2002, 03-01 Permit App: 02001272 RemodelProject Number: 02001272
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/1/2002 Page 1 of 3
Project Information:
Permit Use: FINISH PARTIAL BASEMENT
Setbacks: Front Left:
Right: Rear:
Site Information:
..................................................
Plat Key: 005666 Name: AUTUMN CREST 4TH ADD
Contact: KILLINGSWORTH, JOSEPHINE
Address: 1907 S ST CHARLES RD
C - S - Z: VERADALE, WA 99037
Phone: (509) 927-1893
Group Name:
Project Name:
District:
F
Parcel Number: 45261.4903
Block:
SiteAddress: 1907 S ST CHARLES RD
VERADALE, WA 99037
Location:: VER
Zoning: UR -3.5
Water District:
Area: 10,000 Sq Ft
Nbr of Bldgs: 1
Review Information:
Review
Plan Review
Urban Residential 3.5
Lot:
Owner: Name: KILLINGSWORTH, JOSEPHINE
Address: 1907 S ST CHARLES RD
VERADALE, WA 99037
Hold: ❑
Width: 80 Depth: 125 Right Of Way (ft): 60
Nbr of Dwellings: 1
l bs
Operator: DMD Printed By: DMD
Print Date:
3/1/2002
Project Number: 02001272
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/1/2002 Page 2 of 3
Contractor: OWNER
Address: 0
000000, 00
Const Category:
Nbr Of Dwellings:
Bldg W x D:
Req Parking:
Description
BASEMENT R
000000
Building Permit
Firm: OWNER
Phone: (000) 000-0000
Building Characteristics
Remodel Group: R-3 Type:
Building Height: Stories:
Sprinklers: ElCritical Materials:
This Application: Total Project:
Grp Type Notes Sci Ft Valuation So Ft Valuation
R-3 VN 1,096 $4,603.20 1,096 $4,603.20
Occupant Load:
x Building Sq Ft:
Handicap Parking:
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Contractor: OWNER
Address: 0
000000, 00 000000
Item Description
VENTILATING FANS
MINIMUM FEE ADJUSTMENT
Totals: 1,096 $4,603.20 1,096 $4,603.20
Units
1
1
1
Unit Desc
Y OR BLANK
Y OR BLANK
Y OR BLANK
Permit Total Fees:
Mechanical Permit
Fee Amount
$100.50
$4.50
$22.11
$127.11
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
1 Select
Permit Total Fees:
Plumbing Permit
Fee Amount
$10.00
$25.00
$35.00
Contractor: OWNER Firm: OWNER
Address: 0 Phone: (000) 000-0000
000000, 00 000000
Item Description
TOILETSBIDETS
SINKS
TUBS
MINIMUM FEE ADJUSTMENT
Units
1
1
1
1
Operator: DMD Printed By: DMD
Unit Desc
NUMBER OF
NUMBER OF
NUMBER OF
Select
Fee Amount
$6.00
$6.00
$6.00
$17.00
Permit Total Fees: $35.00
Print Date: 3/1/2002
Project Number: 02001272
Notes:
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 3/1/2002 Page 3 of 3
Payment Summary
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Fee Amount Invoice Amount
$127.11 $127.11
$35.00 $35.00
$35.00 $35.00
$197.11 $197.11
Amount Paid
$0.00
$0.00
$0.00
Amount Owing
$127.11
$35.00
$35.00
$0.00 $197.11
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: DMD Printed By: DMD Print Date: 3/1/2002
SPOKANE COUNJY
4
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
(2-
Street
2-
SPECIFIC SITE INFORMATION
Street Address: / q
( f 7 Sash
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
uilding Permit
❑ Change in Use
❑ Grading
❑ Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Rears
Left Right.
School District
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
Indicate ubn should he ,onluded ardinn this project
❑ Owner:/ Phone:, a 7 7 7 _ /s„.. 93
o
6GSepA; 4e- I ll1h�/5—WIITrILIa.: �—
El Applicant:
Phone:
Fax:
Kadin Address: /
1 Ci oi' S. ST CA q rV/mss 0j .
Nlailing Address:
Dimensions
(:its, State, Zip
VQ rd/ (0/ Wq. % 0 37
City, State, Zip
Finished basement sg. ft.
❑ Contractor
Phone
Fax
❑ :Architect Lngnneer
Phone
Fax
Nailing address
I leaf source (electric, gas, etc.)
Mailing address
Cin', State 'tip
city, State Zip
WA State Contractor license ii
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# i tf stories
Main floor sq. ft.
Unfinished basement sg. ft.
Dimensions
'Total habitable space
2"d floor sq. ft.
Finished basement sg. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project 00
6-0 0 0, -------
I leaf source (electric, gas, etc.)
Manufactured Home a ,
Sign
Width:
Length:
What is the square footage of the sign
face?
!low high is the sign?
Year.
Make:
# of signs
Area of existing signs
Are there slopes greater than 300/0 on the property? (30 ft rise in 100 ft)
(.......„---0/0 0 Yes 0 No
Proposed use
Value
Relocation
Fire Safety
Firm Name
Previous address
Phone
Fire Sprinkler
Tent
Paint booth _ Fire Alarm
Fireworks display
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 300/0 on the property? (30 ft rise in 100 ft)
(.......„---0/0 0 Yes 0 No
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? O Yes O No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 300/0 on the property? (30 ft rise in 100 ft)
(.......„---0/0 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes O No
Address
Inspector
Phone
0 Concrete
D Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes O No
Ifyes, identi' on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ifyes, identibi on site plan O Yes O No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? O Yes O No
Is any part of the property within a 100 yr flood plain?
Ifyes, identift on site plan
O Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
(Eyes, identi(' an the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, identift on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 300/0 on the property? (30 ft rise in 100 ft)
(.......„---0/0 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes O No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
DYes 0 N
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Yes 0 No
DYes 0 N
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
DYes 0 N
Date Received:
Staff Representatve:
METHOD OF PAYMENT
VISA
0 C.vSI1 0 (;III?CK 0 11111111111111
0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DA TI::
I:SI'1RI:S:
B.\N KC:\R1) NUMBI:R:
.11_11'11 012. I %Ell SIGN:A'I'URIf:
SUB'IO'1'.A].
TOTAL FEE
MINIMUM PERMIT FEE IS $35.00 PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
COUN.IN PERMIT CENTER