2004, 03-15 Permit App: BLD-04-03793 Duplex Project Number: 04001250 Inv: 1 Application Date: 3/15/2004 Page 1 of 2
THIS IS NOT A PERMIT
Penalties v 1 be assessed for commencing work without a permit
Project Information:
Permit Use: SEWER CONNECTION-TOWNER(DUPLEX) Contact: FOLSOM,MARK
Address: 4015 S CONKLIN RD
C- S-Z: GREENACRES WA 99016
Setbacks:Front Left: Right: Rear: Phone: (509)921-6602
Group Name:
Site Information: Project Name:
Plat Key: Name: unknown District: F
Parcel Number: 45231.1515 Block: Lot:
SiteAddress: 515 S PROGRESS RD Owner:Name: FOLSOM,MARK
VERADALE,WA USA 99037 Address: 4015 S CONKLIN RD
Location::VER GREENACRES WA 99016
Zoning: UNKN Unknown
Water District: Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Review >
Review by Utilities •
Released By: 7, (.. 1/f �jG� /j Qt
io(,//e_,,o/Acz.67— --,,,Q./w/ 69k(L )
Permits:
Sewer Connection Permit
Contractor: OWNER Firm: OWNER
Phone:
Item Description Units Unit Desc Fee Amount
SEWER CONNECTION 1 NUMBER OF $85.00
PROCESSING FEE 1 Y OR BLANK $15.00
Permit Total Fees: $100.00
Operator: JAS Printed By: JAS Print Date: 3/15/2004
BUILDING PERMIT APPLICATION WORKSHEET
Sof ne City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
400011Va ev Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: c J S S, Oc-z.)-- �- r,t .
a
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: Oup/c,E bu 1 f euij
(Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
n Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: 01(,,v-V-- f"L;1srn ❑ Applicant:
Phone:rxR-61,uI-113 7 Fax: )2-ohog Phone: Fax:
Address: '-Cl5 S. Cen' \t, , AAddress:
C iree, :vv�� v i A- (1 616 K 9
City State Zip Code City State Zip Code
0 Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: I /;� DIMENSIONS: -7y, #OF STORIES:
3�� I
MAIN R("`^" Tn r". FTG: 2"" FLOOR SQ. FTG: UNFIN BASEMT SQ. FTG:
97R6' pe-i- S,Gly 0
FINISHD BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
(a Per s 1t r' 3(q).1)C t":2 u1 .2-CX) Sri h t 2 cie;� . L.
s u. . '-I U,`b `,y.� +
OCCU,PANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
l-/eui6 ,c X Ram e- Fi,tc4 A Z,- 6—
#OF BEDROOMS: TOTAL HABITABLE SPA E: IMPERVIOUS SURFACE AREA:
3 r 5,ce 1192. ��:\ .C\-, Pz°r5/CI e-
COST OF PROJECT: 30% SLOPES ON PRO RTY: SEWER OR ON-SITE SEPTIC
/ 70, 4'YQ /VO 5 tope. SYSTEM? 3 @,,,J�t-
erciE _ ` e`=k - (,1c7
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
El BOLTING ❑ CONCRETE ❑ REINFORCEMENT n 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:
MECHANICAL PERMIT APPLICATION
San'or" City of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
delSpokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
n FOR INSPECTIONS, CALL(509) 688-0054
Project Address: Etc S , Ptjre'c$ Permit Use:
Owner: p'IairK R,6evi- Phone (Daytime Contact): 92-/-6602_
Mailing Address: '/0/5 5. ' ,ikli.t RJ. QQO/a
City State Zip Code
Contractor: 5004 e License#: Phone#:
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 4 .- X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 , X $100.00 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 -=
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE > X $10.00 =
13 RANGE L. C.._L/
X $10.00 = , COf
7
14 DRYER .-, X $10.00 = �l) . (20
15 FUEL BURNING WATER HEATER Z. X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) X $1.00 =
18 DUCT SYSTEMS Z. X $10.00 = 2 G .L/�n0
19 VENTILATING FANS 4 X $10.00 = 4,0• ca
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 =
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $19.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON L X $12.00 = 2 y-00
26 AIR CONDITIONER 3-15 TON X $20.00 , =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 AIR CONDITIONER More than 50 TON X $60.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: ,EXPIRES:* TOTAL TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: /�/ ' /
PLUMBING PERMIT APPLICATION
Set„Vane City of Spokane Valley Community Development Department
11 __J jl BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
4.
