2002, 04-11 Permit App: 02002469 AdditionProject Number: 02002469 Inv: I Application Date: 4/11/02 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
.,:'- G'hLca'-
Permit Use: ADD (2) LEVEL I CLIENTS TO EXISTING ADULT Contact: PETERSON, MERRILL & CRAIG
FAMILY HOME/LOWER LEVEL Address: 14523 E 6TH
C - S - Z: SPOKANE WA 99216
Setbacks: Front Left: Right: Rear: Phone: (509) 928-7681
Group Name:
Site Information: Project Name:
Mn'
a . �.�.
Plat Key: 005421 Name: CANAL ADDITION District: G
Parcel Number: 55184.3114 Block: Lot:
SiteAddress: 18010 E SPRINGFIELD AVE Owner: Name: PETERSON, MERRILL & CRAIG
GREENACRES, WA 99016 Address: 14523 E 6TH
Location:: GRE SPOKANE WA 99216
Zoning: UR -3,5
Water District:
Area: 11,691 Sq Ft Width: 85
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Hold: ❑
Depth: 121 Right Of Way (ft): 50
Review Information.
Review
Septic System Review
Permits:
Building Permit —
Contractor: OWNER Firm: OWNER
Phone:
Building Characteristics
Const Category: Change Of Use Group: LC -1 Type: VN
Nbr Of Dwellings: Occupant Load: Building Height: Stories:
Bldg W x D: x Building Sq Ft: Sprinklers: ❑
Req Parking: Handicap Parking: Critical Materials: ❑
Item Description Units Unit Desc Fee Amount
CHANGE OF USE/SAFETY INSP 1 Y OR BLANK $50.00
STATE SURCHARGE 1 Y OR BLANK $4.50
Permit Total Fees: $54.50
Operator: CKF Printed By: CKF Print Date: 4/11/02
Project Number: 02002469 Inv: I Application Date: 4/11/02 Page 2 of 2
THIS IS NOT A PERMIT
..�
Penalties will be assessed for commencing work without a permit
Notes
WATER DISTRICT APPROVAL REQUIRED FIRE DISTRICT APPROVAL REQUIRED
APPROVED FOR A TOTAL (6) LEVEL I CLIENTS
Payment Summary.
Permit Tune Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $54.50 $54.50 $0.00 $54.50
$54.50 $54.50 $0.00 $54.50
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 contrued 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: CKF Printed By: CKF Print Date: 4/11/02
PROJECT, APPLICATION WORK SHEET
SPOKANE COUNTY DIPISION OF BUILDING & CODE ENFORCE\-iENT
1026 WEST BROADWAY AVENUE
IM -4 SPOKANE, "CX'A 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s): _ _
Legal Description:
Project Description: 4!5z,n ,
❑ Building Permit Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation 0Sgn ❑ Tenant (New/Change) ❑ Other
Department Use Only
\Vater District/Purvcvor.
Sewer Distnct/Purveyor
Road width
Setbacks ,
Dnn(nm ons
✓
/
�Y r 5 F.— % -- G
Front Rear.
School District:
Fire District.
Zoning
Deck>q.ft.
Cost otpnoicct
I ILA Source (elrctric, gaS, rtcJ
Left Right.
OWNER/APPLICANT INFORMATION
0-6,,ncr.
Phone: 2 16 5-57- 66
❑ Arphcaot. Phone
Main floor sy. ft-
Unfinished basement sq. ft.
Dnn(nm ons
✓
/
�Y r 5 F.— % -- G
Fav
NlA g Add, ,
COIIStniehonhpc
i\ta,hng Add,",
Deck>q.ft.
Cost otpnoicct
I ILA Source (elrctric, gaS, rtcJ
Cin, Suatq X,P
Cin, State, rip
❑ Contnctot
Phone
❑ Architect, l-.nh-ne(r Phone
Pas
Fa.
Nlmhmg addrrss
\tailing addres.
Cm, Smtc Xo
- P
-
(.on, State 7,p
\\ A State Cuniractnr
l--0 S
Contact name:
niJ llllC!'T 7H77C/ln 1rAATllIAi
Building Information
Ruddim", height to hrak
# of stun";
Main floor sy. ft-
Unfinished basement sq. ft.
Dnn(nm ons
Total habitable spat(
2^' floor sq. It.
I inishcd bas(mcnt sq. ft.
(keupaneegroup
COIIStniehonhpc
(itragesq It.
Deck>q.ft.
Cost otpnoicct
I ILA Source (elrctric, gaS, rtcJ
Manufactured Home Si gn
\X'idth:
Length: \X1hat is the square footage of the sign
face?
How high is the sign?
Year.
Make_ h of Signs gr '
;1rca of existing signs
Inspector Phone
❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement
Address
Relocation Fire Safety
Previous address
Fire Sprinkler "fent
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
Ifyes, identi on site plan ❑ Yes ❑ No
Inspector Phone
❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement
Address
ADDITIONAL. SITF. INFORMATION
Are there structures on the property? ❑ Yes ❑ No
\What is the current property size?
I ,es, identi# on rite plan
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
\\'hat is the current use of this propcm•?
Ifyes, identi on site plan ❑ Yes ❑ No
Is the property inside the ASA?
Is your property in a designated wildlife habitat area?
\Fill the site be served by a septic system? ❑ Ycs ❑ No
❑ Don't know ❑ Yes ❑ No
Is any part of the property within a 100 yr Flood plain?
Are or will there be wells located on the property?
Ifyes, ident to site plan
Ifyes, ident , on the site plan ❑ Y cs ❑ No
❑ Mavbe ❑ Don't know ❑ Yes ❑ No
❑ No
Are there any wetlands, streams or ponds within 200 feet of the property?
Is there evidence of fill or excavation on the property?
I( -es, idento, on site lan ❑ Yes ❑ No
❑ 1"c1, ❑ No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
Are critical or hazardous materials used or stored on site?
(__-°-o) ❑ Yes ❑ No
❑ Yes ❑ No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
Is public sewer available to the site? ❑ Yes ❑ No
❑ Yes
❑ No
Is the property inside the ASA?
O Yes
❑ No
Is public water available to the site? ❑ Yes ❑ No
❑ Yes
❑ No
Is the property inside the PSSA?
❑ Yes
❑ No
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date RvccneJ:
titaff Rcprc>cmaticc
METHOD OF PAYMENT
�11 j7
VISA
❑ c.\sl I p cl ncch ❑ � ❑ `'' ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I•:Sl'lRl•:�:
B.\NK(:.\RI) 1x11\IRI R:
\L' I'I 10RlXl:I)',IGN.\'I'LTF:
l TTc )T \l .
TOTAL FEE
MINIMUM PERU/T FEE /5 $35.019 Pl.l : k9
COL Nll" PI 10111-Ul\1TR