2001, 09-07 Permit App: 01007664 Existing MH2'
Project Number. 01007664 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 9/7/2001 Page 1 of 2
Project Information:
Permit Use: SINGLE WIDE MANUFACTURED HOME
EXISTING SINCE 1976
Setbacks: Front 25 Left: 20+ Right: 20 Rear. 20+
Site Information:
Phu Key: 000076 Name: APPLE VALLEY ESTATES District: G
Contact: HAYEK, JEREMIAH A & TRICIA
Address: 112 S BELL ST
C - S - Z: GREENACRES, WA 99016-9304
Phone: (509) 681--91180
Group Name:
Project Name:
Parcel Number: 5.5192.10111
Block: 3 Lot: 1
SiteAddress' 112 S BELL ST
GREENACRES, WA USA 990
Location:: GRE
Zoning: UR -7
Water Distract.
Urban Residential -7
Owner: Name: HAYEK, JEREMIAH A & TRICIA
Address: 112 S BELL ST
GREENACRES, WA 99016-93114
Hold ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Wav (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Department Review
BUILDING Site Plan Review
aczrcasons ' 47LA 10 Reel ..N144 —
Perinit Conditions:
BUILDING
Hold Reasons:
Permit Conditions:
4o�
Released By:
Plan ' evicw
HEALTHDISTRICT Septic System Review
Hold Reasons:
-Smatem designed
Permit Conditions: int 6edtooms-only.
PLANNING Landuse/Zoning
Ho asoma ns�%tCrs
Permit Conditions:
Permits:
Released By:
r
Released By:
Ua
•
AfO1s ��MItq�i(�
K . 9-'7 - o
Project Number. 01007664 Inv: 1
Applicatibn
Date: 9/7/2001 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Manufactured Holm
Contractor: OWNER Firm. OWNER
Address: 0 Phone: (000) 000-0000
000000, 00 000000
Item Description Units Unit Dese Fee Amount
INSPECTION FEE 1 SECTIONS $50.00
COUNTY SURCHARGE 1 Y OR BLANK $11.00
Payment Summary:
Operator: RMB
Permit Tvpe
Manufactured Hone
Nates:..
Printed Bv: RMB
Permit Total Fees: $61.00
Print Date: 9/7/2001
Fee Amount Invoice Amount Amount Paid Amount Owing
$61.00 $61.00 $0.00 $61.00
$61.00 $61.00
$0.00 $61.00
KSPECIFIC SITE INFORMATION
Street Address. ' I Z S r e/I -.
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
•
1026 WEST BROADWAY AVENUE
SPOKANE; WA 99260
509-477-3675
Assessor's Tax Parcel Number(s).
S°) \°\ w lob\
Legal Description:
;Project Description:
axis�;v�� Nle Nome pem/7'
O Building Pc r it
O Change to Use
O Relocation
O Sign
actured Home Permit
O Tenant (Nem/Change) ?Co Other
O Grading
De artnlent.Ilie',n, '._. ,`.,
.. ..
.. -,^; .., _.,q �.;, ,; ,; _'_:
•'
-
'.\\ an.r Dntnct/Puncvor • ".
' -
Saner Dntnct/Purrunr :'. ....
• -
}.:'
.. .r':
Road nidth,-
_
..'
''/,onv
- Fn,nt
.•
12car
. .
Schnul Dictnct ..
Fir, Dinners ..,.:
_
1;. A
Lit
OWNER/APPLICANT INFORMATION
I,, b1a/ hnrdd het u;(u.(rd n atrdm^ /ha fru/e.!
I�1ttntrPham So 4- e(/�/` 9//fO
�Irr \\Je'ewt la 44 ye,�' I,.
0 Applicant
'Thom.
I.,.
,.Lith,_ \ddu..
\ i�15 /lW Y J95 S.
Nt tiling Addre..
Dural PI s
ate. ,P WA 77 0/(:
Y
alt.,,,,
15nuhed hascrn, nl ,y Fr
0 funlrupm Phone/
las
0 Archetct/'ngrnctr
Shun.
Fan
Nishing slit.,,
patting :Ricky.,
•
1 Isar souse (.lectns. g.n, etc)
t nt, Si tie /p
em, Slam Zip
\\ \ Melt (:ons as Int Keen,. =
[nntact name
PROTECT INFORMATION
'Building Information
Iauddins height to peal,
it of .stuns,
infant fit ior.y ft
lin llnuhed baa enema al- It
Dural PI s
food hnbrcablI'',p.tce
ltd Iluot sq it
15nuhed hascrn, nl ,y Fr
t kcupann giuup
Construction Ripe
Gail sy fl
I)tek sy ft
t....1 of pu qua
1 Isar souse (.lectns. g.n, etc)
Manufactured Homc
Fire Safety
�8i 3i
Width:
f /
/(/,]��/•�//%_
Longi h: /' /
�/„
V iv
Paint booth
\Vhat is the square Motagc of the sign
face?
I low high ts the sign?
Year:
/ / YI
NIal:c:
ov —fir
Inspector.
