2002, 04-01 Permit App 02002128 Out BldgProject Number: 02002128 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
....... .........
Permit Use: 24 X 40 OUT BUILDING
Setbacks: Front EXI Left: 10 Right: 70 Rear: 310
Site Information:
.............................................................................................
Plat Key: 999999 Name: RANGE
Date: 4/1/2002 Page 1 of 2
Contact: BLACK, MARK E & ELIZABETH
Address: 16615 E BROADWAY AVE
C - S - Z: VERADALE, WA 99037-8510
Phone: (509) 922-5376
Group Name:
Project Name:
District: F
Parcel Number: 45131.9030 Block:
SiteAddress: 16615 E BROADWAY AVE
VERADALE, WA USA 99037
Location:: VER
Zoning: UR 3.5
Water District
Urban Residential 3.5
Lot:
Owner: Name: BLACK, MARK E & ELIZABETH
Address: 16615 E BROADWAY AVE
VERADALE, WA 99037-8510
Hold: ❑
Area: 1.36 Acres Width: 104 Depth: 600 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review
Site Plan Review
Plan Review
Septic System Review
Permits:
Operator: RMB Printed By: RMB
Print Date: 4/1/2002
Project Number: 02002128 Inv: 1 Application Date: 4/1/2002 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Const Category:
Nbr Of Dwellings:
Bldg W x D: 24
Req Parking:
New
1
Occupant Load:
Y 40 Building Sq Ft:
0 Handicap Parking:
Description Grp Type Notes
GARAGE U-1 VN
Item Description
RESIDENTIAL VALUATION
STATE SURCHARGE
RESIDENTIAL SURCHARGE
Permit Type
Building Permit
Building Permit
Firm: OWNER
Phone:
Building Characteristics
Group: U-1 Type: VN
0 Building Height: ctikik Stories: 1
960 Sprinklers: El
0 Critical Materials:
This Application: Total Project:
Sq Ft Valuation Sq Ft Valuation
960 $11,520.00 960 $11,520.00
Totals: 960 $11,520.00 960 $11,520.00
Units Unit Desc
1 Y OR BLANK
1 Y OR BLANK
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$188.00
$4.50
$41.36
$233.86
Fee Amount Invoice Amount Amount Paid Amount Owing
$233.86 $233.86
$233.86 $233.86
$0.00 $233.86
$0.00 $233.86
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: RMB Printed By: RMB
Print Date: 4/1/2002
NO-
SPOWT COUNTY
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:
146,/,.c c oCECIcA)cy
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
VBuilding Permit
❑ Relocation
Oe a`"
O Change in Use
O Grading
O Manufactured Home Permit
O Sign
O Tenant (New/Change)
O Other
Depatunent Use Only
Water District/Purveyor.
Sewer District/Purveyor.
- Road width ,
Setbacks
Front Rear
Left Right
School District
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
fa b., net
Phone:
Fax:
❑ Applicant:
Phone:
Fax:
Mailing Address: /
14: 6f j- L &vai,..UCtV
Mailing Address:
City, Gate, Zip /
tie rcccia le- wA
51103
7
City, State, Zip
❑ Contractor
lrhttne
Fax
❑ Architect/Engineer
Phone
Fax
Mailing address
\lading address
City, State Zip
City, State Zip
WA State Contractor license
Contact name:
Building Information
Building height to peak
14'
# ofsuxics
Uain Floor s.1. ft.
Unfinished basement sq. Ft.
Dimensions t
1
plq x k4C
''oral habitable space
2"d floor s.. ft.
._
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
C160
Deck sq. ft.
Cost of project U
I Teat source (ehetrie. gas, etc)
Manufactured Home
Sign
Width:
Length:
AC/hat is the square footage of thc sign
face?
IT high is the sign?
Year:
Make:
# of signs
Area of existing signs
Relocation
Fire Safety
Previous address
Paint booth
Fire Sprinkler
Tent __
Fireworks display
Fire Alarm _
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
limy Name
Phone
Plans Examiner
Phone
Inspectors-
Address
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
0 Reinforcement Address
ADDITIONAL SITE INFORMATION
Arc there structures on the property? 0 Ycs 0 No
Ifyes, identify on siieplan
AWhat is thc current proper pr size?
(square feet or acres)
1s any part of the property within 250 feet of a shoreline?
If yes, ident5 on site plan 0 Ycs ❑ No
\A/hat is the current use of this properrv?
Is your property in a designated wildlife habitat area?
❑ Don't know 0 Yes ❑ No
Will the site be served by a septic system? 0 Ycs 0 No
Is any part of the property within a 100 yr flood plain?
Ifys, identi, on site plan
0 Mavbe 0 Don't know 0 l'cs 0 No
,Are or will there be wells located on the property?
f per, ideal j' or the the plan 0 Ycs 0 No
;Arc there any wetlands, streams or ponds within 200 feet of the propern4
If yes, identify on site plan 0 Ycs 0 No
Is there evidence of fill or excavation on the property?
0 Ycs 0 No
Arc there slopes greater than 30° o on the property? (30 ft rise in 100 ft)
( — %) 0 Ycs 0 No
,Arc critical or hazardous materials used or stored on site?
0 Ycs 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stomiwater Control Area?
❑Yes
❑No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA?
0 Yes
❑Yes
0 No
❑No
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?
0 Ycs 0 No
Date lard,cd-
S
ffR.pr.s-ncnkc
METHOD OF PAYMENT
VISA
❑ C;ASII ❑ CI II'_fh ❑ `. """ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DAZE:
B \NKC.VtD NUMBER:
\UII IORIZED SIGN \TURIt
SUB.' OT AL
TOTAL FEE
ALIN/MUM PERMIT FEE 1S 5151EI'1t< NOE.
NI %kr CI IRCFS C1]Vells Jc) fl'Oti9AIL
COCVIN PERVIrr taiA11R
-310
Thi
obtinin
rep ese
lin s/di
hake be
bocese
S[gned:
Date:
A 5 -. u4s4320,41(.0‘y
-;—R OA W-1-4)T-1-11-50
FR Ntt5 FLAKING
C9MtENTS=
8
No
1
I
-70
171 qL;erri fted orthW. ose'of
, b Ming pellrWr • nd is a tru an correct
ti5n of 'he p opo I. AO kno n property
ens' ns. irb iries, strukturet-and easements
n id ntified. A so indicated at wetlands,
-•watst$ep.igpes or oth iticreas.
-'