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2002, 06-10 Permit App: 02004636 ResidenceJ Project Number: 02004636 Inv: 1 Application Date: 6/10/2002 Page 1 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Proiect Information: Parcel Number: 45271.9000 Block: A SiteAddress: 13812 E 21ST AVE SPOKANE, WA USA 00000 Location:: SPO Zoning: UR -3.5 Urban Residential 3.5 Water District: 999 UNKNOWN Area: 10,000 Sq Ft Width: 100 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Lot: Owner: Name: CLARK, DAVE Address: 13714 E. 21ST AVE SPOKANE, WA 99214 Hold: ❑ Depth: 100 Right Of Way (ft): 50 Review Information: ................................................................................... . Review Site Plan Review Plan Review Appi Sewer Review Permits: Operator: RMB Printed By: RMB Print Date: 6/10/2002 Project Number: 02004636 Inv: I Application Date: 6/10/2002 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: OWNER Item Description GAS WATER HEATER GAS APPLIANCE<= I 00,000BTU GAS PIPING AIR CONDITIONER:4-15 TONS VENTILATING FANS CLOTHES DRYER RANGE GAS LOG OR GAS INSERT Permit Total Fees: Mechanical Permit - Firm: OWNER Phone: Units Building Permit Contractor: OWNER Firm: OWNER 1 Phone: 6 Building Characteristics Const Category: New Group: R-3 Type: VN Nbr Of Dwellings: 1 Occupant Load: 0 Building Height: 20 Bldg W x D: 76 x 45 Building Sq Ft: 3250 Sprinklers: ❑ Req Parking: 0 Handicap Parking: 0 Critical Materials: ❑ NUMBER OF This Application: Description Grp Tyne Notes So Ft Valuation BASEMENT F R-3 VN 625 $10,475.00 BASEMENT U R-3 VN 1,000 $12,300.00 DECK R-3 VN 144 $1,127.52 GARAGE U-1 VN 700 $8,400.00 RESIDENCE R-3 VN 1,625 $107,250.00 Totals: 4,094 $139,552.52 Item Description Units Unit Desc RESIDENTIAL VALUATION 1 Y OR BLANK STATE SURCHARGE 1 Y OR BLANK RESIDENTIAL SURCHARGE 1 Y OR BLANK Contractor: OWNER Item Description GAS WATER HEATER GAS APPLIANCE<= I 00,000BTU GAS PIPING AIR CONDITIONER:4-15 TONS VENTILATING FANS CLOTHES DRYER RANGE GAS LOG OR GAS INSERT Permit Total Fees: Mechanical Permit - Firm: OWNER Phone: Units Unit Desc 1 NUMBER OF 1 NUMBER OF 6 # OF UNITS 1 NUMBER OF 5 NUMBER OF 1 NUMBER OF 1 NUMBER OF 2 NUMBER OF Permit Total Fees: Stories: 1 Total Project: Sg Ft Valuation 625 $10,475.00 1,000 $12,300.00 144 $1,127.52 700 $8,400.00 1,625 $107,250.00 4,094 $139,552.52 Fee Amount $1,095.00 $4.50 $240.90 $1,340.40 Fee Amount $10.00 $12.00 $6.00 $20.00 $50.00 $10.00 $10.00 $20.00 $138.00 Operator: RMB Printed By: RMB Print Date: 6/10/2002 Page 2 of 3 , Project Number: 02004636 Inv: I Application Date: 6/10/2002 Page 3 of 3 V THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: OWNER Item Description TOILETSBIDETS SINKS SHOWERS TUBS DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER FLOOR DRAINS WATER USING DEVICES Notes Payment Summa Plumhing Permit — Firm: OWNER Phone: Units Unit Desc Fee Amount 3 NUMBER OF $18.00 4 NUMBER OF $24.00 1 NUMBER OF $6.00 2 NUMBER OF $12.00 1 NUMBER OF $6.00 1 NUMBER OF $6.00 1 NUMBER OF $6.00 1 NUMBER OF $6.00 3 NUMBER OF $18.00 Permit Total Fees: $102.00 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Building Permit $1,340.40 $1,340.40 $0.00 $1,340.40 Mechanical Permit $138.00 $138.00 $0.00 $138.00 Plumbing Permit $102.00 $102.00 $0.00 $102.00 $1,580.40 $1,580.40 $0.00 $1,580.40 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 he 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 contrued 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: 6/10/2002 ! ! PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIX`ISION OF BUILDING & CODE ENFORCEMENT 1026 \/FST BROADWAY AVENUE SPOKANE, WA 99260 ini 509-477-3675 SPECIFIC SITE INFORMATION Street address: k1,2 ,v2 .Z l ST C Assessors Tax Parcel Number(s): Legal Descrip!on:?qd � Project Description: �, f" 'Oe. .01 Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home Permit ❑ Relocation ❑ Sign ❑ Tenant (New/Change) ❑ Other Department Use Only watu Distract/Purveyor. Se¢"er Distract/Pun-yor - - • Road. idth- itlailmg AJd—s: Mailing Address: G. Talc, /i Gn', ""',zip Rear. �.