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2004, 11-24 Permit App 04009160 AdditionProject Number: 04009160 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 11/24/2004 Page 1 of 3 Project Information: Permit Use: 26 X 24 ADDITION TO RESIDENCE - BEDROOM Contact: ADAMSON, RICK L & BATHROOM Address: 14115 E BROADWAY AVE C - S - Z: SPOKANE, WA 99216-2023 Setbacks: Front EXI Left: EX Right: 10 Rear: 60 Phone: (509) 922-5855 Group Name: Site Information: Project Name: ......... ......... . . . . . „ . Plat Key: 999999 Name: RANGE District: F Parcel Number: 45142.9131 Block: SiteAddress: 14115 E BROADWAY AVE Location:: SPO Zoning: UR-3.5 Urban Residential 3.5 Water District Area: .25 Acres Width: 0 Depth: 0 Right Of Way (ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Lot: Owner: Name: ADAMSON, RICK L Address: 14115 E BROADWAY AVE SPOKANE, WA 99216-2023 Hold: Review Information: . . Review Site Plan Review Plan Review f ''' • '' ' • Rcleascd By. A Operator: K_C Printed By: K_C Print Date: 11/24/2004 Project Number: 04009160 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: OWNER Group: R-3 Type: VB Total Area 500 Building Height 14 Stories 1 Dwelling Units 1 Building Permit Date: 11/24/2004 Page 2 of 3 Firm: OWNER Phone: (000) 000-0000 Building Characteristics This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation RES ADD R-3 VB 500 $37,340.00 500 $37.340.00 Item Description RESIDENTIAL PERMIT FEE STATE SURCHARGE RESIDENTIAL PLAN REVIEW Contractor: OWNER Item Description VENTILATING FANS Contractor: OWNER Totals: 500 $37,340.00 500 $37,340.00 Units Unit Desc 1 SELECT 1 SELECT 1 SELECT Fee Amount $522.55 $4.50 $209.02 Permit Total Fees: $736.07 Mechanical Permit Firm: OWNER Phone: (000) 000-0000 Units Unit Desc Fee Amount 1 NUMBER OF $10.00 Permit Total Fees: $10.00 Plumbing Permit Firm: OWNER Phone: (000) 000-0000 Item Description Units Unit Desc Fee Amount TOILETS/BIDETS 1 NUMBER OF $6.00 SINKS 1 NUMBER OF $6.00 SHOWERS 1 NUMBER OF $6.00 TUBS 1 NUMBER OF $6.00 Permit Total Fees: $24.00 Operator: K_C Printed By: K_C Print Date: 11/24/2004 Project Number: 04009160 Inv: I Notes: Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Permit Type Building Permit Mechanical Permit Plumbing Permit Fee Amount Invoice Amount $736.07 $10.00 $24.00 $736.07 $10.00 $24.00 $770.07 $770.07 Amount Paid $0.00 $0.00 $0.00 Date: 11/24/2004 Amount Owine $736.07 $10.00 $24.00 $0.00 $770.07 Page 3 of 3 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 coi l ett, 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: K_C Printed By: K C Print Date: 11/24/2004 *lane4.00N/die ECEAVE NOV 19 2004 UMMIN ,1 PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707East Sprague Ave Ste 106 Spokane Valley, WA 99206- .. Phone: (509)688-0036 Fax: (509)688-0037 REQUIRED SITE INFORMATION 1 EIRI~lEOCA'I'ION• ®-SIGN • ]-TENANT STREET ADDRESS: 1 11S E , 13ROPMAY ASSESSOR'S TAX PARCELNUMBE'R(S): 451 Lf2 Cl 131 LEGALDISCRIPTION: (LI) 255 LH 51( FT �j"C ���Z & S Yy ( tW9f EXC.,W(LIOf CXC S 2©1 �X�. i o0 I � PERMIT DESCRIPTION.: ' v71p lC 2.14' / 5. Apo/ TON - IIrDMG-PFRNIT • • CUCHANGE.IlN•USE • aGR•ADJTG . .. a. • AC �ANIT�' T'IJItED HOME 1:3-OTHER- ' OWNER / APPLICANT INFORMATION OWNER: T((.i AM sok) "`PHONE: 922 - 56 53 FAX: • �� ADDRESS: ( US BROA C A). ,,2Q �"i ®CONTRACTOR: 5-ELF' PHONE: ADDRESS: CITY, STATE, ZIP WA ST CONTRACTOR LICENSE # CIT1f�,ST TE', ZIP . LIazi co. 0. ARCHITECT: FAX: APPLICANT: �� ! PHONE: FAX: ADDRESS: CITY, STATE, ZIP PHONE: FAX: ADDRESS: CITY, STATE, ZIP CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: Z-5C'O° BUILDING HEIGHT TO PEAK: Ili BUILDING DIMENSIONS: .249X 2Y NUMBER OF STORIES: 1 NUMBER of BEDROOMS: FLANKING SETBACK: N FRONT SETBACK:7 REAR SETBACK: 6201 ///�� LEFT SETBACK: Cl/Cpl RIGHT SETBACK: 30% SLOPES ON PROPERTY: OCCUPANCY GROUP:. R3 CONSTRUCTION TYPE: MAIN FLOOR SQ FT: 2ND FLOOR SQFT: ./ UNFIN BASEMENT: STRUCTURES ON PROPERTY: I FINISHED BASEMENT: CRITICAL AREAS: GARAGE: CURRENT PROPERTY SIZE: lid Y--:#n35 CURRENT PROPERTY USE: S FR CURRENT SEPTIC USE: SEIVgg CURRENT WELL USE: VERA %u41 IMPERVIOUS SURFACE AREA: COVERED DECK: DECK: MANUFACTURED HOME SIGN WIDTH: LENGTH: YEAR: PIT SET: MANUFACTURER: SQFTOFSIGN: HEIGHT .OFSIGN: ''- # OF SIGNS: AREA OF EXIST SIGN: TYPE OF SIGN: RELOCATION FIRE SAFETY 1 PREVIOUS ADDRESS: PROPOSED USE: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: FIREWORKS DISPLAY: BLASTING: DATE/TIME: WA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: PHONE: FAX: ADDRESS:. CITY, STATE, ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY, STATE, ZIP SPECIAL INSPECTIONS ® BOLTING ® CONCRETE ® REINFORCEMENT ® WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S)- 1 BUILDING STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: . ® YES ®NO IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES, WHICH WATER DISTIIRR: IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: Q YES ❑ NO IF YES: CI COUNTY ® CITY DATE: 1 STAFF: 1 METHOD OFPAYMENT. CASH BANKCARD#,• EXPIRES: VIN# AUTHOR/ZED S/GNATURE- *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD • • CHECK / 11115 E - 2CAD(tiA-�/ f SIDE WALK CEO 21r ADD111 19' ADDRESS F ;( ZONE S ROAD WIDTH FRONT �' I i FLANIgNG i 1,1 COMMENTS Co REVIEWED BY , ..Lt Mrvi1 A \V DRIVENA- (r) This site plan is Wing submitted for the propose of ()Naming a brdldtng permit and is a true and correct representation of the proposal. All known property Irrles/dimensions, curb Tines, structures and easements have been identified. Also indicated are wetlands, bodies of %��ssteep slopes or other critical amas. Signed: Priai'1 i Date: -24 -6 [D6`