1996, 06-19 Permit App 96004620 Remodel Adult Family Home4 44°
-J ,'t'gPROJECT NUMBER= 96004620
APPLICATION DATE= 06/19/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 11215 E BROADWAY AVE PARCEL#= 45162.1122
ADDRESS= SPOKANE WA 99206
PERMIT USE= CHANGE OF USE/REMODEL TO ADULT FAMILY HOME
PLAT#= 001398 PLAT NAME= KRALIK'S SUB.#2
BLOCK= 2 LOT= 5 ZONE= UR-3.5 DIST#= F
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W=
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= THOMS, WILLIAM E
STREET= 11215 E BROADWAY AVE
ADDRESS= SPOKANE WA 99206
PHONE= 509 927 4169
CONTACT NAME= BILL THOMS PHONE NUMBER= 509 927 4169
BUILDING SETBACKS: FRONT= NA LEFT= NA RIGHT= NA REAR= NA
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING PLAN REVIEW REQUIRED
COMMENTS:
HEALTHDIST I NEW
COMMENTS:
l�t, 0k-- 00- C,[-1 6/77/7(
OR ADDITIONAL WASTE WATER
******************************* BUILDING PERMIT *******************************
CONTRACTOR= OWNER PHONE=
NEW= REMODEL= X ADDITION= CHANGE OF USE= X
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
REMODEL LC VN 2300.00
ITEM DESCRIPTION
QUANTITY FEE AMOUNT
RESIDENTIAL VALUATION Y 64.75
STATE SURCHARGE Y 4.50
CHANGE OF USE/SAFETY INSP Y 50.00
RESIDENTIAL SURCHARGE Y 14.25
PROJECT NUMBER= 96004620 APPLICATION DATE= 06/19/96 PAGE= 02
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
BUILDING PERMIT 133.50 .00 133.50
133.50
.00 133.50
* PROJECT NOTE: TOPIC = CONDITIONS DEPT = BUILDING *
*******************************************************************************
REMODEL CONSIST OF WINDOW REPLACEMENTS, BF RAMP, & GARAGE
CONVERTED TO LIVING SPACE (PRE-EXISTING)
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
******************************** THANK YOU ************************************
APPLICATION INFORMATION
What is the JOB SITE address? ASSESSOR'S tax parcel number?
(1
Legal description as it appears on the property dedd
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K r_y 9967c; ‘-
OWNER or OCCUPANT
LAD \ t , a- yy, S t h r'I .5
Mailing address
1 it 0.15 0,1 _, y
Who should we contact regarding this project?
S 0- ro P_
City, statel
C °f ci/IIra N-e
What work is being done under this permit?
TA ( lam „ e, (.)c 41o, fe.
Phone
Phone
9�i'7-5/
w
Zip
n
4,
O
Contractor
Building height
Dimensions
# of stories
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Unfinished basement area
Mailing address
2nd floor area
Finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Manufactured Home
Width:
Length:
Sign
What is the square footage of
the sign face?
How high is the sign?
Year:
Make:
Installer
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address
Mailing address
Relocation
Previous address
Fire Safety,
Fire Sprinkler
Tent
Paint booth Fire Alarm _ Fireworks display _
VALUE
Contractor
Contractor
WA State Contractor license*
WA State Contractor license #
Mailing address
Mailing address
Fuel Storage Tanks
Swimming Pool
(Circle one) Above -ground Underground
Contents of tank(s)
Contractor
Size / gallons
Size / gallons
Private
Contractor
Public/semi-private
Wa State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.