•ii.,ww School Distract Fite District: - Zoning. h1Avn}r aJdtt ss Mailing address 7/y F v�/'rT Lcft Right OWNER/APPLICANT INFORMATION `oO `0/ ❑n: Phonc: L�1 / ` Z ❑ Applicant: Phonc,- Building Information itlailmg AJd—s: Mailing Address: G. Talc, /i Gn', ""',zip ❑ C—Itacux Phone'Ta / „ ^� ` ❑ Archilea/Fngincer Phonc 1/ e `! we A, Fax Fax h1Avn}r aJdtt ss Mailing address 7/y F v�/'rT l"ural habitaba• 12 i Cin, slate'%ip City, Statc !"p \\ A S1.3—[C t. nitatllN Iirt•II�- 4///�/]/� Contact nanw- t mstnlctiun ripe PROIF.CT INFORMATION U Building Information Building height w rcak ft Main fkxlr sy- ft- Unfinished basamtitt sy" ft. -20? Qad Dirrxl�lns � log l"ural habitaba• 12 i 2nd cxtr sq- ft. 1•inislx'd ba>cm'nt sq. (t. — Occtlrancc group t mstnlctiun ripe Garage sq. ft" Dcck sq. ft. ?/C A- 74-90 G)o t of rrnicet I It -at source (electric. tns_ etc.) DO � U Manufactured Horne ' Sign Width: Length: What is the square footage of the sign face? _ How high is the sign? Year. Make: # of signs Area of existing signs O Don't know O Yes Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property? Relocation Fire Safety Previous address Fire Sprinkler Tent Paint booth _ Fire Alarm Fireworks display _ Proposed use Value Special Inspections Required? Non -Residential Energy Code Compliance? Finn Name Phone Plans Eaminer Phone Inspectors: Address Yyes, idenfify on site plan O Yes o Inspector Phone O Concrete O Afelding O Bolting O Reinforcement Address ADD ZONAL SITE INFORMATION Are there structures on the property? ifrYc o \r hat is the current property size? 1 yu, IllPgt7# on .rite plan (square feet or acres) QU O U Is any part of the property within 250 feet of ashore ne? \t lim is the current use of this property? Yyes, idenfify on site plan O Yes o /t/ 7- Z—b % Is your property in a designated wildlife habitat arca? \Fill the site be screed by a septic system? O Yes to O Don't know O Yes Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property? IJju, identi on rite plan IJyer• ident on the site plan O Yes �No O Maybe O Don't know O Yes No O Yes O No Are there any wetlands, streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property? Yyej, irinAion rileplan O Yes o O Yesj(o Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site% % Cl Yes o O Yes o DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? Is public sewer available to the site? O Yes O No O Yes O No Is the property inside the ASA? O Yes O No Is public water available to the site? O Yes O No O Yes O No Is the property inside the PSSA? O ,Yes Cl No Is the property located within 1000 feet of a Natural Resource Area? O Yes O No bate Recckrd: 41ff ItvPr ntali.c: METHOD OF PAYMENT VISA ❑ CASI1 ❑ C111:CK ❑ �11 ❑ ❑ FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD AT - K.\NKCARI) Nl'\IKIiR: \U"II IORI%I::D SIGNA I URI` TOTAL FEE MINIMUM PEZ%1JTFE£ 15535.00PLUA E Nt\KC-. CI-IECI:; PAY. BkJ' TO SPOKANE: COUNTY PFR\IIT CI_\'IF.R ADDRE ZONE ROAD FRC COMM REVIEV 0/- *400o AP G✓ - QAli.� o� This site plan is being submitted for thrt purpose of obtaining a building permit and is a true and correct representation of the proposal. All known property lines/dimensions, curb lines, structures and easements have been identified. Also indicated are wetlands. A00' ,;)- t si L or f ;eA;zT- /Q SF 1240-o) 0-o) 13 9 1-. 5 -*2-1''