1995, 01-19 Permit App: 95000279 Repair Fire Damage A •�
PROJECT NUMBER= 95000279 APPLIC.ATIO1.1 DATE= 01/19/95 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 11213 E 43RD AVE PARCEL#= 45333. 1106
ADDRESS= SPOKANE WA 99206
PERMIT USE= FIRE DAMAGE REPAIR TO TRUSSES
PLAT#= 000877 PLAT NAME= FOREST MEADOW 1ST ADD
BLOCK= 2 LOT= 6 ZONE= SFR DIST#= E
AREA= 00018360 F/A= F WIDTH= DEPTH= R/W=
# OF BLDGS= # DWELLINGS= 1 WATER DIST = UNKNOWN
OWNER= JUTTE, GLEN PHONE= 509 926 0961
STREET= 11213 E 43RD AVE
ADDRESS= SPOKANE WA 99206
CONTACT NAME= PAT PHONE NUMBER= 509 326 0908
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING FIELD INSPEC. REQ PRIOR PERMIT CV___ 1 I).
COMMENTS: 19 .q
******************************* BUILDING PERMIT *******************************
CONTRACTOR= CAPSTONE CONSTRUCTION PHONE= 509 467 5330
STREET= PO BOX 388
ADDRESS= NINE MILE FALLS WA 99026
NEW= REMODEL= X ADDITION= CHANGE OF USE=
DWELL UNITS= 1 OCCUP. LD= BLDG HGT= STORIES=
BLDG W X D = X SQ FT= SPRINKLER= N
REQ PARKING= #HANDICAP= CRITICAL MAT= N
DESCRIPTION GROUP TYPE SQ FT VALUATION
REPAIR R-3 VN 25500. 00
ITEM DESCRIPTION QUANTITY FEE AMOUNT
RESIDENTIAL VALUATION Y 258 .50
STATE SURCHARGE Y 4 .50
RESIDENTIAL SURCHARGE Y 46. 53
******************************* PAYMENT SUMMARY ****************************
PAYMENT DATE RECEIPT# PAYMENT AMOUNT
01/19/95 00000388 309. 53
TOTAL DUE= .b0 TOTAL PAID= 309. 53
PROJECT NUMBER= 95000279 APPLICATION DATE= 01/19/95 PAGE= 02
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
BUILDING PERMIT 309.53 309.53 . 00
309. 53 309.53 . 00
PROCESSED BY: DAWN DOMPIER
PRINTED BY: KATHY CUMMINGS
******************************** THANK YOU ************************************
s.
~ ( 2 //
APPLICATION INFORMATION
( 3
What is the JOB SITE address? ASSESSOR'S tax parcel number?
iii
H ; 3 15 . '-1-3 nee. . Li A.,
Legal description as it appears on the property deed
OWNER or OCCUPANT _ Phone
G /— KO SUIT 9z6-,---(..)76/
Mailing address City,state
Zip
2D•
) I a 1 - if. i-1- S1t) k►4,)ji, ).1")( 99db 6
Who should we contact regarding this project? Phone
014 P STZ?/u,C1 Ceevo57 `( P4`T. 1 3 .6'' o 76 S
What work is being done under this permit?
.Cone
nspecoistrict ;
e.:. 'Hightat way Httthy .
Water district
a)
O
g
Buildin Building height
#of stories
Contractor j 5' "2 I
Dimensions TOTAL SQUARE FOOTAGE
A-4(1s TCNL ClIN.s7- '32)s _5-.5--
WA State Contractor license# Main floor area
_ Unfinished basement area
Mailing address v 47 J S
) 2nd floor area Finished basement area
?o. 3�k /�3e6 7 fit/// �/4cl s 0,21- �b'iJL- .3Lk��C
Architect/Engineer Garage area
Size of decks,etc.
What is the heat source? ZZ 3 / ,- Lk LGA
What is the cost of your project?
As r-�,�,�, � .2-5;57)6, `e' &5.5
Manufactured Home
5 i r
Width: Length: What is the
square footage of How high is the sign?
the sign face?
Year: Make:
Installer Contractor
Wa State Contractor license# Wa State Contractor license#
Mailing address Mailing address
Relocation Fire Safety
Previous address
Fire Sprinkler Tent _
Paint booth Fire Alarm Fireworks display
Contractor VALUE
Contractor
WA State Contractor license# A State Contractor license#
Mailing address Mailing address
Fuel Storage Tanks
Swimming Piot
(Circle one) Above-ground Underground Size/gallons Private
Contents of tank(s) Size/gallons
Contractor Public/semi-private
Contractor
Wa State Contractor license# WA State Contractor license#
Mailing address Mailing address
COMPLETE ALL APPLICABLE INFORMATION