2005, 03-21 Permit App: 05000826 AdditionProject Number: 05000826 Inv: 1
App1 cation
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/21/2005 Page 1 of 2
Project Information:
VINIAMPrAWN MR-',4,4§,-z,Aur:„popr..mag 'Z'..Afkr....;40M.A,MP-ANWP421sP-7.:_,MPA.16PPWSNAVPU.
Contact: STAFFORD, MIKE
Address: 4203 S PONDRA DR
C - S - Z: SPOKANE VALLEY, WA 99206
Phone: (509) 927-9803
Group Name:
Project Name:
Permit Use: 17 X 22 DINING ROOM ADDITION
Setbacks: Front NA Left: 60+ Right: 100 Rear: 72
Site Information:
Plat Key: 0G2093 Name: PONDRA PINES ADD District: Sout
Parcel Number: 45324.1211 Block:
SiteAddress: 4203 S PONDRA DR
Location:: CSV
Zoning: UR -3.5 Urban Residential 3.5
Water District:
Lot:
Ovvner: Name: STAFFORD, MIKE
Address: 4203 S PONDRA DR
SPOKANE VALLEY, WA 99206
Hold: [1]
Area: .00 Acres Width: 152 Depth: 237 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review
Site Plan Review
Plan Review
LReleased By:
Released By:
-L-Z3Septic System Review
R sed By-
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Operator: DMD
Printed By: DMD
Print Date: 03/21/2005
03/21/2005 09:34 5093241567
MAR 21 2005 09:06 FR
SRHD EHS
TO 3241567
Date; 03/21/2005
Project Number, 05000826': 1 Application
• 'WAIS IS NOT Ine E�woxk without a perxn�t
pt�nalties �y1l1 be assessted for tom ����
role i ar�n bion: Contact: STAFFORD, MIKE
Permit Use: 17X212 DINING ROOM ADDITION 4203 S PONDRA R WA 99206
C .i S - Z: SPOKANE VALLEY,
Phone: (509) 927.9803
Setbacks: Front NA Left: 60+ Right 100 Rear: 72 GrouplName:
Project Name: 1
Site _kf r taatio,n iwas
District: Sum
Plat Key: 0t12093 Name: PONDRA PINES ADD ---
Parcel Nutrtlzer. 45324.1211 Block:
SiteAddress: 4203 S PONDRA DR
PAGE 01/02
P.41i4�
Page 1 of 2
Location:: CSV
Zoning: UR 3.5
water District
Area: .00 Acres
Nb r of Bldgs: 1
Urban Residential 3.5
Lot:
Owt cr: Nam: STAFFORD, MIKE
Address 4203 S PONDRA DIt
SPOKANE VALLEY, WA 99206
i Hold: 0
Width: 152 Depth: 237 Right Of Way (ft): 50
Nbr of Dwellings: 1
mom
R 'ew Informattio, rr ex att
]avpew
Site Plan Review
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Permits;
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Operator: DMD
MAR 21 2005 09.41
Printed By: DMD
Print Date: 03/21/2005
5093241567 PAGE.01
Project Number: 05000826 Inv: I
t
Application
Date: 03/21/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Group: R-3 Type: VB
Total Area 223
Building Height 16
Stories 1
Building Permit
Firm: OWNER
Phone: (000) 000-0000
Building Characteristics
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
RES ADD R-3 VB 223 $16,653.64 223 $16,653.64
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
Payment Summary:
Permit Type
Building Permit
Totals: 223 $16,653.64 223 $16,653.64
Units Unit Desc
1 SELECT
1 SELECT
1 SELECT
Permit Total Fees:
re -
Fee Amount Invoice Amount
$395.45 $395.45
Fee Amount
$279.25
$4.50
$111.70
$395.45
Amount Paid
$0.00
Amount Owing
$395.45
$395.45 $395.45 $0.00 $395.45
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: DMD Printed By: DMD Print Date: 03/21/2005
BUILDING PERMIT APPLICATION WORKSHEET
Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
hone: (509) 688-0036; Fax: (509) 688-0037
Spokane
jVauey
REQUIRED SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s):
.K.,7i-e-4-c(
L/S 302 y.
Legal Description: /6/0 d— eie s '.1-( L ii 152-
PERMIT
32
PERMIT DESCRIPTION:
Q Building Permit
❑ Relocation
d l y
❑ Change in Use (1 Grading
❑ Manufactured Home
Tenant Improvement ❑ Fire Safety n Other
OWNER/APPLICANT INFORMATION
n Owner: / t
Phone: q79-yoS a' Fax: 72 7C (i'o . '
ql).d 75/8r Address: 2c
cx icy (Jo.c /j:7 ct 1'J: t
Sta,f Zip Code
n Contractor:
Phone: Fax:
Address:
City
State
WA State Contractor License#:
Zip Code
n
Applicant: Yzr�1 f
Phone:
Address:
Fax:
City
11 Architect:
Phone: Fax:
State Zip Code
Address:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: i
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG: 7
;/ 2 )
2ND FLOOR SQ. FTG: __
UNFIN BASEMENT SQ. FTG:
.
FINISHED BASEMENT SQ. FTG:
(
GARAGE SQ. FTG: _.___--
DECK/COV. PATIO SQ. FTG:
�-`._
OCCUPANCY GROUP:
CONSTRUCTION TYPE: ,
f6i t
HEAT SOURCE:
1)05. 7 ' TJ
# OF BEDROOMS:.ys.,.
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
1 5.(7',!0
30% SLOPES ON PROPERTY:
0
SEWER OR _ -SITE SEPT
SYSTEM? _
MANUFACTURED HOME
Width:
Manufacturer:
Length:
Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone: Fax:
City
Phone:
State
Fax:
Zip
City
State Zip
J
SPECIAL INSPECTIONS
BOLTING fl CONCRETE 1 1 REINFORCEMENT n WELDING
Firm Name:
Inspector(s):
Phone: Fax:
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 i ure to the property owner.
Print Name h. e'/ %k,n eY Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
(l Cash ❑ Check
Bankcard #:
Authorized Signature:
11 Mastercard ❑ VISA 11] Other
Expires:
VIN#:
X p,erVE'rY
ADDRESS LOC
ZONE
nom) WIDTH
FRONT
COMMENTS
+EVIEWED BY
),7s
Thi site plan Is being submitted for the 4grpEe ottoNF,�
oI ',fining a building permit and is a true i t
,,,i . ,,•relation of the proposal. All known property
dimensions, curb lines, structures end eass nt
bn been iter. steel) slopefied. Also s oreated are other critical areas.
h, nes of water,
si, led:
p le:
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