2004, 12-22 Permit App: 04009504 Pole BldgIVA
Valley
641
PERMIT APPLICATION WORK SHEET
SPOKANE VA L L EY COMMUNI TY DEVEL OPMENT
BUILDING DIVISION
99707 East Sprague Ave Ste 906
Spokane Valley, WA 99206,
Phone: (509)688-0036 Fox .• (509)688-0037
IC REQUIRED SITE INFORMATION
STREET
-30S e _.-26
ASSESSOR'S TAX PARCEL NUM
LEGAL DISCRI
PERMIT DESCRIPTION:
J
ae6
0 BUILDING PEIUMn EICHANGE IN USE ❑ GRADING 1 MANUFACTURED HOME
[3RELOCATION [3 SIGN [}TENANT E}oTHEx
OWNER / APPLICANT INFORMATION
M OWNER: 'SCoTr - oev'
PHONE:509 90-0787— FAX:
ADDRESS: 111305 P'+• 21Q 'aVF• + � —AAs jb j6 #jfiJVb
CITY,STATE, ZIP
® CONTRACTOR:
PHONE: FAX:
ADDRESS:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
C3 APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZII
ARCHITECT.:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZI
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:-/-S-
BUILDING
EAK: �-S /
BUILDING DIMENSIONS: .21/Y,30
NUMBER OF STORIES:
NUMBER of BEDROOMS:_
FLANKING SETBACK:
FRONT SETBACK: /DD/
REAR SETBACK: J
LEFT SETBACK:] -3
RIGHT SETBACK:_
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE: Pdle
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE: j 3lox//Z-
CURRENT PROPERTY USE: 5, f, 7hi!U
CURRENT SEPTIC USE:
CURRENT WELL USE: 0'
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
)�(�1Z')
I�If-.��urNc; I LIKED HOME
WIDTH:_______ LENGTH:_
YEAR:__ PIT SET:
MANUFACTURER:
RELOCATION
PREVIOUS ADDRESS:
PROPOSED USE:
SIGN
SQ FT OF SIGN:
HEIGHT OP SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
FIRE SAFETY
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
DATE/TIME:
PLANS EXAMINER: PHONE:
FAX:
ADDRESS:.
CITY, STATE, ZIP
INSPECTOR: PHONE:
FAX:
ADDRESS:
SPECIAL INSPECTIONS
® BOLTING E3CONCRETE E3 REINFORCEMENT
FIRM NAME: PHONE:
INSPECTOR(S):
CITY, STATE, ZIP
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES 13 NO IF YES: 13 COUNTY C3 CITY
IS PUBLIC WATER AVAILABLE: ® YES .® NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: El YES ® NO PSSA: ❑ YES ® NO
)ATE
METHOD OF PA ymENT
iS■ai�
CASH CHECK VI
I NKCAI?D *1 EXP/RES: VIN #
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
) W.
Project Number: 04009504 Inv: 1 Date: 12/22/2004 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
Parcel Number: 45283.3215 Block: Lot:
SiteAddress: 11305 E 26TH AVE Owner: Name: RIDER, SCOTT
Address: 10305 E 26TH AVE
Location:: CSV SPOKANE VALLEY, WA 99206
Zoning: UR -3.5 Urban Residential 3.5
Water District:
Area: .00 Acres Width: 0
Nbr of Bldgs: 2 Nbr of Dwellings: 1
Review Information
Revi
Site:
Plan
Perms t. s:
Hold: ❑
Depth: 0 Right Of Way (ft): 70
Operator: K C Printed By: K_C Print Date: 12/22/2004
Project Number: 04009504 Inv: 1 J -VW Date: 12/22/2004
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Building Permit
Firm: OWNER
Phone: (000) 000-0000
Building Characteristics
Group: U-1 Type: VB
Total Area 720
Building Height 15
Stories 1
Dwelling Units 0
This Application:
Total Project:
Description G_pr Type
Notes
S(I Ft Valuation
So Ft Valuation
GARAGE U-1 VB
720 $13,680.00
720 $13,680.00
Totals:
720 $13,680.00
720 $13,680.00
Item Description
Units
Unit Desc
Fee Amount
RESIDENTIAL PERMIT FEE
1
SELECT
$237.25
ACCESSORY PLAN REVIEW
1
SELECT
$59.31
STATE SURCHARGE
1
SELECT
$4.50
Permit Total Fees:
$301.06
Notes
Payment S
e t umma
ry•
Permit T -)w Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $301.06 $301.06 $0.00 $301.06
$301.06 $301.06 $0.00 $301.06
Page 2 of 2
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: K C Printed By: K_C Print Date: 12/22/2004
l�
C) ��^ PLANNING DEPT. APPROVED
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Signed:_n
Date:
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