2001, 06-06 Permit App: 01004369 Repair Fire Damage Project Number: 01004369 Inv: 1 'Application Date: 6/6/2001 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: FIRE REPAIR TO HOUSE TRUSSES &PTN OF Contact: BELFOR CONSTRUCTION
GARAGE WALL FRAMING Address: 10020 E. KNOX,SUITE 100
C-S -Z: SPOKANE,WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509)893-0001
Group Name:
Site Information: Project Name:
Plat Key: 002764 Name: VERADALE HEIGHTS 02ND District: F
Parcel Number: 45143.1209 Block: Lot:
SiteAddress: 14121 E SPRINGFIELD AVE Owner: Name: JACOBSON,DON &VERNA
SPOKANE,WA 99216 Address: 14121 E SPRINGFIELD AVE
Location:: SPO SPOKANE,WA 99216
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 0 Sq Ft Width: 107 Depth: 140 Right Of Way(ft): 50
Nbr of Bldgs: 0 Nbr of Dwellings: 1
v'ew In
orm _....
Ret
f
Department Review
BUILDIN S ecial Reviews Released By:
( HoReasons: LtQ c i f\k_ } •
Permit Conditions:
Permits: ...... .. .... .
Y 1
Project Number: 01004369 Inv: 1 Application Date: 6/6/2001 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: BELFOR CONSTRUCTION Firm: BELFOR CONSTRUCTION
Address: 10020 E. KNOX SUITE 100 Phone: (509)893-0001
SPOKANE,WA 99206
Building Characteristics
Const Category: Remodel Group: R-3 Type: VN
Nbr Of Dwellings: Occupant Load: Building Height: Stories:
Bldg W x D: x Building Sq Ft: Sprinklers: 0
Req Parking: Handicap Parking: Critical Materials: 0
This Application: Total Project:
Description Grp Type Notes So Ft Valuation Sq Ft Valuation
RESIDENCE R-3 VN FIRE 0 $80,000.00 0 $80,000.00
DAMAGE
REPAIR
Totals: 0 $80,000.00 0 $80,000.00
Item Description Units Unit Desc Fee Amount
RESIDENTIAL VALUATION 1 Y OR BLANK $767.50
STA 1'E SURCHARGE 1 Y OR BLANK $4.50
RESIDENTIAL SURCHARGE 1 Y OR BLANK $168.85
Permit Total Fees: $940.85
Payment Summary:
. ...................
Operator: MKC Printed By: MKC Print Date: 6/6/2001
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $940.85 $940.85 $0.00 $940.85
$940.85 $940.85 $0.00 $940.85
Notes
t C1 — 30
idc, PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
_ = SPOKANE,WA 99260
509-477-3675
SPOKANg CouI TY
SPECIFIC SITE INFORMATION
Street Address: ) >/G > C r . �� t-
Ai" n� id 50U &
Assessor's Tax Par/ceelllNumbber(s):
Legal Description:
Project Description: (--, , `' rih .....6." ,4 , --tit he?, 6* � 97�. IAo
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured e Permit $
Cl Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other
Department Use Only
...Water District/Purveyor: Sewer Disttict/Purveyor Road width Setbacks
Front: Rear.
School District: Fire District: Zoning
Lek: Right
OWNER/APPLICANT INFORMATION
IZI Indicate tabs,bould be raNar/ed re�urdin„MI,'proje i
❑ / r 4p��Owner: �, Phone: ❑ Applicant: Phone:
04,0 i Fax: Fax:
Mailing Address: Mailing Address:
Sic A, i
City,State,Yip City,State,Zip
cw'contractor Phone 3--047/ ❑ Architect/I[ng neer Phone
/3014 las(6-#Q)893--1)0oC l•ax
Mailing address Mailing address
/al 20 (el/ /GH9e- /GU
City,State tip City,State tip
5-PCIS Wa W 2P6
WA State Contractor license# Contact name
J gI4oyG 990/.37
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
Dimensions Total habi able space 2"d floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
5frz& l
Cost of proj; t . — � „ � I Teat source(electric,gas,etc.)
I
Manufactured Home Sign;
Width: Length: What is the square footage of the sign I low high is the sign?
face?
Year: Make: #of signs Area of existing signs
Relocation Fire Safety
Previous address
Fire Sprinkler Tent
Paint booth Fire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
O Concrete O Welding 0 Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes D No What is the current property size?
Ifyes,identij,on site plan (square feet or acres)
Is any part of the property within 250 feet of a shoreline? What is the current use of this property?
If yes,identify on site plan 0 Yes 0 No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes 0 No
0 Don't know 0 Yes 0 No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
1/yes,identif),on site plan If ye.,identfy on the site plan 0 Yes 0 No
0 Maybe 0 Don't know 0 Yes 0 No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
If yes,identify on site plan 0 Yes 0 No 0 Yes 0 No
Are there slopes greater than 30°i,on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site?
( -%) CI Yes 0 N Yes No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No
O Yes 0 No
Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? O Yes 0 No
DYes ONo
Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area?
DYes ONo
Date Received: Staff Representative:
METHOD OF PAYMENT
1C.teiT, SUB l O"1'.Al,
VISA
1:71
❑ CAslI D CIll:CK ❑ ❑ ❑ .-
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
l).\71:: I;SPIRT?S: TOTAL FEE
BANKCARD NUMBI?R: MINIMUM PERMIT FEE IS$35.00PLFASF.
01AI:E CHECKS PAYABLE To SPOKANE
TORI%l:D SItiN.A'I'UltI'.: COUNTY PERMIT CENTER