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: 5/s 5 , iPi('Gre.5- .et - Permit Use:
Owner: M Ct( _. ,rn 1 R i nil �J Phone (Daytime Contact): 9Z-/-46c2..
Mailing Address: LIN‘j `,� SYN K.,i+,' re -]I'e et/y(.0 ve-3 \,111- 9 c10 l6
City State Zip Code
Contractor: 56f of _ License#: Phone#:
Mailing Address:
City State Zip Code
#OF TOTAL j
DESCRIPTION OF WORK UNITS X COST = AMOIIINT
1 TOILETS WATER CLOSET,BIDETS -1/ X $6.00 = l,,
.. co
2 URINALS X $6.00 =
3 TUBS __ X $6.00 = _
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT ,ii X $6.00 = 'LZ._0_V_
5 SINKS LAYS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, H X $6.00 = )H ,OO
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT r�
6 DISHWASHER 2" X $6.00 = 1 2 `0v
7 CLOTHES WASHER .Z X $6.00 = 1›) •C)(
8 GARBAGE DISPOSAL X $6.00 = 12.. 0 0
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE 2.. 12, V 0
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS �1�
15 SEWAGE EJECTOR GRINDER,SUMP PUMP 2. X $6.00 = /2 - (.o
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER Z 11_00
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER: *..";AUTHORIZED SIGNATURE: .-------
5025632
Page: 1 of 2
01/2012004 03.13':
AFTER RECORDING MAIL TO: FIRS , AtIERIC N 0111 E NS $2 . Spokane Co, WA
Mark W. Folsom
4015 South Conclin Road
Greenacres, WA 99016 •
Filed for Record at Request of: *` "" � First American Title
First American Title Insurance Company ; Insurance Company
,r. STATUTORY WARRANTY DEED
i
File No: 4253-216179 (ST) Date: January 15, 2004
Grantor(s): Donna J. Fletcher
Grantee(s): Mark W. Folsom
Abbreviated Legal: LOT 2,SHORT PLAT 14-03,VOL 19 OF SHORT PLATS, PAGES 10 AND 11
Additional Legal on page:
Assessor's Tax Parcel No(s): 45231.1515
THE GRANTOR(S) Donna J. Fletcher, a single person for and in consideration of Ten Dollars and
other Good and Valuable Consideration, in hand paid, conveys, and warrants to Mark W. Folsom,
a a single person, the following described real estate, situated in the County of Spokane, State of
ru Washington.
ci
LOT 2 OF SPOKANE COUNTY SHORT PLAT NO. 14-03,ACCORDING TO SHORT PLAT
o RECORDED IN VOLUME 19 OF SHORT PLATS, PAGES 10 AND 11, RECORDED DECEMBER 15,
4` 2003 UNDER RECORDING NO. 5012481; IN THE CITY OF SPOKANE VALLEY,SPOKANE
COUNTY,WASHINGTON.
Subject To: This conveyance is subject to covenants, conditions, restrictions and easements, if any,
affecting title, which may appear in the public record, including those shown on any recorded plat or
survey.
Donna J. Fletcher
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REVISION RECEIVED 6004/
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PERMIT # &z -0y— 03 793
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REVIEWED FOR CODE COMPLIANCE
SPOKANE VALLEY BUIL9INIa ;VISION
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REVISION RECEIVED .03/AFS
PERMIT #
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This site plan is being submil*ed for the purpose of
obtaining a building permit and is a true and correct
representation of the proposal. Alt known property
Tines/dimensions, curb lines, structures and easements
have been identified. Also indicated are wadands,
bodies ofwater, steep slopes or other critical areas.
Signed.
Date:
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