2011, 08-31 Permit App: 11002667 Remodel Project Number: 11002667 Inv: 1 Application Date: 8/31/2011 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information: � w..&1
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Permit Use: REMOVE A WALL TO CREATE A LARGER Contact: NELSON,JOSEPH C&TIFFANY A
BEDROOM Address: 12409 E 20TH AVE
C-S-Z: SPOKANE VALLEY,WA 99216
Setbacks:Front Left: Right: Rear: Phone: (509)991-9758
Group Name:
Site Information: Project Name:
Plat Key: 001222 Name: HILLCREST ACRES 01ST ADD District: Sout
Parcel Number: 45272.2129 Block: Lot:
SiteAddress: 12409 E 20TH AVE Owner:Name: NELSON,JOSEPH C&TIFFANY A
Address: 12409 E 20TH AVE
Location::CSV SPOKANE VALLEY,WA 99216
Zoning: R-2 SF Res Suburban District
Water District: 101 SPO CO WATER DIST#3B Hold: [I
Area: 11,875 Sq Ft Width: 90 Depth: 125 Right Of Way(ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information: E}F<<
Review
Building Plan Review Released By:
Originally Released: 8/30/2011 By: tmelbourn
Building Permit
Contractor: OWNER Firm: OWNER
Phone: (000)000-0000
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sa Ft Valuation
1&2 FAMILY R-3 VB WALL 0 $3,500.00 0 $3,500.00
REMOVEL
Totals: 0 $3,500.00 0 $3,500.00
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $97.25
WSBCC SURCHARGE 1 SELECT $4.50
SF PLNS RVW<7999 SQ FT 1 SELECT $38.90
Permit Total Fees: $140.65
Operator: JD Printed By: JD Print Date: 8/31/2011
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Project Number: 11002667 Inv: 1 Application Date: 8/31/2011 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
HOME PROFESSION PERMIT REQUIRED FOR"SLS CONSULTING"LETTER SENT TO
ADDRESS ON 12/22/05
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $140.65 $140.65 $0.00 $140.65
$140.65 $140.65 $0.00 $140.65
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: JD Print Date: 8/31/2011
Aug. 29. 2011 11 : 05PM InCyte Pathology No. 1464 P. 2
•• Community Development Department (Staff Use Only)
B-3 PERMIT NUMBER. 1
Permit Center ( ��f
11703 East Sprague Avenue SuiteI SD
Cll:•Y:oh: ;14 Spokane Valley,WA 99206
S
tltl
G
Tel: (509) 688-0036 PERMIT FEE:
w FaX: (509) 688-0037
I•
r ermitcenter s
RESIDENTIAL CONSTRUCTION PERMIT APPLICATION
III NEW CONSTRUCTION ADDITION/REMODEL IIE ACCESSORY BUILDING
MI DECK ''``,�,� q � IN OTHER ( a /,,
SITE ADDRESS! r?-.4o l 6, Z0 .1C 31o{crr>.�RL t 1 COI- 49 919
ASSESSORS PARCEL NO.: 4.�bt�iZ.IRL I LEGAL D�E\SCR
BUILDING OWNER NAME; '--\i4Y1, �c)O5ec)� a )Q&r
NAME: /ar <1c)(6P4 \ `k) �)
ADDRESS: I2-1•4 E i ZCC`t' Avc.
CITY: Pp the_ A l W STATE: 1A.Or ZIp: Q 21 q Iv
PHONE: '1 ' a 1 I FAX CELL: 1 8551 t'in
CONTACT NAME: 1Viflh ,'UeJ O n
r'l__7
PHONE! I 1 egret/ FAX: CELL:
CONTRACTOR NAME: 86-C
MAILING ADDRESS: I7LfO ` (( � . 297th S
AV ���
CITY! ipaaJI�. L)Gk 41C.L1 STATE; ZIP:
PHONE: 1q� L/`
q 111 'L4Zb �--J1 FAX: CELL:
CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESC•IBE THE SCOPE OF WORK 11)1.,DETAIL • ND INDICATE USE L PROPOSED USE:
ip
****YOU MUST COMPLETE THE FOLLOWING****
MARK N/A IF NOT APPLICABLE
Height to P k: Dimensions No.of Stories• Total Habig
ra ��� Space: {7llZ'xxsl
Main Floor SQPT: Upper FI or SQ FT: Unfinished Basement SQ Finished Basement SQ
i , IVI ft FT: Nl i4 Fr: I
Garage SQ FT: Deck/Covered Patio SQ Impervious Surface 30%Slopes on
10 FT: to Area: . 11A Property: itor
No.of Bedrooms: Construction Type:(yf libeA Heat Source: 0A-N Sewer or S5/1c:&t fzr
TOTAL COST OF PROJECT: $ < O o GL
DISCLAIMER
The permitted verifies,acknowledges and agrees by their signature that' 1)if this permit is for construction 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) The City of
Spokane Valley permit is not a permit or approval for any violation of federal,state or local laws,codes or ordinances. 6) Plans or additional
information may be required to be submitted and subsequently approved before this application can be processed.
Effective October 28,2007 Page 1 of 2
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Residential Construction Permit
App 10.28.07.doc
Received Time Aug. 29. 2011 10: 55PM No. 4158
Aug. 29. 2011 11 : 05PM InCyte Pathology No. 1464 P. 3
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Signature ( i filli Date: I
Method of payment:,
Ili gash Check ' Visa ❑ Mastercard
6ankcard #: , _ - - - - P(i'v VIN#:
Authorized Signature: J I Ki)je I,/Ili .vO
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN G52014-030.
•
Effective October 28,2007 Page 2 of 2
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Residential Construction Permit
App 10,28.07.doc
Received Time Aug. 29. 2011 10: 55PM No. 4158 •
▪ Aug. 29. 2011 11 : 05PM InCyte PathologyInNo. 1464 P 1
o
Cyte Pathology
(.11\1(YTE
Sp Box 3405
InCyte
P WA 99220-3405
(509)892-2700
PATHOLOGY (sae)814-6277
FAX(509)892-2740
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Phone: Rei a _
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Fax#. —7 Pages to Follow:
RE: leviyvQ.A iv±.--,,c\eAak ,cescro
CJ Urgent 0 For Review ❑Please Coultne-t ❑Please Reply ❑Per Your Request
Notes:
•
The Information contained In the facsimile Is privileged,confidential and exempt from disclosure under applicable law.Itis intended
only for the use of the person(s)listed above.If you have receNed this communication In error,please call 509492-2700 immediately
to inform us of this error and then shred the documents as soon as possible_
If you are neither the Intended recipient nor the employee/agent responsible for delivering this information to the intended recipient
you are hereby notified that any use,disclosure,copying or redistributing of this information is strictly prohibited.
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Received Time Aug. 29. 2011 10: 55PM No. 4158