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
Select
Permit Total Fees:
Printed By: CKF Print Date:
Fee Amount
$10.00
$12.00
$2.00
$20.00
$10.00
$54.00
Fee Amount
$6.00
$6.00
$6.00
$6.00
$11.00
$35.00
9/9/02
Project Number: 02007747 Inv: I Application Date: 9/9/02 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes: MW W
"MUFF
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $188.11 $188.11 $0.00 $188.11
Mechanical Permit $54.00 $54.00 $0.00 $54.00
Plumbing Permit $35.00 $35.00 $0.00 $35.00
$277.11 $277.11 $0.00 $277.11
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: 9/9/02
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
Not 509-477-3675
SPO 09-477 9260
3675
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: '%t to (k> 7 ie kt —114d 1, 4t 17"40yC-- G t'l-D i 4 5'if
wilding Permit ❑ Change in Use ❑ Grading ❑ 1\-Ianufactured Home Permit
❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Mailing Address:
O
Unfinished basement sq. ft.
Front: Rear.
School District
Fire District:
Zoning
-5432 Ea r,
Dimensions
❑Contractor Phone
Lek: Right:
OWNER/APPLICANT INFORMATION
M1-4; .Jn .,,h, .h.,,.ld ho .,...... 1;—, J6;, hrn;a:J
(teener: Phone: '141�r'---, %-20
❑ Applicant: Phone
�i Far 7�
I�ac
Mailing Address:
Mailing Address:
O
Unfinished basement sq. ft.
City, State, Zip
City, State, Zip
-5432 Ea r,
Dimensions
❑Contractor Phone
❑ Phonc
Architcctjlinlnncer
Fns
FIX
Mailing address
Mailing address
CitY, State Zip
Cit, State Zip
VA'A State Contractor license #
Contact name
PROIRCT INFORMATION
51
v
Manufactured Home rsign
Building Information
Building height to peak
# of storks
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitablcc space
21,11 Floor sq. ft.
Finished basement sq. ft.
z� X .2- e '
Occupancy group
Construction tvpc
Garagc sq. ft.
Deck sq. ft.
Cost of p144cct
1 Icat source (electric, gas, ctc.)
00,
I
51
v
Manufactured Home rsign
Width:
Length:
'
What is the square footage of the sign
face!
I low high is the sign?
Year:
Make:
# of signs
Area of existing signs
Tent
Fire Alarm
Fireworks display
.\re or will there be wells located on the property?
1_Jj�es, ident on the site plan ❑ Yes No
Relocation
Fire Safety
Firm Name
Is any part of the property within 250 feet of a shorelin
If yes, identif on site plan ❑ Yes ( No
Previous address
What is the current use o -f. this property?
UCQ AZT
Paint booth
Fire Sprinkler
Tent
Fire Alarm
Fireworks display
.\re or will there be wells located on the property?
1_Jj�es, ident on the site plan ❑ Yes No
Address
Proposed use
Value
in 100 ft)
Are critical or hazardous materials used or stored on site?
❑ Yes No
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
Is any part of the property within 250 feet of a shorelin
If yes, identif on site plan ❑ Yes ( No
Phone
What is the current use o -f. this property?
UCQ AZT
Plans Examiner
Phone
Inspectors:
Is any part of the property within a 100 yr flood plain?
If yes, identif, on site plan,
❑ Maybe ❑ Don't know ❑ Yes �Nc7
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
.\re or will there be wells located on the property?
1_Jj�es, ident on the site plan ❑ Yes No
Address
Is there evidence of till or excavation on the property? ,/'
N
❑ Yes E7 o
Are there slopes greater than 30°'0 on the property? (30_ft rix
( .......---Th) ❑ Yes C➢�No
in 100 ft)
Are critical or hazardous materials used or stored on site?
❑ Yes No
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
❑ Reinforcement
Address
ITIONAL SITE INFORMATION
.ire there structures on the property? ❑ Yes 'No
Ifies, ident t on site plan
0 N
\X'hat is the current property size?
(square feet or acres) 100
Is any part of the property within 250 feet of a shorelin
If yes, identif on site plan ❑ Yes ( No
❑ Yes
❑ Yes
What is the current use o -f. this property?
UCQ AZT
Is your property in a designated wildlife habitat arca?\X'ill
❑ Don't know ❑ Yes dr
Is the property inside the PSSA?
the site be served by a septic system? ❑ Yes
Is any part of the property within a 100 yr flood plain?
If yes, identif, on site plan,
❑ Maybe ❑ Don't know ❑ Yes �Nc7
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
.\re or will there be wells located on the property?
1_Jj�es, ident on the site plan ❑ Yes No
Are there any wetlands, streams or ponds within 200 festmf the property?
If yes, identif' on site plan ❑ Yes
Is there evidence of till or excavation on the property? ,/'
N
❑ Yes E7 o
Are there slopes greater than 30°'0 on the property? (30_ft rix
( .......---Th) ❑ Yes C➢�No
in 100 ft)
Are critical or hazardous materials used or stored on site?
❑ 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
❑ Yes
❑ No
❑ No
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 Received:
Staff Representam e:
METHOD OF PAYMENT
VISA
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FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATI
?:
NYPIKI(S:
B.\NKC.\RD NUNIBFR:
AUI'I IORI'/.I;D SIGN.111112F:
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS $35.019 PLEASE
MAKE CI IECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER
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COMMS 'S
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