2007, 10-26 Permit App: 07004185 Residence Project Number: 07004185 Inv: 1 Application Date: 10/26/2007 Page 1 of 4
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW SFR W/ATT GAR Contact: YAKOV BANAR
Address: 6528 PINEBURR CT
C-S-Z: ORANGEVILLE,CA 95662
Setbacks: Front 25 Left: 5 Right: 5 Rear: 98 Phone: (509)225-2836
Group Name:
Site Information: Project Name:
Plat Key: Name: BETTMAN'S ADD District: Sout
Parcel Number: 35243.0987 Block: Lot:
SiteAddress: 6105 U E 14TH AVE Owner:Name: BANAR,YAKOV
Address: 6528 PINEBURR CT
Location::CSV ORANGEVILLE,CA 95662
Zoning: UR-3.5 Urban Residential 3.5
Water District: 100 SPO CO WATER DIST#3A Hold: ❑
Area: 6,750 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information: = G . .. .. 4mgawg,. , tt,b . -:=a {5,.
Review
Flood Plain Released By:
BETTMAN'S ADDITION- LOTS 7 THROUGH 18 OF BLOCK 8;AND LOTS 9, 10,15 AND 16 OF
BLOCK 5 HAVE BEEN PULLED OUT OF THE FLOOD PLAIN.
Originally Released: 10/26/2007 By: MTURBAK
Building Plan Review Released By:
Originally Released: 10/23/2007 By: tmelbourn
Other Reviews Released By:
RECORDED TITLE DOCUMENT BROUGHT IN 10/23/07
Originally Released: 10/23/2007 By: jdavis
Operator: JD Printed By: jmm Print Date: 10/26/2007
Project Number: 07004185 Inv: 1 Application Date: 10/26/2007 Page 2 of 4
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Driveway/Approach Released By:
Originally Released: 10/24/2007 By: jdavis
Potable Water Review Released By:
PER GEORGE-SCWD#3-VIA PHONE-10/24/2007-MT
Originally Released: 10/24/2007 By: mturbak
Landuse/Zoning/HE Conditions Released By:
Originally Released: 10/26/2007 By: MPALANI
Sewer Review Released By: — J
07007429
Originally Released: 10/24/2007 By: JLMain
Permits: s .. .$ xZ.MIVAES ::. ;.
Operator: JD Printed By: jmm Print Date: 10/26/2007
Project Number: 07004185 Inv: 1 Application ' Date: 10/26/2007 Page 3 of 4
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Building Characteristics
Group: R-3 Type: VB
Group: U-1 Type: VB
Total Area 3040
Building Height 25
Stories 2
Dwelling Units 1
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
1&2 FAMILY R-3 VB 1,042 $95,197.12 1,042 $95,197.12
2ND FLOOR R-3 VB 1,285 $95,963.80 1,285 $95,963.80
COV DECK R-3 VB 40 $600.00 40 $600.00
GARAGE U-1 VB 673 $12,787.00 673 $12,787.00
Totals: 3,040 $204,547.92 3,040 $204,547.92
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $1,581.75
WSBC SURCHARGE 1 SELECT $4.50
SF PLNS RVW<7999 SQ FT 1 SELECT $632.70
Permit Total Fees: $2,218.95
Mechanical Permit
Contractor: OWNER Finn: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
DUCT SYSTEMS 1 NUMBER OF $10.00
GAS WATER HEATER 1 NUMBER OF $10.00
GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00
GAS PIPING 3 #OF UNITS $3.00
CLOTHES DRYER 1 NUMBER OF $10.00
RANGE 1 NUMBER OF $10.00
GAS LOG OR GAS INSERT 1 NUMBER OF $10.00
Permit Total Fees: $65.00
Operator: JD Printed By: jmm Print Date: 10/26/2007
Project Number: 07004185 Inv: 1 Application ' Date: 10/26/2007 Page 4 of 4
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Plumbing Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 3 NUMBER OF $18.00
SINKS 5 NUMBER OF $30.00
SHOWERS 1 NUMBER OF $6.00
TUBS 2 NUMBER OF $12.00
DISH WASHERS 1 NUMBER OF $6.00
GARBAGE DISPOSAL 1 NUMBER OF $6.00
CLOTHES WASHER 1 NUMBER OF $6.00
MISCELLANEOUS FIXTURES 2 NUMBER OF $12.00
Permit Total Fees: $96.00
BETTMAN'S ADDITION- LOTS 7 THROUGH 18 OF BLOCK 8;AND LOTS 9, 10, 15 AND 16
OF BLOCK 5 HAVE BEEN PULLED OUT OF THE FLOOD PLAIN.
BETTMAN'S ADDITION- LOTS 7 THROUGH 18 OF BLOCK 8;AND LOTS 9, 10, 15 AND 16
OF BLOCK 5 HAVE BEEN PULLED OUT OF THE FLOOD PLAIN. SEE PLAT FILE.
Payment.Summary: �.. y ��� .� .,.� mw ,ff" ' . ._ ;rnd
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $2,218.95 $2,218.95 $0.00 $2,218.95
Mechanical Permit $65.00 $65.00 $0.00 $65.00
Plumbing Permit $96.00 $96.00 $0.00 $96.00
$2,379.95 $2,379.95 $0.00 $2,379.95
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: JD Printed By: jmm Print Date: 10/26/2007
Permit CenterI
lio .,_w,�_ 11703 E Sprague Ave, Suite B 3 PERMIT NUMBER: i �
Skane Spokane Valley,WA 99206 PERMIT FEE:
jVallevi (509)688-0036 FAX:(509)688-0037
• www.spokanevalley.org
Community Development
Residential Construction , New Construction Accessory Bldg
Permit Application nAddition/Remodel Deck
n Other:
SITE ADDRESS: - F 1H A j,,r)
ASSESSORS PARCEL NO: ��CAI , l LEGAL DESCRIPTION:
Building Owner: CO\(U Vv 17'.. k 1l 0,v. Contractor: (4.it-o v A nct j/
�
Name: Al i LA'C/1ct"-- Name: YCO'/
Address. C i - Address: / L.�� i/ ( 'Li 7
City:, y+ State: Zip: I. Ci alikr State: A Zip: J i
Phori� i W) , �U3 Lax: Phone:R (Y 4'2�7 2 Fax:
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:
Name: y u DV ,(, ! ► f i IA
Phone:1C-'l l .Q) t 7i �- 2 geJ CO
Ci)u
Describe the scope of work in detail: Cost of Project: $ 6 j
-w
.�f
Proposed Use: k. ,LW,-'e 4A.
**************The following MUST be complete: (write N/A if not applicable)**********************
HEIGHT T¢ DE I1: DIM I,S O #OF STORIES: TOTAL HABITABLE SPACE:
MAIN FLOOR TO SQ. 2" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE
FTG: ji/ - /0V
2— /-2 --( I2 S` �% AREA:
FINISHED BBASSEME GARAGE Q. FTG: DECK! OV. PATI• SQ. FTG: 30% SLOPES ON
SQ. FTG: ( _ G 73 40 PROPERTY: I:\
#OF BEDROO : CONSTR
IU
d CTION TYPE: HEAT S•• : SEWER OR SEPTIC?
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. ) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be p es d.
SIGNATOZe :AI DATE: ,/O / .7 0%
Method of _ent:: " RECEIVED BY
0 Cash (.Check 0 Mastercard 0 VISA(;ITY OF SPOKANE VALLEY
Bankcard#: / Expires: VIN#:
OCT 1. 7 7007
Authorized Signature:
REVISED 2/15/07 ')r:t%l T CENTER
dP" 1
SCITYOF1
pokane
Valley
11703 E Sprague Ave Suite B-3 ♦ Spokane Valley WA 99206
509.688.0036 ♦ Fax: 509.688.0037 ♦ cityhall@spokanevalley.org
Residential Plan Submittal Minimums
❑ Completed Building & Mechanical application with: Accurate address, Parcel
Number and/or Legal Description, description of work, owner and contractor
information, signature, and date.
❑ Two sets of plans including Site Plan, elevations, floor plans, foundation plans
With details, roof plan, framing plans & details.
❑ Show the height of any proposed buildings or accessory structures.
❑ Floor plan for each floor: Dimension to scale (minimum 1/8") and label each
Room (including sq. footage of house and garage on plans) Show each
level of existing house and square footage of any additions.
❑ All braced wall panel types: show locations and details of installation, including
engineered design.
❑ Egress windows: Provide at least one window or exterior door approved for
Emergency escape or rescue from a basement and in every room for sleeping.
❑ Smoke detector locations
❑ 22" X 30" attic access location
❑ 18" X 24" crawl space access:
❑ One-hour separation detail: between house and garage
❑ Floor framing details: Joist type, size, spacing and installation details
❑ Roof framing plan and details
❑ Furnace and hot water heater location.
❑ All header locations: type, size, and connections
❑ Foundation plan
❑ Insulation information
7'�� \ Permit Center
Wiliam �a 11703E Sprague Ave,Suite B-3 PERMIT NUMBER:
P Spokane Valley,WA 99206
Waller (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.spokanevallev.ore
Mechanical Permit Application ❑ Commercial 0 Residential
SITE ADDRESS: 6/0 S f/'n ,fre .
Building Owner //�� ,9 /� aloft- t 83 6
Name: Vida ' fc./�l/719i�'� Phone:MO Fax: �?
Address:`Y�1" Y;rebGr�k� L'1� City: `04i/'1,eaafie State: 1 /0 Zip: 9 (, Iv
Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 I X $12.00 = (Z_00
2 FUEL BURNING APPLIANCE More than 100,000 X $15.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
5 USED APPLIANCE(WSEC min.AFUE rating) Equal to or less than 400,000 X $50.00 =
6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $12.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $20.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $35.00 =
• 11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 =
•
• 12 .GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 = 1
13 RANGE X $10.00 = /f
14 DRYER - X $10.00 = (%:
15 FUEL BURNING WATER HEATER c X $10.00 = /i;.'
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 3 X $1.00 = .�-13
18 DUCT SYSTEMS 1 X $10.00 = .az% t 0
19 VENTILATING FANS X $10.00 = ,i-r)
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 =
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
26 AIR CONDITIONER 4-15 TON X $20.00 = 2 0
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 AIR CONDITIONER More than 50 TON X $60.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
33 REPAIR&ADDITIONS X $15.00 =
34 VENTILATION SYSTEMS X $12.00 =
35 VENTILATION MECHANICAL EXHAUST X $12.00 =
36 INCINERATOR-RESIDENCE X $19.00 =
37 INCINERATOR-COMMERCIAL X $22.00 =
METHOD OF PAYMENT: SUBTOTAL
❑CASH D CHECK 0 VISA 0 MC EXPIRES: PROCESSING FEE $35.00
CARD#: VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
,'A„ Permit Center
SiTM°�kane 11703E Sprague Ave,Suite B-3 Spokane Valley,WA 99206 PERMIT NUMBER:
4, Valley$ (509)6p8-kanevalley.org0036 FAX:(509)688-0037 PERMIT FEE:
tvww.s o
Community Development j
Plumbing Permit Application2n Commercial 'dential
`
SITE ADDRESS: 3 1�) . o/,y
Building Owner
'//o.�C v\ / L,��YVI 1( .4 Sh t4it.CJv Sk�tj l a ►I t t :r)
Name: )1 0-4
V I va.Ir\rt�r v �Plhone: ' ip_A J 7�'ax:
Address: 1 _ ' ( 1Y c+. City: ( ti /t l�State: c f\ Zip: qs vags
ContractorlY�/�`t( ho. wl r-
Name:
/IAA, I v
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact\i:
�1 ((eV 34e)city al7r- �h/ <h I V eri f (n
Name: 1 y c c VYa/n rc � Phone: fie)
) a —( Gc s t -
_DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS -- X $6.00 = 15?. 0
2 URINALS !-_ X $6.00 -
3 TUBS OP X $6.00 = , ''LO V
, •T
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT ‘ X $6.00 = / t 0
LAVS/BASINS,BAR,FLOOR,KITCHEN, \
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, r X $6.00 = C/J1
X-RAY,FOOD,PREP/CULINARY MEAT UVJ\ d 'O/
6 DISHWASHER X $6.00 = , 4 0 0
7 CLOTHES WASHER 1 X $6.00 = [ `0 6
8 GARBAGE DISPOSAL ' X $6.00 = c l! Q
9 _Er SOFTENER X $6.00 =
10 .— OT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =NT P7. ,�
AREA,CASE,COIL,TRENCH,
11 •OR i-.•INS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PU X $6.00 =
ICE AN/OR COFFEE MAKE HOSE BIB,
16 WATER USING DEVICE STEAMER ---- g- X $6.00 = '� /\�\
PROOFER,CARBONATOR,SWAMP �J LJ
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
R
SUBTOTAL 02, DO
METHOD 0 ENT: REC E °Y-q l A''
it5kNGE
F
CITY OF SPOa
CASH CHEC 0 VISA 0 MC EXPIRES: $35.00 /
Card# VIN: OCTOT�Lr%EINI pEE DUE: / `J (/�0
AUTHORIZED SIGNATURE:AleIA , -- �jy PER If EN T E�'
REVISED 8/26/05 Sr u l r l
A
3
• f
I
U.S-DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 I
Federal Emergency Management Agency
Expires February 28. 2009 j
National Flood Insurance Program Important: Read the instructions on pages 1-8.
SECTION A-PROPERTY INFORMATION For Insurance Company Use:
Al. Building Owner's Name Y� V Policy Number
cr,r J
_ Veniamin Shiskovsklv xnv
A2- Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or O.Route and Box No. Company NAIC Number
City
_Spokane Valley State SIA ZIP Code
A3, Property Description(Lot and Block Numbers,Tax Parcel Number, Legal Description,(etc.)
lot 14, Block 8, BRettman's Add . Parcel No . 35243 .0987
A4. Building Use(e.g.,Residential,Non-Residential,Addition,Accessory,etc.) Residential _
A5. Latitude/Longitude:Lat. Long. Horizontal Datum: ❑NAD 1927 0 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
AT Building Diagram Number
A8. For a building with a crawl space or enclosure(s),provide: AA A9. For a building with an attached garage,provide: n
a) Square footage of crawl space or enclosure(s) I'r!/A sq ft a) Square footage of attached garage I l/A sq ft
b) No.of permanent flood openings in the crawl space or III/A b) No.of permanent flood openings in the attached garage
enclosure(s)walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in
SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION
81.NFIP Community Name&Community Number ' B2.CountyName B3.State
Spokane County 530174 Sookane WP.
84.Map/Panel Number ' B5.Suffix I 86.FIRM Index I 87.FIRM Panel B8.Flood B9.Base Flood Elevation(s)(Zone
1 Date Effective/Revised Date Zone(s) AO,use base flood depth)
530174 03001 C 9/30/1992 A 2002
B10. Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in Item B9.
❑FIS Profile ❑FIRM n Community Determined ❑Other(Describe)
511. Indicate elevation datum used for BEE in Item B9:ri NGVD 1929 ❑NAVD 1988 ❑Other(Describe)
812. is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? ❑ Yes 21 No
Designation Date ❑CBRS ❑OPA
SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED)
Cl. Building elevations are based on: F 1 Construction Drawings` ❑ Building Under Construction* ❑ Finished Construction
-A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations-Zones A1-A30.AE,AH,A(with BFE),VE,V1-V30,V(with BFE),AR,AR/A,ARAE,AR/A1-A30,AR/AH,AR/AO. Complete Items C2.a-g
below according to the butlding dia ram suecified J;Ite �
Benchmark Utilized spokahe CCounty r HCVD 29
M #64 Vertical Datum
Conversion!Comments
1� Check the measurement use/d.
a) Top of bottom floor(including basement,crawl space,or enclosure floor) N/A .feet ❑m6� re140 a tkl0 sy
b) lop of the next higher floor ISI _ feet ❑meths(PirtSlik0i�yq' E VALLEY
c) Bottom of the lowest horizontal structural member(V Zones only) ^'=1 ._❑feet El meters(P °('Rico only)
d) Attached garage(top of slab) t^'i/A . ❑feet ❑meters(Natal Rido bnly�067
e) Lowest elevation of machinery or equipment servicing the building N/A . ❑feet ❑meters(Puerto Rico only)
(Describe type of equipment in Comments) 1��r P. • IT CENTEF�
f) Lowest adjacent(finished)grade(LAG) +/ feet ❑ -.._ Pu.rt. Rico on y
g) Highest adjacent(finished)grade(HAG) �i �.[feet ❑meters(P r.o -r i . )
i
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION '.i -- ar(
This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation ,.,.
information. i certify that the information on this Certificate represents my best efforts to interpret the data available. S .N 1
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code,Section 1001. �t
Check here if comments are provided on back of form. ti , 'Cr'''4},.. _ ,„..iii.;, '
-- License Number 4' .k7,-;:q3•
„�E J
Certifier's Name 8740
_ Forl F. Sanders O �� c'�,
Title- Company Name ' . 15740 �{!
