2005, 05-02 Permit Application: 05001394 MHn
Spokane
jUalley
l3`1S nc 39q
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688 -0036; Fax: (509) 688 -0037
REQUIRED SITE INFORMATION
Street Address: / '/ j'o aj�(
Assessor's Tax Parcel Number(s):
Legal Description:
#v5--/y3. d0 3
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
/ i'2
❑ Change in Use ❑ Grading
❑ Manufactured Home
❑ Tenant Improvement
❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: 4L/9710 (44///licc__
Phone: 9A-607o Fax:
Address: S? 7
City
7, Contractor:
Phone: ' 1, - 270
Address: ,psis
City
State
WA State Contractor License #:
❑ Applicant:
Phone:
Address:
City
❑ Architect:
Phone:
Address:
City
Fax:
State Zip Code
Fax:
State Zip Code
Contact:
Spokane Valley Bus. Liscense #: Contact:
N
PERMIT /BUILDING INFORMATION
HEIGHT TO PEAK:
MAIN FLOOR TO SQ. FTG:
FINISHED BASEMENT SQ. FTG:
DIMENSIONS:
2"" FLOOR SQ. FTG:
# OF STORIES:
UNFIN BASEMENT SQ. FTG:
OCCUPANCY GROUP:
# OF BEDROOMS:
GARAGE SQ. FTG:
CONSTRUCTION TYPE:
DECK/COV. PATIO SQ. FTG:
CAST OF PROJECT:
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I
Gt/
TOTAL HABITABLE SPACE:
30% SLOPES ON PROPERTY:
HEAT SOURCE:
IMPERVIOUS SURFACE AREA:
SEWER OR ON -SITE SEPTIC
SYSTEM?
i
11
t
MANUFACTURED HOME
Width: ,, g- Length:
Manufacturer:7�����L /��
Year:
e/L
60
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Alarm: Paint Booth:
# of Heads:
Fire Sprinkler:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above /Underground Storage Tank Size:
WASHINGTON STATE NON - RESIDENTIAL ENERGY CODE
Plans Examiner:
Phone: Fax:
Address:
Inspector:
Address:
II
City
State Zip
Phone: Fax:
city
SPECIAL INSPECTIONS
State Zip
BOLTING fl CONCRETE (l REINFORCEMENT ❑ WELDING
Firm Name:
Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees t their 2j90wnership of this this
City of Spokane Valley Permit inure to the
dwelling, the dwelling is/will be served by potable wa
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.
Signature
Print Name
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash [1] Check ❑
Mastercard ❑ VISA f Other
Bankcard #:
Expires: VIN #:
Authorized Signature:
Project Number: 05001394 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: DOUBLE WIDE MANUFACTURED HOME FOR
DEPENDANT RELATIVE
Date: 05/02/2005
Setbacks: Front 94 Left: 41 Right: 11 Rear: 75
Site Information:
Contact: CONINE, ED
Address: 14502 E ALKI AVE
C - S - Z: SPOKANE VALLEY, WA 99216
Phone: (509) 928 -6070
Group Name:
Project Name:
Plat Key: 002763 Name: VERADALE HEIGHTS, 01ST ADD TO
Parcel Number: 45143.0233 Block:
SiteAddress: 14502 E ALKI AVE
Location:: CSV
Zoning: U4 Unknown
Water District:
District: Nort
Lot:
Owner: Name: CONINE, ED
Address: 14502 E ALKI AVE
SPOKANE VALLEY, WA 99216
Hold: ❑
Area: .00 Acres Width: 90 Depth: 135 Right Of Way (ft): 50
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Review
Plan Review
Landuse /Zoning
Released By:
Page 1 of 2
Released By:
Sewer Review
Permits:
Contractor: OWNER
Item Description
INSPECTION FEE
Manufactured Home
Firm: OWNER
Phone: (000) 000 -0000
Units Unit Desc
2 SECTIONS
Fee Amount
$100.00
Permit Total Fees: $100.00
Operator: K_C Printed By: K_C Print Date: 05/02/2005
Project Number: 05001394 Inv: 1
Application
THIS IS Penalties will be assessed for commencing A PERMIT
m
menc><ng work without a permit
Notes:
Date: 05/02/2005 Page 2 of 2
Payment Summary
Per it T_vtie
Manufactured Horne
Disclaimer:
Fee e Amount Invoice Amount
$100.00
$100.00
$100.00 $100.00
Amount
$0.00
Amount Owin
$100.00
$0.00 $100.00
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the
contained within to be true and correct, and agrees that all provisions of laws and /or regulations governing this type of work with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation p k of will be
information of
the provisions of the code or of any other state or local laws or ordinances.
any of
Signature:
Operator: K_C Printed By: K_C Print Date: 05/02/2005
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