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''