2005, 08-22 Permit App: 05002999 Addition Project Number: 05002999 Inv: 1 Application Date: 08/22/2005 Page 1 of 2
THIS IS'NOT'A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: ADDITION OF DECK AND REPAIR RAMP Contact: CLARK,BRIAN
Address: 15405 E 12TH AVE
C-S-Z: VERADALE,WA 99037
Setbacks:Front 52 Left: 22 Right: 54 Rear: 26 Phone: (509)892-7674
Group Name:
Site Information: Project Name:
Plat Key: 003120 Name: CASTLE COURT District: Sout
Parcel Number: 45234.4001 Block: Lot:
SiteAddress: 15405 E 12TH AVE Owner:Name: CLARK,BRIAN
Address: 15405 E 12TH AVE
Location::CSV VERADALE,WA 99037
Zoning: UNK
Water District: Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review Released By:
Originally Released: 08/18/2005 By: cjjanssen
Plan Review Released By:
Originally Released: 08/22/2005 By: TMELBOU
Permits:
Operator: CJJ Printed By: CJJ Print Date: 08/22/2005
Project Number: 05002999 Inv: 1 Application Date: 08/22/2005 Page 2 of 2
THIS IS'NOTA PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
DECK R-3 VB DECK 0 $1,000.00 0 $1,000.00
ADDN&
REPAIR
Totals: 0 $1,000.00 0 $1,000.00
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $69.25
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $27.70
Permit Total Fees: $101.45
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $101.45 $101.45 $0.00 $101.45
$101.45 $101.45 $0.00 $101.45
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: CJJ Printed By: CJJ Print Date: 08/22/2005
�-: BUILDING PERMIT APPLICATION WORKSHEET
Sjôkn City of Spokane Valley Community Development Department
ane �-. Building Division
�� �� 07 E. Sprague Avenue, Suite 106
RE ((� [ Spokane Valley, WA 99206
400,V
\7aiIey
_ 1 d) As- Phone: ( (f9) 688-0036; Fax: (509) 688-0037
�f
REQUIR SITE, IISFP)R'M 7' -N
Street Address: 15 y 0 5 // 5 y0-7 E, 1,2 e
/ Assessor's Tax Parcel Number(s): I-15,�-5 / 2/00Legal Description: LI 6 r i1 4( -e C 0uc k-
PERMIT DESCRIPTION: P a 114.p rew,ode I ato c c : -
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Er Owner. Q 6 k aitl C f a-rk Er Applicant: G;ce,i k_ C 1 a.rlx
Phone: $99,-74'7/ Fax: Phone: T-la-7(4. 'zi Fax:
Address: i 5 o S E. la A,,,e Address: /s,f 0 5 r 12=`
X -Ifyike" (j te' 037 5,c1Cr-V�. (4 l j (tater q9vZp Code
Zip Code G►tY i
❑ Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
• WA State Contractor License#: Contact:
Spokane Valley Bus. Liscense #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: t , #OF STORIES:
sy/o veci< 41 s x %S Ai(..cA!`t
MAIN FLOOR TO SQ. FTG: 2""FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
/ z sF
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
_24E2/(279f OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
fl e✓()(i' 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-
uCODE
Plans Examiner: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ 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 t Cl y( C I a (O Signature •
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Li Cash ❑ Check ❑ Mastercard
❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature: