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2004, 04-06 Permit App: 04001823 Residence Project Number: 04001823 Inv: 1 D e: 4/6/2004 Page 1 of 3 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: RESIDENCE/ATTACHED GARAGE-FORCED Contact: KOREN,ANDREY V&SVETLANA M AIR GAS Address: 2625 W SANSON AVE C-S-Z: SPOKANE,WA 99205-5744 Setbacks:Front 30 Left: 78 Right: 30 Rear: 100 Phone: (509)323-1639 Group Name: Site Information: Project Name: Plat Key: Name: SP-1247-00 District: D Parcel Number: 35262.0902 Block: Lot: SiteAddress: 4518 E 16TH AVE Owner:Name: KOREN,ANDREY V&SVETLANA SPOKANE,WA USA 00000 Address: 2625 W SANSON AVE Location::SPO SPOKANE,WA 99205-5744 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 1.16 Acres Width: 165 Depth: 307 Right Of Way(ft): 60 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: . . - x- Review Site Plan Review ,/ � cried By: I' _. r ./ C I - cx.) Pl 'ev ew .. Released By: ® ., +� . 416 Approach/Drainage Released By: Se • • jw Released.B '` isi - Permits: Operator: RMB Printed By: RMB Print Date: 4/6/2004 Project Number: 04001823 Inv: 1 Application Date: 4/6/2004 Page 2 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Building Permit Contractor: OWNER Firm: OWNER Phone: This Application: Total Project: Description Grp Type Notes Su Ft Valuation Si Ft Valuation COV DECK R-3 VN 46 $463.22 46 $463.22 GARAGE U-1 VN 575 $6,900.00 575 $6,900.00 RESIDENCE R-3 VN 1,818 $119,988.00 1,818 $119,988.00 Totals: 2,439 $127,351.22 2,439 $127,351.22 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,035.00 STATE SURCHARGE 1 SELECT $4.50 RESIDENTIAL SURCHARGE 1 SELECT $227.70 REGIONAL PLNG SURCHARGE 1 SELECT $165.60 Permit Total Fees: $1,432.80 Mechanical Permit Contractor: OWNER Firm: OWNER Phone: Item Description Units Unit Desc Fee Amount GAS WATER HEATER 1 NUMBER OF $10.00 GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00 GAS PIPING 3 #OF UNITS $3.00 VENTILATING FANS 5 NUMBER OF $50.00 CLOTHES DRYER 1 NUMBER OF $10.00 GAS LOG OR GAS INSERT 1 NUMBER OF $10.00 REGIONAL PLNG SURCHARGE 1 SELECT $15.20 Permit Total Fees: $110.20 Operator: RMB Printed By: RMB Print Date: 4/6/2004 • Project Number: 04001823 Inv: 1 Application Date: 4/6/2004 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Plumbing Permit Contractor: OWNER Firm: OWNER Phone: Item Description Units Unit Desc Fee Amount TOILETSBIDETS 2 NUMBER OF $12.00 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 WATER USING DEVICES 2 NUMBER OF $12.00 REGIONAL PLNG SURCHARGE 1 SELECT $14.40 Permit Total Fees: $104.40 CONTOL AREA FOR DRAINAGE MORITORIUM SEE MAPS FOR SPECIFICS Payment Summary: .. .. .. .,... Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Building Permit $1,432.80 $1,432.80 $0.00 $1,432.80 Mechanical Permit $110.20 $110.20 $0.00 $110.20 Plumbing Permit $104.40 $104.40 $0.00 $104.40 $1,647.40 $1,647.40 $0.00 $1,647.40 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: 4/6/2004 lOci PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING& CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE iM ilk SPOKANE,WA 99260 509-477-3675 SPoi<COUNTY SPECIFIC SITE INFORMATION NI Street Address: 45/6 /6 i, Assessor's Tax Parcel Number(s): C� 3�,��2. ©q o 2- Legal Description: 26-2 5-4 ?) , 112Q C.-1- a z SIw p- pla-f sp _ 12 4 7—r,0 A 1-( Di-lc l'1P//-e 4 4 7 7 4®7J i 4) f-C /bl 1. _it op 1- p T ent h /7c i_5'..e ZS--- 6Mc1 Cd 2_ . \J Project Description: 0 Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit ❑ Relocation ❑ Sign ❑ Tenant(New/Change) ❑ Other Department Use Only / r:,-- ) ( ' ` [! Water District/Purveyor: Sewer District/Purveyor Roa th ,/ , / Setbacks -/ Font Rear i School District: her District: Zoning Left Right: OWNER/APPLICANT INFORMATION El Indieaie m/S 1m1r1(1 be contacted re;;ardin,ibisprojec7 g ❑( caner Phone(.t3\) ��.31i L^ C nApplicant Phone:(5Dcl Lip"-0 70 S E ,// p ` ; ct Jif 4 3i� ESQ/\J L7'IL'- c. t 1f�RE1u ANDE:: lax: OVc� Iax: Mailing Address: Mailing Address: ' 2G25 v1/4) Sa City,State,Zip (:it,,State,Zip Nif ❑El Contractor Phone i Phone Architect,/ ngineer l•ax l.ax ( Mailing address Mailing address (:it,,State lip Cit,,State Zip WA State Contractor license# Contact name: PROJECT INFORMATION Building Information Building height to peak #of stories Main floor sq.ft. Unfin:ie.basement sq.ft. //its / ' I)imensions Total habitable space 2°t floor sq.ft. him led base :11 sq.ft. 5ve, x 57° Occupancy group Construction type Garage sq.ft. , Deck sq.ft. i ( (- -)1-- v ) e( L, t Cost of project I feat source(electric,gas,etc.) _ Manufactured Home Sign width: length: What is the square footage of the sign I low high is the sign? face? Year: Make: #of signs :Area of existing signs Relocation Fire Safety Previous address Fire Sprinkler fent Paint booth Fire alarm Fireworks display Proposed use Value Special Inspections Required? Non-Residential Energy Code Compliance? I arm Name Phone Plans I.xaminer Phone Inspectors: Address Inspector Phone 0 Concrete 0 Welding 0 Bolting 0 Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? 0 Yes 0 No What is the current property size? \ Ifyes,identijjs on site plan (square feet or acres) I C, rte Is any part of the property within 250 feet of a shoreline? What is the current use of this property? Ifyes,ident on site plan 0 Yes 171.No Is your property in a designated wildlife habitat area? Will the site be served by a septic system?0 Yes 0 No 0 Don't know 0 Yes No Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property? Ifyes,identift on site plan Ifyes,identifyon the site plan 0 Yes at No 0 Maybe 0 Don't know 0 Yes $ No Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property? If yes,ident j�on site plan 0 Yes I,i No 0 Yes 0 No Are there slopes greater than 30°o on the property?(30 ft rise m 100 ft) Are critical or hazardous materials used or stored on site? ( /%) D Yes 1—No 0 Yes gi No DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No D Yes 0 No Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No DYes 0No Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area? DYes 0No Date Received: Staff Representative: METHOD OF PAYMENT !CAC- SUBTOT:U, VISA ❑ C\SII ❑ CHECK ❑ WON ❑ 0 ._ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD TOTAL FEE B:NKC ARI)NUMBI'.R: MINIMUM PERMIT FEE IS$35.07PLEASE MAKE.(:HOCKS PAYABLE TO SPOKANE .AU1I IORI'/,h.D SK;NVTURI?. COUNTY Plmfrr CI:ss:IER . . ^ . . ^ ~°=° ( { | /' �-- ~ .00�=8 . . ' '/ .00*Lm; > ./ ' / ~ / ' ~~''ESu ' «�� / ZONE ^-- / ROAD VNDT ` '/ . ..~,' LANFUNG_______ // REVIEWED or ��. __- / -~` / .11V3Im9»3 • � `^ /