2004, 12-02 Permit App: 04009250 RemodelProject Number: 04009250
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 12/02/2004 Page 1 of 2
Project Information:
Permit Use: FINISH BASEMENT - REC RM, (2) BEDRMS,
STORAGE RM & BATHRM
Setbacks: Front Left:
Site Information:
Plat Key:
Right: Rear:
Contact: DANIEL, KEN
Address: 838 S SHELLEY LAKE LN
C - S - Z: SPOKANE VALLEY, WA 99037
Phone: (509) 924-9499
Group Name:
Project Name:
Name: SHELLEY LAKE 03RD ADD PUD
District: F
Parcel Number: 45243.2709 Block: 3
SiteAddress: 838 S SHELLEY LAKE LN
Location:: SPO
Zoning: UR -3.5
Water District:
Area: 9,204 Sq
Nbr of Bldgs: 1
Ft
Urban Residential 3.5
Lot: 9
Owner: Name: DANIEL, KEN
Address: 838 S SHELLEY LAKE LN
SPOKANE VALLEY, WA 99037
Hold: ❑
Width: 80 Depth: 121 Right Of Way (ft): 9204
Nbr of Dwellings: 1
Review
Plan Review
Released By:
Contractor: OWNER
Description Grp Type Notes
BASEMENT R R-3 VB
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
Building Permit
Finn: OWNER
Phone: (000)
This Application:
Su Ft Valuation
1,683 $8,415.00
Totals: 1,683
Units Unit Desc
1 SELECT
1 SELECT
1 SELECT
Operator: K_C Printed By: K_C
$8,415.00
Permit Total Fees:
Print Date:
000-0000
Total Project:
Su Ft Valuation
1,683 $8,415.00
1,683 $8,415.00
Fee Amount
$167.25
$4.50
$66.90
$238.65
12/02/2004
Project Number: 04009250 Inv: 1
Application
Date: 12/02/2004 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Item Description
VENTILATING FANS
Notes:
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Mechanical Permit
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
Permit Total Fees:
Fee Amount Invoice Amount
$238.65 $238.65
$10.00 $10.00
$248.65 $248.65
Fee Amount
$10.00
Amount Paid
$0.00
$0.00
$10.00
Amount Owing
$238.65
$10.00
$0.00 $248.65
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 12/02/2004
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BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 8 3$ S- S• JG e /Gel
Lamle ter ,v
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: / �'r
A rs/t %3 a6 t,t epi/
X Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement n Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: Kew Oe,//e L 111 Applicant:
Phone: C, 2,q -1, Fax: Phone: Fax:
Address: S3€ G Jae/1Qy ee4e [G</C- Address:
5 ,,kee/ve t,z, /Cry rdl�- ' �t o,3 7
City State Zip Code City State Zip Code
❑ Contractor:
Phone: Fax:
Address:
City
State
WA State Contractor License #:
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:
2M11D FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
f
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
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:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
Above/Underground Storage Tank Size:
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
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) AU 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: