2004, 01-20 Permit App: BLD-04-03424 Addition crrr06.°1%**,Or e
400 011;Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: V-,; I O Q 1 'k ' V tie ei ,{Y \ okQ nz V iAV 4 . 9.9qoal
ASSESSOR'S TAX PARCEL NUMBER(S): 4Ur /' . 1' O j
LEGAL DISCRIPTION: (i q c,1e[A
PERMIT DESCRIPTION: -�' c'
Re l e assns �a� owl j ) -al ���i �QYr�e ��ft ��o
UILDING PERMIT 0 GRADING a MANUFACTURED HOME(�
,9--
,� �-CHANGEI1�tUSE
}RELOCATION ®SIGN . D TENANT f OTHER...
OWNER / APPLICANT INFORMATION
EIVWNER: 'lei/ 1 er ® APPLICANT:
„PHONE: 'J0!') Q,G-'k ill (1't }moi I`Si PHONE: FAX
.l �J ,t ACJ Z �1 j Q
ADDRESS:.; a.5 Uan l`4L1(t -pcokcnValt° )�� ADDRESS:
i I CITY,ST E,ZIP . CITY,STATE,ZIP
®CONTRACTOR: GL hi0f�b 0 n� ® ARCHITECT:
PHONE:( 0.) / "Z/ -?' O FAX: PHONE: FAX:
ADDRESS: ..04. f,.4j;k,j .JJjv°j4.lf✓�lt1>S4Tk 2501? ADDRESS:
ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# ,L.MOM 4.44/1 `"""i7/ P ONTACT:
No i r. i NVatm--
1
PERMIT/BUILDING INFORMATION
COST OF PROJECT: ,V VI30%SLOPES ON PROPERTY: . MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: I D OCCUPANCY GROUP 2ND
_' n FLOOR SQ FT:
BUILDING DIMENSIONS:g X\J CONSTRUCTION TYPE:1„J s -Pflef„e UNFIN BASEMENT:
NUMBER OF STORIES: 1 STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL.AREAS: A 7,/k',rt.,
FLANKING SETBACK: •CURRENT PROPERTY SIZE: IU C5./ COVERED DECK:,
FRONT SETBACK: t. 6 CURRENT PROPERTY USE: R DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: ,D ! CURRENT WELL USE:
RIGHT SETBACK: NA1 Ifti;CB( _ IMPERVIOUS SURFACE AREA:/ D to
IMANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OrSIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE
.1, _
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
I
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 NO IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: ® YES 0 NO
IDATE: STAFF:
METHOD OF PAYMENT‘ -
EI ® ® r —- . El .......• a
44a5n Mc7I W. coo„,Atte'
CASH CHECK t �...�� h
t o,Aii 00°1 0:00 te
BANKCARD#,S %RES,_ doc'oaK i RSV1.9:255.aesto l d
eIto ft' ed %1 % a C' ' 03
AUTHORIZED S/GNATUI cOa ode p 3 G52o1 0
th ps0 P.34
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH M•.R� ?.• i.•" • -D
P°
,.
00 03 AUDITOR'S CERTIFICATE
0656-11 FILED FOR RECORD THIS DAY
OF , 2003 AT M.
IN BOOK OF AT PAGE
IAT THE REQUEST OF ADAMS & CLARK, INC.
I
(Signed)
I County Auditor
LEGAL DESCRIPTION PARCEL A
I (Prepared by Adams & Clark, Inc.)
I That portion of the east 90 feet of Tract 196 of Opportunity, according
the plot recorded in Volume "K" of Plats, Pages 20, to
I NW1/4 of Section 21, 9 21 and 22, in the
/ Township 25 North, Range 44 East, W.M., City of
Spokane Valley, Spokane County, Washington, described as follows:
IBeginnin at thenor
Q i 9theast corner of said Tract 196 and the northwest
corner of Spokane County Short Plot No. 606-89, according to the short
0, plot recorded in Volume 6 of Short Plots, Page 81; thence S0O'01'21"W,
lY along the east line of said Tract 196 and along the west line of said
Short Plot, and then along said east line and along the west line of the
J plot of Heartland Second Addition, according to the plot recorded in Book
I 20 of Plats, Page 18, a distance of 170.93 feet; thence S87'35'47"W 90.81
feet (Record 90.08 feet per the Statutory Warranty Deed recorded
i. September 26, 2001, as Auditor's Document No. 4634869) to a point on
the east line of Sorensen's Subdivision, according to the plot recorded in
I
Book 1 of Plots, Page 90; thence N00'06'09"W, along said east line, 174.12
feet to the northeast corner of said plat; thence N89'36'23"E, along the
I north line of said Tract 196, a distance of 91.11 feet (Record 90.08 feet
per the Statutory Warranty Deed recorded September 26, 2001, as
I Auditor's Document No. 4634869) to the point of beginning;
Containing 15,687 square feet.
