2004, 07-20 Permit App: BLD-04-07128 MHSpokane
./svalley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
MANUFACTURED HOME
Job Address: 1623 N HODGES LN
GREENACRES WA 99016
Description: PLACEMENT OF DOUBLE WIDE MANUFACTURED HOME
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
NANCY BURTZOFF
MISSION MEADOWS LLC
15918 E CAMERON CT
VERADALE, WA 99037 -9001
Lot: Blk:
Parcel No:
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
Application #: BLD -04 -07128
Phone: (509) 953 -3923
Phone:
Lic No:
Applied:
Issued:
Expires:
Zoning:
07/20/2004
07/20/2004
01/16/2005
General Information:
SECTIONS
YEAR BUILT
DIMENSIONS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
FLANKING SETBACK
MANUFACTURER
2w
2004
26'8" X 44
14
6
5
11
11
VALLEY QUALITY H
Fees:
PER SECTION FEE
Total Calculated:
Deposits /Receipts:
Total Due:
100.00
100.00
0.00
100.00
OF SPOKANE VALLEY
APPROVE, FOR SUBMITTAL
/CITY
Public Works~
THIS IS NOT A RECEIPT
*lane`
jUalley
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
11
REQUIRED SITE INFORMATION
Street Address:
/6 23 /; •/74 ?bey 69
Assessor's Tax Parcel Number(s): 5-5-0e3,
Legal Description:
14'5/c)17 Med.64,0s
PERMIT DESCRIPTION: Se"/ � /.
n Building Permit
(l Relocation
f] Change in Use n Grading Manufactured Home
(T Tenant Improvement —] Fire Safety n Other
OWNER/APPLICANT INFORMATION
n
Owner: /// 1g
Phone: 92 -/ Fax:
Address: /:7 z��,����u,.�c
City State Zip Code
Contractor:
Phone: 2-
Address:
/7/ Z 3 F
Zip Code
Applicant: ///5-_s/
Phone:
Address:
5 Z-(l/i2- 776-37
ity State Zip Code
f j Architect:
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #: Contact:
PERMIT /BUILDING _INFORMATION
HEIGHT TO PEAK: / 3 is
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"i' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/GOV. PATIO SO. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE. SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON -SITE SEPTIC
SYSTEM?
1
MANUFACTURED HOME
1
Width: Z& Length: Year: ZOo q
Manufacturer Val/ . C u4,6 ^y /7h/90_5
Pit Set: Ye,5
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
1
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting:
Valuation: Above /Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON- RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
Firm Name: Phone:.
I nspector(s):
Fax:
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is /will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
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.
Print Name V i c�YI k? /�� I j & b d, Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #: Expires: VIN #:
Authorized Signature:
❑ Check
0 Mastercard
VISA
❑ Other