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2005, 06-22 Permit App: 05002092 Egress WindowProject Number: 05002092 Inv: 1 • "Appli;ation THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 06/22/2005 Page 1 of 2 Project Information: Permit Use: INSTALL EGRESS WINDOW Setbacks: Front Site Information: Plat Key: 006156 Name: SHELLEY LAKE 03RD ADD PUD Left: Right: Rear: Contact: MATT HOLLIDAY Address: 32967 N HAWK CREEK RANCH RD C - S - Z: DAVENPORT, WA 99122 Phone: (509) 725-0198 Group Name: Project Name: District: East Parcel Number: 45241.2604 Block: 1 SiteAddress: 845 S SHELLEY LAKE LN Location:: CSV Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: 1,176.00 Acres Nbr of Bldgs: 1 Review Information: Permits: Lot: 4 Owner: Name: SLOTEN, VON Address: 2 S 3RD AVE YAKIMA, WA 98902 Hold: ❑ Width: 80 Depth: 202 Right Of Way (ft): 30 Nbr of Dwellings: 1 Contractor: HOLLIDAY CONSTRUCTION Address: 32967 N HAWK CREEK RANCH RD Phone: (509) 725-0198 DAVENPORT, WA 99122 Building Permit Firm: HOLLIDAY CONSTRUCTION This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation RESIDENCE R-3 VB INSTALL 0 $1,200.00 0 $1,200.00 EGRESS WINDOW Totals: 0 $1,200.00 0 $1,200.00 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $69.25 STATE SURCHARGE 1 SELECT $4.50 Permit Total Fees: $73.75 Operator: K_C Printed By: MT Print Date: 06/22/2005 Project Number: 05002092 Inv: 1 Notes: Applitation THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 06/22/2005 Page 2 of 2 Payment Summary: Permit Type Building Permit Fee Amount Invoice Amount Amount Paid Amount Owing $73.75 $73.75 $0.00 $73.75 $73.75 $73.75 $0.00 $73.75 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: MT Print Date: 06/22/2005 Spokanell,F5 BUILDING PERMIT APPLICATION WORKSHEET City of Saokane Valley Community Development Department L _ \\11 E �\ Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 done: (509) 688-0036; Fax: (509) 688-0037 skid i REQUIRED SITE Its ORMATION Street Address: RYS .tP ‘\L L iN k' L t hj Assessor's Tax Parcel Number(s): Legal Description: PERMIT DESCRIPTION: 5151 Building Permit Relocation Fps s t t,).ry ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION 1 ❑ Owner. VOI.> ' (o -VE I) 0 Applicant: C. ary t -n F✓ Phone: Fax: Phone: Fax: Address: +i, 7 ; . r.,.n P1U-r _ Address: Ya-kik...a L \ . 9'939C}7_ City State Trp Code City State Zip Code (a Contractor: (\11(\--k* I -kA 1 t D'ctty0 Architect: Phone: -72S-CGnt3 Fax: \ Phone: Address: 3 2167 R wwk C fare k_ (z.tekt4- fi=b',Address: lAc)orck {A 1l l a? City 1 State Zip Cbde City of l t GLfclSaN S WA State Contractor License #: Contact: Y - H Q \ s nP Spokane Valley Bus. Liscense #: Contact: Fax: State Trp Code HEIGHT TO PEAK DIMENSIONS: # OF STORIES: MAIN FLOOR TO SQ. FTG: 2'4° 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:, 12. © 0- OM% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? Width: Manufacturer: MANUFACTURE HOME , Length: Year: Pit Set: 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: Address: Phone: Fax: City State Inspector. Phone: Fax: Address: Zip City State Zip SPECIAL INSPECTIONS ❑ BOLTING D CONCRETE Firm Name: ❑ REINFORCEMENT Phone: Inspector(s): Fax: 0 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 prope owner. Print Name k o < t i,D Au( Signature Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash 0 Check 0 Mastercard 0 VISA ❑ Other Bankcard #: Authorized Signature: Expires: VIN#: