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2005, 08-24 Permit App 05003079 Residence, GarageProject Number: 05003079 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: NEW RESIDENCE W/ATTACHED GARAGE -GAS Contact: SAMS, MARNI & JAMES Address: 16818 E INDIANA AVE C - S - Z: SPOKANE VALLEY, WA 99016 Setbacks: Front 40 Left: 20 Right: 13 Rear: 88 Phone: (509) 998-6291 Group Name: Project Name: Site Information: Plat Key: uzuffirmagtogoom Name: GREENACRES IRR DISTRICT A Date: 08/24/2005 Page 1 of 3 District: East Parcel Number: 45124.0144 Block: SiteAddress: 16818 E UNKNOWN ADDRES Location:: CSV Zoning: UR-3.5 Water District: Urban Residential 3.5 Lot: Owner: Name: SAMS, MARNI & JAMES Address: 16818 E INDIANA AVE SPOKANE VALLEY, WA 99016 Hold: ❑ Area: 3.96 Acres Width: 250 Depth: 620 Right Of Way (ft): 40 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information:. Review Site Plan Review Released By: Plan Review Originally Released: 08/24/2005 By: cjjanssen Released By: Approach / Drainage Originally Released: 07/20/2005 By: TMELBOU Released By: Septic System Review Originally Released: 08/24/2005 By: cjjanssen Released By: PER LANCE @ COUNTY HEALTH Originally Released: 08/24/2005 By: cjjanssen Operator: CJJ Printed By: CJJ Print Date: 08/24/2005 Project Number: 05003079 Inv: 1 Application THIS IS NOT A 1ERIVIIT Penalties will be assessed for commencing work without a permit Permits: ,,,==maxgamAsatomm,atsoolawaawl-40vm Contractor: OWNER Item Description APPROACH INSPECTION CONST IN ROW - APPROACH Contractor: OWNER Description Grp Type Notes BASEMENT U R-3 VB GARAGE U-1 VB RESIDENCE R-3 VB Item Description RESIDENTIAL PERMIT FEE STATE SURCHARGE RESIDENTIAL PLAN REVIEW Contractor: OWNER Item Description DUCT SYSTEMS GAS WATER HEATER GAS APPLIANCE<=100,000BTU GAS PIPING HEAT PUMP OR A/C 0-3 TONS VENTILATING FANS CLOTHES DRYER RANGE GAS LOG OR GAS INSERT Date: 08/24/2005 Page 2 of 3 Approach Firm: OWNER Phone: (000) 000-0000 Units Unit Desc 1 NUMBER OF 1 NUMBER OF Permit Total Fees: Building Permit Fee Amount $25.00 $25.00 $50.00 Firm: OWNER Phone: (000) 000-0000 This Application: Total Project: Su Ft Valuation Su Ft Valuation 1,814 $27,210.00 1,814 $27,210.00 792 $15,048.00 792 $15,048.00 1,814 $135,469.52 1,814 $135,469.52 Totals: 4,420 $177,727.52 4,420 $177,727.52 Units Unit Desc 1 SELECT 1 SELECT 1 SELECT Permit Total Fees: Mechanical Permit Fee Amount $1,430.55 $4.50 $572.22 $2,007.27 Finn: OWNER Phone: (000) 000-0000 Units Unit Desc 1 NUMBER OF I NUMBER OF 1 NUMBER OF 6 # OF UNITS 1 NUMBER OF 2 NUMBER OF 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF Permit Total Fees: Fee Amount $10.00 $10.00 $12.00 $6.00 $12.00 $20.00 $10.00 $10.00 $10.00 $100.00 Operator: CJJ Printed By: CJJ Print Date: 08/24/2005 Project Number: 05003079 Inv: I Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: OWNER Item Description PRIVATE SEWAGE DISPOSAL TOILETSBIDETS SINKS SHOWERS TUBS DISH WASHERS CLOTHES WASHER WATER PIPING - DWV Notes: Q,m Payment Summary: Permit Type Approach Building Permit Mechanical Permit Plumbing Permit Plumbing Permit Firm: OWNER Phone: Units Unit Desc 1 SELECT 3 NUMBER OF 5 NUMBER OF 1 NUMBER OF 2 NUMBER OF 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF Fee Amount $50.00 $2,007.27 $100.00 $104.00 Permit Total Fees: Invoice Amount $50.00 $2,007.27 $100.00 $104.00 Date: 08/24/2005 Page 3 of 3 (000) 000-0000 Fee Amount $20.00 $18.00 $30.00 $6.00 $12.00 $6.00 $6.00 $6.00 Amount Paid $0.00 $0.00 $0.00 $0.00 $104.00 Amount Owing $50.00 $2,007.27 $100.00 $104.00 $2,261.27 $2,261.27 $0.00 $2,261.27 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: CJJ Printed By: CJJ Print Date: 08/24/2005 $a- -3 .P� BUILDING PERMIT APPLICATION WORKSHEET ct't1 Vt_ ► City of Spokane Valley Community Development Department S�kane 4 C�� Building Division _ 0(it�c►. 11707 E. Sprague Avenue, Suite 106 4001,Va e Spokane Valley, WA 99206 �9 688-0036• Fax: (509) 688-0037 one: (50) Oi > - C' 1_7 U�U� Street Address: \ ?\`TOC If it /k_ REQUIRED SITE INFORMATION 1v. E Assessor's Tax Parcel Number(s): 4J \ OVA cx5s- \cx\ cx `Trc>it 351 o'F plc`- .1 R' 6c- tic roc, Legal Description:-eccfCCl `k\(\ pair 01 err PERMIT DESCRIPTION: [y] Building Permit ❑ Change in Use ❑ Grading El Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety El Other i OWNER/APPLICANT INFORMATION Owner: (1v( 'n1 -cameS Phone:q , to* 1 Fax: - 53-Qa13 Address: —Po boy, City State Zip Code ❑ Applicant: Phone: Address: Fax: City State Zip Code ❑ Contractor: ❑ Architect: Phone: Fax: Phone: Fax: Address: Address: City State Zip Code City State Zip Code WA State Contractor License #: Contact: Spokane Valley Bus. Liscense #: Contact: PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: DIMENSIONS: # OF STORIES: MAIN FLOOR TO SQ. FTG 2" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: - GARAGE SQ. FTG: �.,jr,] III DECK/COV. PATIO SQ. FTG: 57.7rI OCCUPANCY GRQUP: CONSTRUCTION TYPE: HEAT SOURCE: # OF BEDROOMS: t TOTAL HABITABLE SPACE. IMPERVIOUS SURFACE AREA: IC SEWER OR ON -SITE SEPTIC ` / n COST OF PROJECT:1��IC� �„ 30% SLOPES ON PR PERTY: C) 7 MANUFACTURED HOME Width: Manufacturer: Length: Year: Pit Set: RELOCATION Previous Address: Proposed Use: FIRE SAFETY Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth: Tent: Fireworks Display: Blasting: Date/Time: Valuation: Above/Underground Storage Tank Size: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Address: Inspector: Address: Phone: Fax: City Phone: State Fax: Zip City State Zip SPECIAL INSPECTIONS ❑ BOLTING Firm Name: ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING Phone: Fax: Inspector(s): DISCLAIMER The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. Ownership of resulting development rights granted by any issued permit inure to the property owner. Print Name Mar i r j 5 Signature Yhii , Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other Bankcard #: Expires: VIN#: Authorized Signature: 08/24/2005 08:25 5e3241567 5RHD UNU r�u� e_Eui BUILDING PERMIT APPLICATION WORKSHEET Ir 41---1°7 ‘IetCity of Spokane Valley Community Development Department p � O ne ,P) d.t Building Division #Valle arai 1-i I EQUIRED SITE VU11..1�1 Street Address: 1LP?lam E T t a. 11707 J- Sprague Avenue, Suite 106 Spokane Valley, WA 99206 one; (509) 688-0036; Fax: (509) 688-0037 ORMATION Assessx's Tax Parcel Number(s): i d'kd • NA cF lt'nc� '�l of Ala ►f Exrer cros r Legal Description: ' p/a, s (pore, cp./ PERMIT DESCRIPTION: (J Elul ding Permit Change in Use Grading ❑ RQI! cation Tenant Improvement Fire Safety al Ul Manufactured Home Other OWNER/APPLICANT INFORMATION Owner- nee- 11 3 M al IcmQS ¶tri.S . ❑ Applicant: 1:1'hone:c , l4�at Fax: 75 -q�I3 Phone: Fax Address: --po txpi, Address: c:Ity :hawcoal Cab State (;:ontractor. F'honc: Fax Address: G sty State Zip Cade Architect Ip coda Phone: Fax: Addres9: City Stale Dp Code WA Stal e Contractor License #: Contact: ipokane Valley Bus. Liscense #: Contact HE}Ol °if O PEAK RUIN FL( IOR TO SQ. FIG SIN SHI Eta BASEMEN4SQ. FTG: DCCU AIiJCY RQUP: tof ; �{ MS: ;OST OF ROJECT PERMIT/BUILDING INFORMATION O.➢Z.c)* _NSIONS- LOOK F G: GARAGE SQ. FTC: CONSTRUCTIOWtYPE: ABLE SPACE: 30% 5LOP?.$ ON Pi —0— a Nip sycfsel tissior s fora tms,drrewrirsi 3 bedrooms, or gallon, per day. 7_ ,OCCUPANCY NOT ALLOWED unt! syatarn ins IetfationhapSl3Jtidlo.,".,t-,..._.:: . # OF STORIES: UNFIN BASEMENT SQ. FTG: 1f94 DECKJCOV. PATIO SQ. FTG: HEAT SOURCE: are cs�. ENVIOUS SURFACE AREA: —v-- 3EVWEF OR QN-SITe 5ErTIG SYSTEM? �Y1 rt2. _Se Q J ) PUG 24 2005 09:36 5093241567 PAGE.01 ISfkkiine' s1t they MECHANICAL PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, CaII (509) 688-0054 Project Address: I tS?d a T/?fll• l,�ytet_ Owner: YY)rt rn, --' S-i £ 5 Snrr Mailing Address: Contractor: Mailing Address:-'c.trc-a a s ONY-t/t<, Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Permit Use: Phone (Daytime Contact): (ic, Ordo r()IS i! ,04 City State License #: Phone #: Zip Code ZiD Code D DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $12.00 = 2 FUEL BURNING APPLIANCE More than 100,000 X $15.00 = 3 UNLISTED APPLIANCE (Additional Fee) Equal to or less than 400,000 X $50.00 = 4 UNLISTED APPLIANCE (Additional Fee) More than 400,000 X $100.00 = 5 USED APPLIANCE (WSEC min. AFUE rating) Equal to or less than 400,000 X $50.00 = 6 USED APPLIANCE (WSEC min. AFUE rating) More than 400,000 X $100.00 = 7 BOILER/REFRIGERATION 1 - 100M BTU X $12.00 = 8 BOILER/REFRIGERATION 101 - 500M BTU X $20.00 = 9 BOILER/REFRIGERATION 501- 1,000M BTU X $25.00 = 10 BOILER/REFRIGERATION 1,001 - 1,750M BTU X $35.00 = 11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 = 12 GAS LOG, GAS INSERT, GAS FIREPLACE I X $10.00 = IV ' 13 RANGE f X $10.00 = 10 " ' 14 DRYER I- X $10.00 = t/ 0 OCR 15 FUEL BURNING WATER HEATER I X $10.00 = I Q eL 16 MISC. FUEL BURNING APPLIANCE X $10.00 = 17 GAS PIPING (each outlet) f _ LP X $1.00 = (D 00 18 DUCT SYSTEMS I X $10.00 = l O " 19 VENTILATING FANS X $10.00 = 00 ." Equal to or less than 10,000 CFM X $12.00 = 20 AIR HANDLER (DOES NOT include ducting) 21 AIR HANDLER (DOES NOT include ducting) Greater than 10,000 CFM X $15.00 = 22 EVAPORATIVE COOLERS X $10.00 = 23 TYPE I HOOD X $50.00 = 24 TYPE II HOOD X $10.00 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON 1 X $12.00 = / I ci c.V 26 AIR CONDITIONER 3-15 TON X $20.00 = 27 AIR CONDITIONER 15-30 TON X $25.00 = 28 AIR CONDITIONER 30-50 TON X $35.00 = 29 AIR CONDITIONER More than 50 TON X $60.00 = 30 LPG STORAGE TANK X $10.00 = 31 WOOD OR PELLET STOVE/INSERT X $10.00 = 32 WOOD STOVE - FREE STANDING X $25.00 = 33 REPAIR & ADDITIONS X $15.00 = 34 VENTILATION SYSTEMS X $12.00 = 35 VENTILATION MECHANICAL EXHAUST X $12.00 = 36 INCINERATOR - RESIDENCE X $19.00 = 37 INCINERATOR - COMMERCIAL X $22.00 = METHOD OF PAYMENT: 0 CASH ❑ CHECK ElVISA ❑ MC CARD #: DATE: SUBTOTAL >S. ° PROCESSING FEE $35.00 EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX:.(509) 688-0037 For Inspections, CaII (509) 688-0054 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Project Address: MPAB, 6 }d Il _11.7L- Permit Use: 1\Qt f CM}ru( I tan (- 64iid. G -P0 (y►1ji-' Owner: Mafit i _ yy)e Sai.0 Phone (Daytime Contact):9,,)- 7/('3 Y Mailing Address: h501 ,t ( ] (rh,th< Wo 9 ;107 City State Zip Code Contractor: Mailing Address: License #: Phone #: City State Zip Code D DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6.00 = I ,").' 2 URINALS X $6.00 = 3 TUBS X $6.00 = ' �' 4 SHOWERS (PER TRAP) BATH, STALL, ON -SITE BUILT 1 X $6.00 = Lp n`' 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT - X $6.00 = OQ 6 DISHWASHER 1 X $6.00 = Li) 00 7 CLOTHES WASHER X $5.00 = CD. 8 GARBAGE DISPOSAL X $6.00 = 9 WATER SOFTENER X $6.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6.00 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6.00 = 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS, DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X $6.00 = 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER X $6.00 = 17 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS X $6.00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X $6.00 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = ) . 