2005, 03-09 Permit App: 05000711 Remodel, Plumbing, Mechanical FixturesProject Number: 05000711 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/09/2005 Page 1 of 2
Project Information:
solum_.
immomomme..7026eftar 'NORM. NON.
Permit Use: CONVERT ENCLOSED PORCH INTO LIVING
RM, BATH & LAUNDRY RM
Contact: JONES, WILLIAM L & MILDRED E
Address: 2612 N MCMILLAN RD
C - S - Z: OTIS ORCHARDS, WA 99027
Setbacks: Front Left: Phone: (509) 499-2792
Group Name:
Project Name:
Name: BARKER ROAD MOBILE HOMES ADD District: East
Site Information:
Plat Key:
Right: Rear:
Parcel Number: 55082.1220
Block:
SiteAddress: 2612 N MCMILLAN RD
Location:: OTI
Zoning: UR -7
Water District:
Area: 9,000 Sq Ft
Nbr of Bldgs: 0
Review Information: ti --
Urban Residential -7
Width: 0
Nbr of Dwellings: 0
Lot:
Owner: Name: JONES, WILLIAM L & MILDRED
Address: 2612 N MCMILLAN RD
OTIS ORCHARDS, WA 99027
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
Plan Review
Permits:
Released By:
Contractor: OWNER
Description
RESIDENCE
Grp Type
R-3 VB
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
Notes
CONVERT
TO LIVING
SPACE
Building Permit
Totals:
Nom.
Firm: OWNER
Phone: (000) 000-0000
This Application: Total Project:
Sq Ft Valuation So Ft Valuation
0 $1,700.00 0 $1,700.00
0 $1,700.00
Units Unit Desc
1
1
1
Operator: K_C Printed By: K_C
SELECT
SELECT
SELECT
Permit Total Fees:
0 $1,700.00
Fee Amount
$69.25
$4.50
$27.70
$101.45
Print Date: 03/09/2005
Project Number: 05000711
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/09/2005
Contractor: OWNER
Item Description
VENTILATING FANS
Contractor: OWNER
Item Description
TOILETSBIDETS
SINKS
TUBS
CLOTHES WASHER
Payment Summary
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Mechanical Permit
Page 2 of 2
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
Permit Total Fees:
Plumbing Permit
Fee Amount
$10.00
$10.00
Firm: OWNER
Phone: (000)
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Fee Amount
$101.45
$10.00
$24.00
Permit Total Fees:
Invoice Amount
$101.45
$10.00
$24.00
000-0000
Fee Amount
$6.00
$ 6.00
$6.00
$6.00
Amount Paid
$0.00
$0.00
$0.00
$24.00
Amount Owing
$101.45
$10.00
$24.00
$135.45 $135.45 $0.00 $135.45
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: K_C Printed By: K_C
Print Date: 03/09/2005
*fame
lleY
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
1 Af fl c, %'1; I 1 at/L_
Assessor's Tax Parcel Number(s):
I 0-ao
Legal Description:
-- PERMIT DESCRIPTION: dL� �c� �t 4U l r�tti'�►'y 11 Sly �Cc -
❑ Building Permit
❑ Relocation
❑ Change in Use ❑ Grading
❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Or)
e
Owner: , ,1
Phone: i_rci-���i), Fax:
Address:
City
State Zip Code
Contractor: x_�
Phone:
Address:
Fax:
City
State
WA State Contractor License #:
Zip Code
Applicant: _;t 4,1v
L
Phone:
Address:
Fax:
City
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2N0 FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
6C «
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone: Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
U4