2005, 05-27 Permit App: 05001834 Addition Project Number: 05001834 Inv: 1 Application Date: 05/27/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: 20 X 18 LIVING ROOM&DINING ROOM Contact: HOOPER,KEITH R.
ADDITION Address: 11404 E 12TH
C-S-Z: SPOKANE VALLEY,WA 99206
Setbacks:Front EXI Left: EX Right: EX Rear: 100 Phone: (509)891-2052
Group Name:
Site Information: Project Name:
Plat Key: CONV Name: CONVERTED CNTY DATA District: Sout
Parcel Number: 45213.9099 Block: Lot:
SiteAddress: 11404 E 12TH AVE Owner:Name: HOOPER,KEITH R.
Address: 11404 E 12TH
Location::CSV SPOKANE VALLEY,WA 99206
Zoning: UR 3.5
Water District: Hold: ❑
Area: .00 Acres Width: 75 Depth: 310 Right Of Way(ft): 60
Nbr of Bldgs: 2 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review , I c AReleased By: yy , t
Li A.-.J. I.Nak Ott tat Styk.. s
uliz
Plan Review Released By: 1' 11/1,fir .k..6t'
Permits:
Operator: K_C Printed By: K_C Print Date: 05/27/2005
s +
Project Number: 05001834 Inv: 1 Application Date: 05/27/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will b• assessed for commencing work without a permit
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Building Characteristics
Group: R-3 Type: VB
Total Area 360
Building Height 15
Stories
Dwelling Units 0
This Application: Total Project:
Description Grp Type Notes Su Ft Valuation Su Ft Valuation
RES ADD R-3 VB360 $26,884.80 360 $26,884.80
Totals: 360 $26,884.80 360 $26,884.80
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $411.45
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $164.58
Permit Total Fees: $580.53
Notes:
Payment Summary: .,
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $580.53 $580.53 $0.00 $580.53
$580.53 $580.53 $0.00 $580.53
Disclaimer:
Submittal of this application certifiethe 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 olther state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 05/27/2005
BUILDING PERMIT APPLICATION WORKSHEET
CITY t&
City of Spoka Valley Community Development Department
Slane Building Division
D 11707 E. Sprague Avenue, Suite 106
400 lie ' Spokane Valley, WA 99206
: r3Ine. (509) 688-0036; Fax: (509) 688-0037
Q I D SITE INFORMATION
Street Address: //min,/ ,E /z '-
Assessor's Tax Parcel Numl er(s): y S"2 /3, 7 0 7 7
Legal Description: ✓- 12 5 ''I‘l 1v Z S Ft' QP w lz or >.1 i l/ G e 5 _/
40 P' 5.-(..,4,1 FxL KO, te/�/
PERMIT DESCRIPTION:
Q Building PermitChange in Use Grading 11] Manufactured Home
❑ Relocation ❑ ii Tenant Improvement n Fire Safety ❑ Other
bWNERIAPPLICANT INFORMATION
❑ Owner: A4,,">, r2 //veil;fi A ❑ Applicant: Sirrn C
Phone: " Fax: Phone: Fax:
Address: Address:
(V City S.ate Zip Code City State Zip Code
❑ Contractor: ,J i.Air, ,e ❑ Architect:
. Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: I ( ,k DIMENSIONS: !? #OF STORIES: •
MAIN FLOOR TO SQ_FTG: ,µ , , . `'
..2" .FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: t HEAT SOURCE: c..",\__ ,c--#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES" PROPERTY: �`l�'1'l_a%'OR ON-SITE SEPTIC.
2 C OW , /U/n' 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
❑ BOLTING (1 CONCRETE ❑ 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 /-"e,iN" /7edifik-2Z Signature //2-4`
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash • ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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