2004, 03-12 Permit App: BLD-04-03748 ResidenceSionliane
.000Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
Application #: BLD -04-03748
Job Address: 632 S SHELLEY LAKE LN
SPOKANE VALLEY WA 99037
Description: NEW RESIDENCE W/ATTACHED GARAGE - NATURAL GAS
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
MADDEN, KEVIN M
MADDEN CONSTRUCTION
10601 E NIXON LN
SPOKANE VALLEY, WA 99206
KEVIN MADDEN CONSTRUCTION
10601 E NIXON LN
SPOKANE WA 99206-3794
Lot: Blk: Parcel No:
Phone: (509) 924-6497
Phone:
Lic No:
(509) 927-7526
KEVINMC146J5
Applied:
Issued:
Expires:
Zoning:
03/12/2004
09/08/2004
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
# OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SHOWERS (PER TRAP)
SINKS
DISHWASHER
CLOTHES WASHER
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
TYPE II HOOD
sfr
166499
35' MAX
58 X 41
2
3
30
47
6
6
r-3
5-n
1
70 X 120
no
no
3
3
1
6
1
1
2
1
1
1
1
3
3
1
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SHOWERS
SINKS
DISHWASHER
CLOTHES WASHER
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
Total Calculated:
Deposits/Receipts:
Total Due:
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
Building
Planning
547.58
1,368.95
4.50
18.00
18.00
6.00
36.00
6.00
6.00
12.00
15.00
10.00
10.00
10.00
3.00
30.00
2,101.03
0.00
2,101.03
...• P-0Aarpg
PI E COMPLW
HHC[oi c DWISis
49,.E
Jnitials / Date P
Public Worcs ►10/ t kt \ % k_(
atok
THIS IS NOT A RECEIPT
jai
'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:
Assessor's Tax Parcel Number(s):
Legal Description:
4/i/e
/02, elaciL
PERMIT DESCRIPTION:
�c Building Permit I I Change in Use
n Relocation
II
Tenant Improvement
❑ Grading
11
[j Manufactured Home
Fire Safety 1 I Other
OWNER/APPLICANT INFORMATION
❑ Owner: 1t/2 i//i/ 4% ed CO//5 7 ❑
Phone:91 /f.- 76---1-6 -Fay C�.e. ,."7._67c2
Ad ress: sz2 / q f /9-0,e..,
City State Zip Code
❑ Contractor: /1--Z-,)//1/ /1'i)e,dd✓g17
Phone: Fax:
Address:
City
State
Zip Code
WA State Contractor License #: ffe2Y,W me /46 d -'
S
Applicant: ,�i-� %Yja.dder✓
Phone: `/— cl qi Fax:
Address: I1e‘„,o/ /y, I'M 4, rr�
Q �i 0_ )//Z L/ UJ/✓ 99:2g
ode State Lip ode
❑ Architect: eei/,; /2a4ei e,(
Phone:
Address:
Fax:
City
State
Zip Code
Contact: /C.A.,/** 9v/_(o47 kev.W c�,CQ��7-675o
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: Gee f,/,a,., �.
DIMENSIONS:
sx X q i
# OF STORIES:
Ort e..
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNPIN BASEMENT SQ. FTG:
1310
DECK/COV. PATIO SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
-O
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
Ala 1:u kia-L.a-5
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURF CE AREA:
/bode
COST OF PROJECT: l
-- jya 0 0A
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? g Ver
MANUFACT URRD HOME
Width:
Manufacturer:
Length: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler:
Tent:
# of Heads: Fire Alarm:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING n CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
Inspector(s):
Fax:
❑ WELDING
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:
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