2003, 01-28 Permit App: 03000510 Addition Project Number: 03000510 Inv: 1 Application Date: 1/28/2003 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: RESIDENCE ADDITION-FAMILY ROOM Contact: MIKE PEPLINSKI
Address: PO BOX 178
C -S -Z: NEWMAN LAKE,WA 99025
Setbacks: Front EXI Left: 13 Right: 13 Rear: 72 Phone: (509)994-9315
Group Name:
Site Information: Project Name:
Plat Key: 000639 Name: DOBRAVEC 03RD ADD District: F
Parcel Number: 45213.2004 Block: Lot:
SiteAddress: 11324 E 9TH AVE Owner: Name: CLARK,BRUCE W
SPOKANE,WA 99206 Address: 11324 E 9TH AVE
Location:: SPO SPOKANE,WA 99206
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 13,500 Sq Ft Width: 90 Depth: 150 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review '`Released By work_� ', '` ' �� ,p,,a
Plan Review
Released By. "►. � '"�
Operator: RMB Printed By: RMB Print Date: 1/28/2003
Project Number: 03000510 Inv: 1 Application Date: 1/28/2003 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: MIKE PEPLINSKI Firm: MIKE PEPLINSKI
Address: PO BOX 178 Phone: (509) 226-3963
NEWMAN LAKE,WA 99025
Building Characteristics
Const Category: Addition Group: Type:
Nbr Of Dwellings: Occupant Load: Building Height: Stories:
Bldg W x D: x Building Sq Ft: Sprinklers:
Req Parking: Handicap Parking: Critical Materials: E
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
RES ADD R-3 VN 410 $27,060.00 410 $27,060.00
Totals: 410 $27,060.00 410 $27,060.00
Item Description Units Unit Desc Fee Amount
STATE SURCHARGE 1 Y OR BLANK $4.50
RESIDENTIAL SURCHARGE 1 Y OR BLANK $83.38
RESIDENTIAL VALUATION 1 Y OR BLANK $379.00
Permit Total Fees: $466.88
Payment Summary
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $466.88 $466.88 $0.00 $466.88
$466.88 $466.88 $0.00 $466.88
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: RMB Printed By: RMB Print Date: 1/28/2003
i PROJECT APPLICATION WORK SHEET
ik SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
Air
1026 WEST BROADWAY AVENUE
- SPOKANE,WA 99260
509-477-3675
SPOKAECOUVY
SPECIFIC SITE INFORMATION
Street Address:
\ % 30)y E. (,tea
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: i Co x ,$ Pips)(-1-mi -ID 9Ac,v-- cf E KNS. . ,.cc, t,),>je
Ilt-Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit
❑ Relocation In Sign ❑ Tenant(New/Change) Cl Other
Department Use Only
Water District/Purveyor. Sewer District/Pun-eyor Road width Setbacks
Front Rear.
School District Fire District Zoning
Left Right
s
OWNER/APPLICANT INFORMATION
El Indicate who should he contacted re,iardieg this jar jed
® Owner: Phone 91 e211,.. 94,1-)... ❑ Applicant: Phone:
R.Uct. C.-1.-A fl.� Fax: V\I\\Kc RSR Ls y S xl! Fax:
Mailing Address: Mailing Address:
1 \ 3 ‘)js/ E • )��'a
(:in,State,tip Cit,State,Zip
5‘?'D 10b,, E ~�R
Contractor (—s..,, Phone Phone
M 39tp� ❑ Architect/]inlnncer
\�C Z.Z�^
�liL17'75(J las lax
Mailing address Mailing address
Pry, Q.,,,,,<-... ,1 r3
Cin,State Zip City,State Zip
�-• M31. L.A Ko 'A °i 43
VV A State Contractor license it Contact name
IA.\ SCE-Pc-- Yog
PROJECT INFORMATION
Building Information
Building height to peak #of stories Main floor sq.ft. Unfinished basement sq.ft.
\3 3 1 -viol v:_)(p<
llimensions Total habitable space 2"d floor sq.ft. Finished basement sq.ft.
t e 1C (45`f (- 1a*' 'Y it) / ),,, ei1 X
Occupancy group Construction type Garage sg.ft. Deck sq.ft.
Cost of project I Ieat source(electric,gas,etc.)
( ,3NE2.-f 477 f, —
Manufactured Home Sign
Width: Length: What is&te square footage of the sign How high is the sign?
face?
Year: Make: #of signs Area of existing signs
Relocation Fire Safety
Previous address Fire Sprinkler Tent
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
Inspector Phone
O Concrete O Welding O Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? la Yes O No What is the current property size?
Ifyes,identify on site plan (square feet or acres) y V C
Is any part of the property within 250 feet of a shoreline? What is the current use of this property?
Ifyes,ident i on site plan O Yes )g No )�
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?O Yes ,Q No
O Don't know 0 Yes `2J No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifyes,identifi,on site plan 1 fyes,ideate on the site plan O Yes g No
O Maybe O Don't know O Yes ;133. No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identi'on site plan O Yes A No O Yes IX 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?
( %) OYes No CI Yes rn. No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? CI Yes O No
CI Yes CI No
Is the property inside the ASA? 0 Yes O No Is public water available to the site? 0 Yes O No
OYes 0 N
Is the property inside the PSSA? O Yes O No Is the property located within 1000 feet of a Natural Resource Area?
OYes 0 N
Date Received: Staff Representative:
METHOD OF PAYMENT
MOM=
SUB"I'O'1':Al.
VISA
0 CASA clll(CK ❑ 0 ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
I?\PIRI:S: TOTAL FEE
B:ANKCARI)NMINIMUM PERMIT FEE IS$3500Pik:‘SE
319KE CHECKS P_11-AII1E.1.0 SPOKANE
:AU 1'1 IORI'/A:D SIGNA'1 ORI':: COCNTY PIRMITCENTE_R
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ADDRESS
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ROFARDoWNITD_TH
COMNil - St' LANWING _
REVIEWL.
f This sit plan is being submitted for the purpose of
obtaini, -2; !t ;,:!ing permit-and is a true and correct
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represe tation of,the proposal.All known property
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lines/dirtensions, curb lines,structures and easements
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I have been identified.Also indicated are wetlands,
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bodies df water, steep slopes or other critical areas.
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