2003, 09-23 Permit App BLD-03-02562 PorchSpokane
`"=Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
RESIDENTIAL ADDITION/REMODEL
Job Address: 17623 E INDIANA AVE
GREENACRES WA 99016-9546
Description: 360 SQ FT ADDITION TO MANUFACTURED HOME - BUILT IN 2000
NON -HEATED PORCH
Subdivision:
Owner:
STUKEL, THOMAS J
Applicant: STUKEL, THOMAS J
Address: 17623 E INDIANA AVE
GREENACRES, WA 99016-9546
Contractor: OWNER
Address:
Lot: Blk:
Phone:
Phone:
Lic No:
Application #: BLD-03-02562
Applied:
Issued:
Expires:
Parcel No: 55073.0820 Zoning:
09/23/2003
03/21 /2004
General Information:
VALUATION
REROOF
BUILDING HEIGHT TO PEAK
DIMENSIONS
COST OF PROJECT
# OF STORIES
# OF BEDROOMS
#FRONT SETBACK
REAR SETBACK
=LEFT SETBACK
RIGHT SETBACK
FLANKING SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
CURRENT PROPERTY USE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
5400
N
9
12 X 30
1800.00
1
3
110
400+
69
52
NA
r-3
5-n
2
198 X 640
RESIDENCE
yes
no
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
Total Calculated:
Deposits/Receipts:
Total Due:
50.10
125.25
4.50
179.85
0.00
179.85
5/
43 re -a- 77'49- 40 _,m,r
€PP L- �
THIS BUILDING SUBJECT
TO FIELD INSPECTION CORR�
OF SPOKANE VALLEY
P VED FOR SUBMITTAL
• Initials / pate
Buil• ing . /
nning �/ y2.5
Public Works
4eidlu
0
.23 07
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete all spaces, including the signature box (marked with an X).
2. Draw a map on reverse side of WHITE copy only.
• 3. Forward completed permit and fees to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.
(?_r 9a5/e/ne �yr C
ALTERATION PE,R' MIT
Do not complete shaded areas
Permit #
6319
Invoice #
Insignia #
Owner last name first name Day time phone Date
Address
/ -ar City State ZIP
instal ler/Contractor/Dlealler
Address
4: i- ae e.r
Phone Contractor's registration number
( )
City
State ..........................._................
Check the appropriate boxes in section A and section B. e3 _' CP 5 FEES
A
B ❑ Alteration Inspection (check appropr att*ss i'e1p j0 625 ,
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — -
Plan Review
Commercial Coach
Mobile Home
Recreational Vehicle or Li Park Trailer
Serial No.
Model No. or Plan Approval No.
'F'l i} .t i0ti . F1631'
Trans 1D ' 100274648
109/24/2Wti' 12:10
Curren-y : $80.00
'Serial No.
RV Inspection
Reinspection
Tec1 I spection
Note: This permit expires one year after date of pur F/ase. (Non-refundable)
Signature of applicant or authorized repres tative Make check payable to: Dept. of Labor & Industries
\A ,�� ! , FEES DUE $ 52 .
Department use only
Request approved or j Request denied because of specific violations of Washington_ rules and regulations. Violations must,;
be corrected and relnspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). It is unlawful . offer for
sale, rent, 'or lease any
non -complying mobile home, commercial coach or recreational vehicle.
}nginal Permit .
No
Included are forms required which must be completed and fees submitted before reinspection.
( Date ` - Area office
F622-012-000 alteration permit 7-01
Inspector,,:
ie-Olympia Canary -Inspector Green -Contractor PA -Purchaser Goldenrod -Purchaser
Total pages
Spokane
. Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
RESIDENTIAL ADDITION/REMODEL
Application #: BLD-03-02562
Job Address: 17623 E INDIANA AVE Applied: 09/23/2003
GREENACRES WA 99016-9546 Issued:
Description: 360 SQ FT ADDITION TO MANUFACTURED HOME - BUILT IN 2000 Expires: 03/21/2004
NON -HEATED PORCH
Subdivision:
Owner:
Applicant:
Address:
Lot: Blk: Parcel No: 55073.0820 Zoning:
STUKEL, THOMAS J
STUKEL, THOMAS J Phone:
17623 E INDIANA AVE
GREENACRES, WA 99016-9546
Contractor: OWNER
Address:
Phone:
Lic No:
General Information: Fees:
VALUATION 5400 PLAN CHECK FEE
REROOF N BASIC PERMIT FEE
BUILDING HEIGHT TO PEAK 9 WSBCC SURCHARGE
DIMENSIONS 12 X 30 Total Calculated:
COST OF PROJECT 1800.00 Deposits/Receipts:
# OF STORIES 1
# OF BEDROOMS 3 Total Due:
FRONT SETBACK 110
REAR SETBACK 400+
LEFT SETBACK 69
RIGHT SETBACK 52
FLANKING SETBACK NA
OCCUPANCY GROUP r-3
CONSTRUCTION TYPE 5-n
STRUCTURES ON PROPERTY 2
CURRENT PROPERTY SIZE 198 X 640
CURRENT PROPERTY USE RESIDENCE
SERVED BY SEPTIC SYSTEM yes
WELLS LOCATED ON PROPERTY no
50.10
125.25
4.50
179.85
0.00
179.85
THIS BUILDING SUBJECT
TO FIELD INSPECTION CORRECTIONS
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
Building
Planning
Public Works
'IG
7--
09/23/2003 14:40 _ _5093241567
SRHD EHS
PAGE d1/b1
TO 3241567 P.02/03
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
Job Address:
Description:
Subdivision:
Owner
Applloant:
Address:
Contractor.
