2004, 08-19 Permit App: BLD-04-07409 ROW BUILDING PERMIT APPLICATION WORKSHEET
SCITY OF �]#0"\kCity of Spokane Valley Community Development Department
j , e Building Division
117Q7 E. Sprague Avenue, Suite 106
�� � s • Spokane Valley, WA 99206
Phone: (509) 6884)036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION. - .
Street Address: //qq j- 4----:-. F7/2 •
Assessor's Tax Parcel Number(s): • .
Legal Description: .
PERMIT DESCRIPTION: S •
0 Building Permit D Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: ,/,6-17//4,f' 271 /e zrs�.) ❑ Applicant:
Phone: 9‘2,__Z-_:,,E/9_1 /2. ax: 0 Phone: Fax:
Address: //<-i e 14' � ', Address:
' . - _ i(o
'.
vim' I' , ,tate Zip Code City State Zip Code
❑ Contractor: ^ (�ei..7. cz -,F.2 -❑ Architect:
Phone:1-61,- -.Ex: Phone: Fax:
c
Address: 2 6 -.)y, j� 1171,,,,,Li',1r-2f Address:
City I State Zip Code City • State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK ' DIMENSIONS: #OF STORES . ..
MAIN FLOOR TO SQ. FTG: ` 2'"r FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ:FTG: - DECK/CONI. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: ' TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: • 30°k SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width; Length: Year: Pit Set: •
Manufacturer: •
• RELOCATION
Previous Address: .
Proposed Use:
FIRE SAFETY •
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: • Date/Time:
Valuation: Above/Underground Storage Tank Size:
•
•
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
•
Plans Examiner: Phone: Fax:
Address: •
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
D BOLTING 0 CONCRETE 0 REINFORCEMENT ❑ -WELDING
Firm Name: Phone:. Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to,be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
•
Print Name • Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard),
❑ Cash 0 Check . • ❑ Mastercard . • D VISA
0 Other
• Bankcard #: Expires: • VIN#:
Authorized Signature: •
Inspections performed 10 days after
r scheduled completion to schedule call
(509)688-0195 or Fax(509)688-0037. Any re-
inspection will incur an additional$25.00
charge
E Sprague Ave,Suite 106
Spokane Valley,WA 99206
ROW Construction Permit
Permit# ROW 04-688 Issue Date 8/26/200.4 Account#
Completion Date Issued by Kcummings Construction Utility
Location of Property Project Description
� O
11409 E 8TH construction
Comments
IPAVING 14 X 84 STRIP OF RNV IN FRONT YARD
Trench Dimensions AC Cut Required
Applicant/Contractor Name Licence # Individual Name
J &J Construction
Address Contractor Phone#
N 9200 Market (509) 468-8557
Spokane WA 99206-
Account#
Permit Fee Inspection Fee Total Fees Collected
$16.00 $25.00 $41.00 (� n h
Permittee Signature Approved 410 Date O - ! U -(
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Credit Card# Expiration Date
Name of Holder Signature
In addition to the permit application fee of$16.00(utility)or$25.00(construction),inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(signed) Date
PERMIT MUST BE KEPT ON SITE
J & J CONSTRUCTION
ASPHALT CONSTRUCTION ESTIMATE
9200 N. Market Street
Spokane,WA. 99217 DATE
509-468-8557 Office
NAME
509-468-4786 Fax# 8/12/2004
/ Arthur M. Pederson For Scheduling: John Russell Sr.
11409 E. 8th On Site Manager: John Russell Jr.
Estimator: Brent McCoy
Spokane Valley,WA. 99206
REP: BMC
DESCRIPTION OF WORK TO BE COMPLETED
Total
Job Location: 11409 E. 8th
We propose to fine grade and pave the specified area(driveway approach between lawn and street- 14'x 84') 1,900.00
using 2 inches of crushed rock and 2 inches of asphalt compacted. Apply weed preventative prior to paving.
Approximately 131 square yards. J &J Construction to supply labor and materials to complete the project as
quoted. This price is based on the square yards above.
Exclusions: Permits
Note: Due to rising oil prices this proposal is valid for 30 days. If accepted after 30 days, a review on
material cost may be necessary.
Sales Tax 153.90
•
DOWN PAYMENT REQUIRED $684.63 Total $2,053.90
If estimate is acceptable,please sign,and return with 1/3 down payment, and you will be contacted per scheduling.
This estimate is valid for 30 days from date above. After 30 days,this estimate can be reviewed to make any necessary
adjustments.Work outside the scope of this contract will be performed only with a properly executed change order at a
price to be agreed upon at the time the change in work is requested. Any changes as per specified area and the price will be
adjusted accordingly. If additional work is needed there must be a signed"Work Change Order"
Other Terms&Conditions see reverse side
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SIGNATURE &DATE
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