I
I LEGAL DESCRIPTION PARCEL B
(Prepared by Adams & Clark, Inc.)
iThat portion of the east 90 feet of Tract 196 of Opportunity, ac
the plot recorded in Volume "K" of Plats, Pages 20, 21 and22, in rttheg to
NW1/4 of Section 21, Township 25 North, Range 44 East, W.M., City of
Spokane Valley, Spokane County, Washington, described as follows:
Beginning at the northeast corner of said Tract 196 and the northwest
corner of Spokaie County Short Plot No. 606-89, according to the short
plot recorded in Volume 6 of Short Plots, Page 81; thence S00'01'21"W,
along the east line of said Tract 196 and along the west line of said
Short Plot, and then along said east line and along the west line of the
plot of Heartland Second Addition, according to the plot recorded in Book
20 of Plots, Page 18, a distance of 170.93 feet to the TRUE POINT OF
BEGINNING; thence continuing SO0'01'21"W, along said east line of Tract
196 and along the said west line of Heartland Second Addition, and then
along said east line and along the west line of Cr,n....... A.�,,.._ __
r
I
1" IRON PIPE
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79.88' 80.18'
SPIKE IN7 N N 91.11
CC iv Q: xN89'36'23"E�(80.00 )S 879-89 (80.00')SR9
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SR9 & SR10. 1 n N I NR, 2 c �� �� �� WITH SMASHED WITH SMASH
1 " " 1 N o"toA Nc ,rio YPC, [0.4'W] YPC
1/2" IRON PIPE I 3/4" IRON PIPE 1 0 0 ' Q Q, .1 D 1 2
WITH NO ID WITH NO D N a �o �p� �, S.P. IC)
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0 o d-. WITH NO ID, BENT
2 ori ,n cv 3 �...�0.811/2" REBAR WITH YPC
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1/2" IRON PIPE .° 0 706" PER SR8
WITH NO IO p, " 4 0 N o �o O
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cj �' WITH NO ID �' ^'E' 90' x^ MART-LA-ill
W� w --+ HEAR
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Lu.
p n) S 202.16' t j�n ig io B _—�..__5�5TH _ COURT----
_ c�� WITH NO ID Irl $ N89'36'54"Ea; 196 54.-00' 1/2" REBAR WITH
S 01 <I z 5/8 IRON PIPE .o�� `No - YPC MARKED "LS
1/2" PINCHED a' Cl)oWITH NO ID, OI ^o^ o cn 18091" PER SR11
TOP IRON PIPE Z1
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WITH NO ID a �- ^ '� D-
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6 No JJ ", NWITH NO ID cn o 3 0
3/4" IRON PIPE -91
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WITH NO ID o ^ v►� c FliN.
vii o' TH, IRON 0 0 PIPE cv o Z op 1/2" REBAR WITH I
7 .m a, z. .- 0 �o N h. YPC MARKED
1/2" PINCHED TOP ^ ^ ^ ^ 8 ^ / in "SIMPSON LS 706" CARANC
PIPE WITH NO ID-. • N8936'5611 •• ___ N ' PER SR7 1 'S
I No o . 202.56' x > ° � 1 I 2OI 3 I
8 I o 3/4" IRON PIPE 9 N Lo,1-1/4" IRON ADDIT1OP
I a° 'Q id WITH NO ID, BENT ad PIPE WITH NO
°r•° 0 ^ [0.2'S] REPLACED g9 ggs. ( ID, [0.7'E]
345.53 _ _ _ I N8932 33 E 202.70' S89'32'33" P-K NA
- 6TH AVENUE N89'32'33"E 317.38' — —1--_— — — — —-— —
321.73'
14 13 12 11 10 9 8 7 6 I 5
i
1
LEGEND
• = SET 1/2" REBAR WITH
II
YELLOW PLASTIC CAP
MARKED "A&C INC 12Qne."
APPROVED BY 4e ,
" IRON PIPE ✓
VI TH NO ID 1 /2" REBAR
DARE WITH SMASHED 1 /2" REE
BOLD YPC WITH NO
117. 65' 79. 88' 80. 00')SRg F
91 .11 '
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9'36'23"E
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