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: 0 CASH 0 CHECK DATE: SUBTOTAL /0 .b ❑ VISA ❑ MASTERCARD PROCESSING FEE $35.00 EXPIRES: TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: QUIT CLAIM DEED (Statutory Form) IBI IIII IIIIII IIIIII II II VIII III II II III III Page iA 20 of ea 6p AMS QCD C A Spokane Co, LIR CW afi.18 aM RCW 65.09) 1/91: (pleue prim lav tome IrWexing Information required by Um WssNngttm State Audltoea/Rxorders Oaice. (R Reference x Of applicable): Grantor(s) (Seller): (1)(,.191.11. (\•%14�P r (21 �.-1J\Ct — Add -1. on pg. Grantee(s) (Purchaser): (1) �WrF' M,,p�ci..��Y n���� (2) Adf�ois, nq�p}g�_� Legal Description (abbreviated): i1ttT�1J]12fSy+lL a rrmwvn9>G9�,.r �' .leg'al�is bn pg Assessors Property Tax Parcel /Account 8 4 E U'A 0` n A Countyof`°" convey and quit-claim_to of n Pi' _ _ •City of of (�RtC ('k7lnntTlG.Countyof ,State oP ,all interest in the following described Real Estate: �i 0AC, * d situated intheCountyof %dane,Stateofu V (Z—. Datedthis day of Mali 29 9�iJ.� sZ-115:-1-62SJ CL ` o �- STATE OF WASHINGTON SS. (INDIVIDUAL ACKNOWLEDGEMENT) e– ,1 1 ,T7T w�Gd Coon of f� , I certi I know or have satisfactory evidence that W %t" W-f�LC.(s the person who appe fore me, and said person acknowledged that _ Signe Is instrument and acknowledged it to be free and volu act for the uses and purposes mentioned in th trument. Dated this 9 S���day o 02. Print ` ••� - v�tC Notary Public in an he State of N Y �. r M a mtment expires: 61 �~ V cult -Claim Deed (Smtumry F Y pP0 p ► B0C OWUNngon lsgal 9laa. ..Issaquah. WA Form No.289 6/97 •• MATERLaL MAY NOT EPRODUCED IN WHOLE OR W PART W ANY FORM WHATSOEVER. '/ ; ' jO• //V 6/7/2005 CBG f2.00 200510809, �F4LEIDEVELOPMENT SEGREGATIONACO NUMBER This application for segregation must be completed in entirety and signed. To expedite r 005-0540 processing please include all recorded documents and/or maps necessary to show ownership changes, mailing addresses, and any other pertinent details. APPLICANT: Name: ' fy\ S Address: Q G 1C City: State:\\�(� zip:(\d 1 Phone: - OWNER iF NOT APPLICANT: Name: \'t- \o )C \ �? Address:G\^al�����/� City: L l \P K7. k' State: ��� Zip: Cii>l � o TAXPAYER Name: �`���•IA�I�i Address: A om E --rh l n n rh_ City: Y (Ndi-e ,\V)AA 'P tl — r�— State: _ Zip: ggoi � o Work: tom. •��.i.� . Zip: GgotU Phone: Clu LL4-ILLWork: YhonelAo�p` IQ�p(- Work: APPLICANT IS: 7C - Name: Name: Owner Purchaser A6jPjjlC0 �,Aj' ,,� Co' FLessee ©Other " Ci�� Bim P, A� �7t��'—t� —.race* P Sta on V,.{ttet ) " Phone: ' ork: ACKNOWLEDGEMENT: (PLEASE READ BEFORE SIGNING) This segregation is for the division of property: same owner; sale or lease; or transfer of ownership by recorded deed or contract. A division of land for the purpose of transfer must be performed in accordance with applicable State and Local Laws. Local City or County Planning Departments grant final permissions for divisions of land. Taxes are current at this time, and will be kept current until.request is processed. 1.22 � 7m 4 PRINT NAME SI NATURET%1 -- DATE PARCEL NUMBERS TAX STATUS: (went t All taxes must be current at application, and must be kept current until request is finished. Building locations indicated on map. ❑ Segregation ❑ Merge FZTBLA-MLLA ❑ TCA Lr,Lw -3i-6Y ❑ Survey Map ❑ Notes (See back) CITY or Co. PLANNING - Approved ❑ Denied k6�rt r 6—tel— Larf$-664 b Official Name (Print) Phone ASSESSOR OFFICE 1116 W. B'wda y, OCH -1 Spokane, WA 99260 sif� Received by