Address:
17623 E INDIANA AVE
THIS IS NOT A PERMIT
Penalties will be assoased far
commencing work without a permit
RESIDENTIAL ADDITION/REMODEL
GREENACRES WA 99010-9548
360 SQ FT ADDITION TO MANUFACTURED HOME BUILT IN ' 000
NON -HEATED PORCH
Applicatlon #: BLD-03-02562
Applied: 09/2312003
Issued:
Expires: 03/21/2004
Lot: 91k; Parcel No: 55073.0820
STUKEL, THOMAS J
STUKEL, THOMAS J Phone:
17823 E INDIANA AVE
GREENACRES, WA 99016-9546
OWNER
Phone;
Llc No:
Zoning;
Qeneral Information:
VALUATION
REROOF
BUILDING HEIGHT TO PEAK
DIMENSIONS
COST OF PROJECT
# OF STORIES
# OF BEDROOMS
MONT SETBACK
NEAR SETBACK
LEFT SETBACK
RIGHT SETBACK
FLANKING SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
CURRENT PROPERTY USE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
5400
N
9
12 X 30
1800.00
1
3
110
400+
69
52
NA
r-3
5-n
2
198 X640
RESIDENCE
yea
no
rem
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
Total Calculated:
Deposits/Reoeipts:
Total Due:
50.10
125.25
4 50
179.85
0.00
179.85
CITY OF SPOKAi4E VALLEY
APPROVtD FOR SUBMITTAL
Building
Planning
Initabiatalit
SEP 20 2003 14:42
5093241567
PAGE.01
s1�I'
..."Vy
(tOotoc,A
1-•(—
STREET ADDRESS:
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVIS/ON
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
76 2- E. n4L`ana
ASSESSOR'S TAX PARCEL NUMBER(S): SCd 7.-/ • D 8 D !.J'K Code ' 0 144
Grraanrj J; r,'pa ; o; - A.; / a/ ff/, /T
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
a BUILDING PERMIT
® RELOCATION
® CHANGE IN USE a GRADING 0 MANUFACTURED HOME
® SIGN 0- TENANT
® OTHER
OWNER / APPLICANT INFORMATION
El OWNER: / G .' 4'�" /
PHONE: 0 /'" /510 a FAX:
014: ("r'" r'ee%c ADDRESS:
CITY,STATE, ZIP
El APPLICANT:
PHONE:
FAX:
®CONTRACTOR: CIARCHITECT:
PHONE: FAX:
ADDRESS:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
PHONE:
CITY, STATE, ZIP
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: /900 , 06
BUILDING HEIGHT TO PEAK: 7
BUILDING DIMENSIONS: 42- 7'..7e
NUMBER OF STORIES: I
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP: 2ND FLOOR SQ FT:
CONSTRUCTION TYPE: Lt>U pl/Y1ce UNFIN BASEMENT:
STRUCTURES ON PROPERTY FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: /7 /)(0/1 COVERED DECK:
CURRENT PROPERTY USE: 42e1! -ia%f
CURRENT SEPTIC USE:
CURRENT WELL USE:
MAIN FLOOR SQ FT: .l'oG
DECK:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
DATE/TIME:
i
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME:
INSPECTOR(S):
PHONE:
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES, WHICH WATER DISTIIRR:
IF YES: ® COUNTY ® CITY
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO
DATE:
METHOD OF PAYMENT:
PSSA: ® YES ® NO
STAFF:
0
mmtazsprt
CASH CHECK
VISA
BANKCARD /i; EXPIRES: V/N #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
ProPerfy is lib' X 6 H°
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