2002, 05-21 Permit App: 02003938 Addition Project Number: 02003938 Inv: 1App lication Date: 5/21/02 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: RES ADD-DINING ROOM,BEDROOM & Contact: R R MERRILL CONSTRUCTION
STORAGE AREA IN BASEMENT Address: 12922 E SEMRO AVE
C- S-Z: SPOKANE,WA 99216
Setbacks:Front Left: Right: Rear: Phone: (509)924-5026
Group Name:
Project Name:
Site Information:
Plat Key: 005230 Name: MIDILOME 7TH ADD District: F
Parcel Number: 45331.4305 Block: 2 Lot: 5
SiteAddress: 11921 E 40TH CT Owner:Name: WAGNILD,ED
SPOKANE,WA 99206 Address: 11921 E 40TH CT
Location::SPO SPOKANE,WA 99206
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review L Releasee
...al
Plan Review Release �...../
Permits:
Operator: JAS Printed By: JAS Print Date: 5/21/02
Project Number: 02003938 Inv: 1 Application Date: 5/21/02 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: R R MERRILL CONSTRUCTION Firm: RANDY/R R MERRILL CONST C
Address: 12922 E SEMRO AVE Phone: (509)924-5026
SPOKANE,WA 99216
Building Characteristics
Const Category: Addition Group: Type:
Nbr Of Dwellings: Occupant Load: Building Height: Stories: 1
Bldg W x D: 20 x 15 Building Sq Ft: 300 Sprinklers:
Req Parking: Handicap Parking: Critical Materials:
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
BASEMENT F R-3 VN 300 $5,028.00 300 $5,028.00
RES ADD R-3 VN 300 $19,800.00 300 $19,800.00
Totals: 600 $24,828.00 600 $24,828.00
Item Description Units Unit Desc Fee Amount
RESIDENTIAL VALUATION 1 Y OR BLANK $350.50
STATE SURCHARGE 1 Y OR BLANK $4.50
RESIDENTIAL SURCHARGE 1 Y OR BLANK $77.11
Permit Total Fees: $432.11
Mechanical Permit
Contractor: ALLIED HEATING INC Firm: ALLIED HEATING INC
Address: 10213 E BUCKEYE LN Phone: (509)928-8252
SPOKANE,WA 99206
Item Description Units Unit Desc Fee Amount
DUCT SYSTEMS 1 NUMBER OF $10.00
MINIMUM FEE ADJUSTMENT 1 Select $25.00
Permit Total Fees: $35.00
Operator: JAS Printed By: JAS Print Date: 5/21/02
Project Number: 02003938 Inv: 1 Ap lication Date: 5/21/02 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
208 REQUIRED/SEE PLAT FILE FOR SITE PLAN&OTHER NFO
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $432.11 $432.11 $0.00 $432.11
Mechanical Permit $35.00 $35.00 $0.00 $35.00
$467.11 $467.11 $0.00 $467.11
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be contrued to be a permit for,or an approval of,any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JAS Printed By: JAS Print Date: 5/21/02
lit PROJECT APPLICATION WORK SHEET
COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
I- SPOKANE
SPOKANE,
` 3675WA 9260
SPOWV COMFY
SPECIFIC SITE INFORMATION
Street Address: (1921
4-aik
l�n .9.v�
Assessor's Tax Parcel Number(s): 1/' ".YSI- r i4
Legal Description: '[
•
Project Description: 4414 rt i tr.., 4-6. '"-�.4s 1 0.e r....,G..,__
rBuilding Permit - O Change in Use O Grading Cl Manufactured Home Permit
O Relocation Cl Sign O Tenant(New/Change) O Other
Department Use Only
Water District/Purveyor. Sewer Distract/Pun-eyor - - Road.wtddr Setbacks - - - - _
- - -Front Rear.
School District. Fire District: Zoning
Left Right
OWNER/APPLICANT INFORMATION
El #ndno/e oho should be eon lacted reeardhr.g ibh-projed
Omer: Phone: ( .Applicant: Phone
r[wn✓ Cr 0A40,1f -l) t;s: -E Mtui t,(. Piw6'4-oiat(0a• .5217 fz(s7,24
MailingAddress: Mating Address:
i 19 2-/ ,C- 4O d1 (Z 9 z-2- h- .s.i rza a✓--
Gn,State,zip Cin,State,Zip
Sport VA 4921 ‹.F"6.1.4.. . GU if 99uj
Phone
❑^Contraaor a//' Phone ❑Architect/Engineer
1� t le P$ILL-C11N� - Fac
Mailing aldres' heading address
Cat ,State Zip Cin-,State Zip
WA State Contractor license s Contact name,
�Z. ie mi it c.c.!) s 8 61-
PROJECT INFORMATION
Building Information
Buildingheight to peak 1#of stones Main tflloor sq.ft Un ini'hed basement sq.ft.
1 et
Din ..- "Iota(liabitable space 2"d floor sq.Din... Finished basement sq.ft.
/C)t '
Occupancy group (:otu(ruction n.pe Garage sq.ft. Deck sq.ft.
Cost of prosect I!eat source(ek-ctric.gas.etc.)
Manufactured Home Si
Width: Length: '"-'
What is the square footage of the sign How high is the sign?
face?
Year
Make:
of signs Area of existing signs
Relocation Fire Safe
ty
Precious address
Fire Sprinkler Tent
Paint booth Fire Alarm
— Fireworks display
Proposed use
Value
Special.Inspections Required? Non-Residential Energy Code Compliance?
Firm Name
Phone
Plans Examiner Phone
Inspectors:
Address
Inspector
Phone
0 Concrete 0 Welding 0 Bolting 0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Arc there structures on the property? 0 Yes 0 No
I yes,identii on site'Ion (s. at is the current property size?
Is any part of the propcm within 250 feet of a shoreline? (s'uare feet or acres)
I ver,irlenti on site Ian What is the current use of this property?OY"cs 0 No
Is your property in a designated wildlife habitat area?
0 Don't know Will the site be served by a septic system?0 Yes 0 No
O Yes O No
Is any part of the property within a 100 yr flood plain?
If an ideut on riteplon Are or will there be wells located on the property?
the site 0 Maybe 0 Don't know f)'Pr,irlP/Jt or/ Inn 0Yes 0No
O }'cs ONo p
Are there any wetlands_streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
I es,/demi) on site shin
0 Yes 0 No
Are there slopes greater than 30%on the property?(30 ft rise in 100 ft 0 Yes 0 No
) Are critical or hazardous materials used or stored on site?
0 Yes 0 No
0 Yes 0 No
Is the property in a designated Stormwater Control Area? DEPARTMENT USE ONLY
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA?_ O Yes O No
P pen➢ 0 Yes 0 No
Is public water available to the site? 0 Yes 0 No
ro O Yes 0 NoIs the
property inside the I'SSA? 0,Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
starnaPr, 0 Yes 0 No
cman%c:
METHOD OF PAYMENT
VISA - _ COt` ' VR7'()'1'.11_
o (:_vii 0 (HECK ❑ OMNI ❑
❑ 17,z —
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DA 1.1.::
EXPIRES: •
BANKCARD NV1IBLR: TOTAL FEE
_WMORIZED SiGNA VRI-.: M/V/Mut1PERMIT FEE/SSJs.aol'trAse
>t+Kf.cot-c-yy PEY ust_To spok{NE
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