Land Surveyor/Owner K.A . Durtschi & Assoc . Inc `, ,s
Address City State ZIP Code
__ ,O . Box 70:0 Hoyden lake Idaho 83835 " �"`i�-uk
.S Date 10/12/2r.tthone 208-772-2233__ PlaES(S -a � 'itee-
FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions -
•
IMPORTANT_ In these spaces,copy the corresponding information from-Section A. For Insurance Company Use:
•
Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or P.O.Route and Box No. Policy Number
Unknown
City State ZIP Code Company NAIC Number
Spokane Valley WA
SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED)
Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner.
Comments Vacant Lot
_SeI_ TBM on face of 18" Pine, Flev. 2030.36' Marked down 26.36 feet to
lowest finish flo r .
SignatureDate 10/12/2007 df
Gt��-, [A Check here if attachments
SES►ION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE)
For Zones AO and A(without BFE),complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request,complete Sections A, B,
and C. For Items E1-E4,use natural grade,if available. Check the measurement used. In Puerto Rico only,enter meters.
E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent
grade(HAG)and the lowest adjacent grade(LAG).
a)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑ meters ❑above or ❑ below the HAG.
b)Top of bottom floor(including basement,crawl space,or enclosure)is ❑feet ❑meters ❑above or ❑ below the LAG.
E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A Items 8 and/or 9(see a e 8 of Instructions),the next higher floor
(elevation C2.b in the diagrams)of the building is ❑feet ❑meters ❑above or u below the HAG.
E3. Attached garage(top of slab)is ❑feet❑meters ❑above or O below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is ❑feet ❑meters ❑above or ❑below the HAG.
E5. Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the community's floodplain management
ordinance? ❑Yes ❑ No ❑Unknown. The local official must certify this information in Section G.
SECTION F-PROPERTY OWNER(OR OWNER'S REPRESENTATIVE)CERTIFICATION
The property owner or owners authorized representative who completes Sections A,B,and E for Zone A(without a FEMA-issued or community-issued BFE)
or Zone AO must sign here. The statements in Sections A, 8, and E are correct to the best of my knowledge.
Property Owner's or Owner's Authorized Representative's Name
Address City State ZIP Code
Signature Date Telephone
Comments
❑Check here if attachments
SECTION G-COMMUNITY INFORMATION(OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A,B.C(or E),
and G of this Elevation Certificate. Complete the applicable item(s)and sign below. Check the measurement used in Items G8.and G9.
01. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor,engineer,or architect who
is authorized by law to certify elevation information. (indicate the source and date of the elevation data in the Comments area below.)
02 0r A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.
03. u The following information(Items G4.-G9.)is provided for community floodplain management purposes.
G4.Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7.This permit has been issued for: 0 New Construction ❑Substantial Improvement
08.Elevation of as-built lowest floor(including basement)of the building: ❑feet ❑meters(PR) Datum
G9.BFE or(in Zone AO)depth of flooding at the building site: ❑feet 0 meters(PR) Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
❑Check here if attachments
FEMA Form 81-31, February 2006 Replaces all previous editions
10/23/2007 03:21:26 PM 5603538
Recording Fee $40.00 Page 1 of 1
Quit Claim Deed BANAR YAKOV
Spokane County Washington
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QUIT CLAIM DEED
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THE GRANTOR Sr\14 V VQfl \a r 1 n
for and in consideration of C-i I -c f
conveys and quit claims to � (��a.r-� 1 �� k\\I
va e in
the following described real estate,situated in the County of S o\cc'..
State of Washington,together with all after acquired title of the graritor(s)therein:
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Assessor's Tax Parcel ID# SSa.1(2
Dated 49, ,;23. 07
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Notary Seal
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STATE OF WASHINGTON,
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County of u�cin /1-�- _ _e,
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I hereby certify that II know or have satisfactory evidence 9•'9ic �`18
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D"i is the person(s)who appeared before me,and said person(s)acknowledged that(he,she,they)signed this
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d instrument and acknowledged it to be(his,her,their)free and voluntary act for the uses and purposes mentioned
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f7 Notary Public in and for the State of Washington
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• Building Photographs
Continuation Page
Per:Insurance Company Use:
Building Street Address(including Apt.,Unit,Suite,and/or Bldg_ No.)or P.O. Route and Box No_ Policy Number
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City State ZIP Code comPaftyNAICNuitter
Spokane Valley 1AJA
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all
1 photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View."
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PLANNING DEPT. APPROVED co
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DATE: /0464 0.2
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