2001, 12-19 Permit App 01010970 Safety InspectionProject Number: 01010970 Inv
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
'Cate: 12/19/01 Page 1 of 2
Project Information:
Permit Use: SAFETY INSPECTION: 20 X 24 DETACHED STG Contact: ANDERSON, ARTHUR G.
BLDG (BUILT W/OUT PERMITS) Address: 420 N FELTS RD
C - S - Z: SPOKANE, WA 99206
Setbacks: Front Left: Right: Rear: Phone: (509) 893-2717
Group Name:
Site Information: Project Name:
Plat Key: CONV Name: CONVERTED CNTY DATA
Parcel Number: 45174.2314
Block: Lot:
District: F
SiteAddress: 420 N FELTS RD Owner: Name: ANDERSON, ARTHUR G.
SPOKANE, WA 99206 Address: 420 N FELTS RD
Location:: SPO SPOKANE, W99
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold:
Area: 15,000 Sq Ft Width: 120 Depth: 125 R. t O Wf a 0 �ti/
Nbr of Bldgs: 2 Nbr of Dwellings: 1 U.
Review Information:
Review
Site Plan Review
Permits:
Released By: _
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Operator: CKF Printed B : nt Date: C.'
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Project Number: 01010970 In. Application •Date: 12/19/01
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: OWNER Firm: OWNER
Address: 0 Phone: (000) 000-0000
000000, 00 000000
Building Characteristics
Const Category: New Group: U-1 Type: VN
Nbr Of Dwellings: Occupant Load: Building Height: 13 Stories: 1
Bldg W x D: 20 x 24 Building Sq Ft: 480 Sprinklers: ❑
Req Parking: Handicap Parking: Critical Materials:
Item Description
CHANGE OF USE/SAFETY INSP
STATE SURCHARGE
Notes:F<
Payment Summary:
Permit Type
Building Permit
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
Fee Amount
$54.50
$54.50
Permit Total Fees:
Invoice Amount
$54.50
$54.50
Fee Amount
$50.00
$4.50
$54.50
Amount Paid
$0.00
$0.00
Amount Owing
$54.50
$54.50
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 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: CKF
Printed By: Print Date:
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: (/ 4
2 O
Assessors Tax Parcel Number(s):
Legal Description:
4i l�
A/ o 0-C Lo (A I 3
Project Description:
❑ Building Permit
❑ Relocation
❑ Change in Use
I
❑ Grading
❑ Manufactured Home Permit
❑ Sign
❑ Tenant (New/Change)
Other ScL 4-y gftthi 1
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front: Rear.
Left: Right:
School District.
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
❑ tt h, ncr: �% Phone: 89,3
Az/Au/La lax:
? /,
ElApplicant:
s/►%
�?� s 0 �4 i�� 2
Phone:
Fax:
Mailing A dress:
Al4.6 /- `/
Mailing .Address:
City, State, Zi.11
,oL0.04/G , L) - i9..›04,
City, State, Zip
❑ Con actor Phone ;
� 4 5�5
(9 ci__ (e50.4....)/ist..7 lax
���❑
:\rchitea/Ilnl�inccr
Phone
Ias
11aj mg address J/ I
S. 7/ r3 /L.. c i ( r--- 7`
Mailing address
(:in•, State tp
(:in, State tip
WA Sty to Contractor license # •
Contact name:
Building Information
Building height to peak �j
iy
vv
r /
# of stories
0 •c/G=�
Alain floors ft.
y
'` .�i
Unfinished errtent sq. ft.
.4/
Dimcnsiot
O2O 7t: /�'f
'Total habitable;;pace ace
2'°t floor sq. ft.
.¢
Finished bas e•nt sq. ft.
Oc pancy group
' nstruction typi,
Garage sq. ft.
OQ
Deck sq.
of projeetly d tD
I kat source (electric, gas, crtc.)
(.ost
w
Jk/i5�c /v�/l /2,,, 2p add.,` i'
lta
Manufactured Home III
Sign •
Width:
---1
Length:
1
What is the square footage of the sign
face?
Flow high is the sign?
.---
Year.
Make:
# of signs
Area of existing signs
Relocation
Fire Safety
Previous address
/4,1_
Fire Sprinkler
'1'cnt _____
Fireworks display _ ___
Paint booth Fire Alarm
_
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name Phone
flans Idsamincr
Phone
Inspectors:
.\ddress
Inspector
Phone
O Concrete O Welding 0 Bolting 0 Reinforcement
wdn's
A.
Are there structures on the property? ps Yes 0 Noy ~ `v +� v
If yes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
Ifyes, identify on site plan 0 Yes 1X. No
What is the current use of this property
v
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes "No
Will the site be served by a septic system? 0 1'es No
Is any part of the property within a 100 yr flood plain?
Ifyes, itient61 on site plan
0 Maybe 0 Don't know 0 Yes ICS No
Are or will there be wells located on the property?
Ifyes, identifi, on the site plan O Yes "I No
0
Are there any wetlands, streams or ponds within 2 0 feet of the property?
If identify on site plan 0 Yes No
Is there evidence of fill or excavation on the property?
0 Yes A No
yes,
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( — %) OYes No
Are critical or hazardous materials used or stored on site?
DYes INo
D
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
D Yes
O No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Yes
O Yes
0 No
DNo
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA? 0 Yes
0 No
Is the property located within 1000 feet of a Natural Resource Area?
O Yes DNo
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASH ❑ CIIIiCK ❑ r ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
D:1'l'I
EXPIRES:
BANK(:.\RD NU �IBI:R:
.\L1'I'11ORIZI?D SIGNATURE:
SUB'1'OT.11.
TOTAL FEE
MINIMUM PERMIT FEE IS $,35 QO PLEASE
MAKE CI IBCKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER
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