2005, 11-15 Permit App: 05004327 Safety Inspect Project Number: 05004327 Inv: 1 Application Date: 11/15/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project In formation:
'
Permit Use: SAFETY INSPECTION Contact: SINGH,KULDEEP
Address: 4231 DIXON LANDING RD#128
C-S-Z: MILPITAS,CA 95025
Setbacks:Front Left: Right: Rear: Phone: (510)299-1705
Group Name:
Site Information: Project Name:
Plat Key: 002146 Name: RENNER SUB District: F
Parcel Number: 45232.0106 Block: Lot:
SiteAddress: 14109 E 3RD AVE Owner:Name: SINGH,KULDEEP
Address: 4231 DIXON LANDING RD#128
Location::CSV MILPITAS,CA 95025
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: .00 Acres Width: 185 Depth: 191 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 2
Review Information: :.� ,-w. � �.. �
Review
Special Inspections Released H ;- Ati6 ictS
Permits: , .- a r,..._ a __. P._ MENOMEMMONIM23.4181
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
CHANGE OF USE/SAFETY INSP 1 SELECT $47.00
Permit Total Fees: $47.00
Operator: KKZ Printed By: KJK Print Date: 11/15/2005
Project Number: 05004327 Inv: 1 Application Date: 11/15/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes: ".'"1.4P1,„„, curt . ry MUT, ._. a . 1 ._a m �.. kms.
Payment Summary: e-- ZAEW zgKRLP.,.,=,.atA maw— ..:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $47.00 $47.00 $47.00 $0.00
$47.00 $47.00 $47.00 $0.00
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: KKZ Printed By: KJK Print Date: 11/15/2005
City of Spokane Valley
Building Dept
Receipt
Receipt Number: 3506 Customer Number
Projects
Full
Project Nbr Inv Nbr Fee Amt Inv Amt Owink PAID Pint
05004327 1 $47.00 $47.00 $47.00 $47.00 ❑�
Total: $47.00 $47.00 $47.00 $47.00
Miscellaneous Items
Total PAID: $47.00
Tender
Type Check Acct Balance CC Nbr Exp Date TENDERED
Checkl 7078 47.00
Payer: SINGH; KULDEEP
Total TENDERED: 47.00
Over /(Short) $0.00
Change $0.00
Notes:
Tran Date/Time: 11/15/2005 3:41:16 PM
By: KJKURTZ
Logon User: kjkurtz
Station: CX SV00015
Override By:
Printed: 11/15/2005 3:41:19 PM Page 1 of 1
� )11/14/2005 MON 11:44 FAx 509 789 8750 Coldee/1 •Benxer NW Group @j002/OO4
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SITE ADDRESS, / 404/0 7/ /W// F_ 3,-../ 4 vt.
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Describe the scope of work in detail: Cost of Project: 3
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HEIGHT TO PEAK :DIMENSIONS: 1*OF STORIES: TOTAL roarrAsLe SPACE
MAIN FLOOR TO SO. 2 FLOOR SQ.FTG: LINFIN BASEMENT SO_FTG: clAPERVIOUS SURFACE
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FINISHED BASEMENT GARAGE SQ.FTG: DECK COv.PATIO SQ.FTG: •30%stoPos ory
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*OP BEDROOM 'CONSTRUCTION TYPE: MEAT SOURCE: SEWER OR SEPTIC?
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Te pen:bhee versos,odonewieddas and wee*by their signature shat 1) If Ibis wall is far coernve ief of or on s dwdlfry.the
AweIinp term's be served by potable water. 2) Ormeadrlo of this City of Spokane Valley Peoai1 trees to the property owner. 3) The
eIgnabo.y is ttb.p ees:7y owner*etas permissive to represent the property owner in Ods ora.saeI n.a) An eo nseuekore is to b.don.
R tub comp iortoe lir*,!+e CQ rof Spokane Veh.ry Devebpa+ent Coda. Rdeseneed oodles are available br review at the City of
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local taws.codas a ordkto IGes.II) Pians or ad d10onat ielofraalfon maybe fagaked to be subiribeck and=bsrcl8rer1y eDpeowed betbe
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11/14/2005 HON L1: 45 Fax 509 789 8750 Coldwel.1 'asnlier Nw GrQLp 0004/004
11/14/05 ON 11:D1 FAX 510 683 7068 WESTERN DrGITAL 002
Nov 14,2005
As owner of the property at 14109& 14111 E 3td Spokane Valley,WA 99216,I
authorize Merlon and/or Mary Ellen Curtis to act as my agents in securing a permit for
WABO safety inspection.
Signed: F.�Af
Kuldecp Singh
2175 Castillejo Way
Fremont,CA 94539
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