# of st ins
Area of es 'sting signsG
0 CASH ■ CHECK ■ CEO ■ : .;; : ■
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR
1) VIII I -SPIRITS
TOTAL FEE
,1fINL JU%C PERMIT FEE 1S A75.110
pntA.h. li.\ K1, CI IPfk, Poison 1. rn
SIlffi \Nf.l r t N rn '':111'' CES' 0a
'
Address
\Il'I I Il1RI/f.D SIGN:1111th
Relocation
Fire Safety
Non-Residential,Energy Code Compliance?.,
Fim, Name
Previous address
the site be screed by a septic system? ❑ Yes ❑ No
Paint booth
hire Spunkier
Tent
Fire Alan
Fireworks display
Phone
Inspector.
Proposed use
Value
0 CASH ■ CHECK ■ CEO ■ : .;; : ■
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR
1) VIII I -SPIRITS
TOTAL FEE
,1fINL JU%C PERMIT FEE 1S A75.110
pntA.h. li.\ K1, CI IPfk, Poison 1. rn
SIlffi \Nf.l r t N rn '':111'' CES' 0a
'
Special Inspections Required?
•
Non-Residential,Energy Code Compliance?.,
Fim, Name
Is your pripe rev Int a designated 'vikllifc habitat arca?Will
CIDon't know ❑ Ycs �No
the site be screed by a septic system? ❑ Yes ❑ No
Is any part of the property within n 100 yr flood plain?
Ifjes, ,r/en/ilY 0// i/e pla/,
0 t\ lathe 0 l)tti r know 0 Yes 0 No
Phone
Are there:uly 3s eilands, streams or ponds within 200 feet of the property;
If vs, blend/?' on site plan 0 Ycs 0 No
Is there evidence of fill or excavation nn the propel n'?
0 Yc5 0 No
Plan, Examiner
Phone
Inspector.
OIICOVER
).•-
0 CASH ■ CHECK ■ CEO ■ : .;; : ■
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR
1) VIII I -SPIRITS
TOTAL FEE
,1fINL JU%C PERMIT FEE 1S A75.110
pntA.h. li.\ K1, CI IPfk, Poison 1. rn
SIlffi \Nf.l r t N rn '':111'' CES' 0a
'
Address
\Il'I I Il1RI/f.D SIGN:1111th
In.Prcinr
Phone
In Concrete
❑
Welding
❑
Bolting
❑
Rcmbt rcement
Adre..
ADDITIONAL SITE INFORMATION
Arc rheic structures on the properly? ❑ Yes ❑ No
1 f j'er, rrin//yir on rile plan
What is the cut rent property si?c?
(square teet or acres)
Is any parr of the propel ty within 250 fret of a shotcline; -
If)es. Melnik' 0// si/e plan ❑ Yes ❑ No
\\'hat is the current use of this property?
Is your pripe rev Int a designated 'vikllifc habitat arca?Will
CIDon't know ❑ Ycs �No
the site be screed by a septic system? ❑ Yes ❑ No
Is any part of the property within n 100 yr flood plain?
Ifjes, ,r/en/ilY 0// i/e pla/,
0 t\ lathe 0 l)tti r know 0 Yes 0 No
Art or will thine be wells It nn the propcnv?
Ij_1'er, IAen/f' o// /be sl/ep/an ❑ Yes ❑ Ni,
Are there:uly 3s eilands, streams or ponds within 200 feet of the property;
If vs, blend/?' on site plan 0 Ycs 0 No
Is there evidence of fill or excavation nn the propel n'?
0 Yc5 0 No
.\re there slopes greater than 309k on the property? (30 ft rise in 100 ft)
( /a,6) 0 \'cs 0 No
Are critical or ha, at dous materials used or Stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stonnwater Control Arca?
0 Yes 0 No
'Is public sewer available to the site? , 0 Yes 0 No
I5 the property inside the,ASA? _ 0 Yes - 0 Nri
0 Yes 0 No
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA? 0 Yes 0 No
Ts the property locoed within 1000 feet of a Naniral Resource Arca?
❑Ycs 0 No
1).ne Pimst 1
Staff Itt preen um e.
METHOD OF PAYMENT
VISA
CREDIT CARD
SUR tont.
OIICOVER
).•-
0 CASH ■ CHECK ■ CEO ■ : .;; : ■
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR
1) VIII I -SPIRITS
TOTAL FEE
,1fINL JU%C PERMIT FEE 1S A75.110
pntA.h. li.\ K1, CI IPfk, Poison 1. rn
SIlffi \Nf.l r t N rn '':111'' CES' 0a
'
la.\Nl.l.ARD NU,\1I5PIt
\Il'I I Il1RI/f.D SIGN:1111th
This c�'- R;aR is being
obtam.'r� a auis s,ibn::ed for int purpose of
representation ILog permit and is a true and correct
representation
thu proposal. An known property
curb lines, structures and easements
have been identified_ Also indicated are tve. ,,,ds
bodies of water, steep slopes or other critr: i areas
Signed:
Dale
ADDRESS
ZONE
ROAD WIDTH
FRONT FLANKING
COMMENTS
REVIEWED BY
50
c O
_S 1
3e 1 l st
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1.