2002, 09-03 Permit App: 02007552 MHPROJECT APPLICATION WORK SHEET
SPOKANE, COUNTY DIVISION OF BUILDING & CODE ENFORCIShIENT
1026 WEST BROADWAY AVENUE
SPOKANE, \\',\ 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: OZ, / 7 5 Sk u E. c RR pLti c
Assessor's Tax Parcel Number(s):
Legal Description
I 1) D w,
Project Description:
• Budding Permit
O Change in Use
O Grading
O Dlanu factui cd 1-loinc Permit
O Relocation
O Sign
O Tenant (New/Change)
O Other
Department Use.On1}r , .
R'attr Dntnct/I'uncyor
,Front.'
Scx er Dntnct/Pusey nr
Road..Idth -
Setback,
Rear
_
Right' -
School District - .
Pyre District ' .- -
'Zoning
OWNER/APPLICANT INFORMATION
E Li.lnidr nho,Gaul(/ Gr mffinjtI res.n'.Grre /lin ptr
EY-)„,, Thom 9 .A, j, 7 3 L/ q
DON ni Dc,t R 1 ei'1 Fit,
❑ Applicant
Phone
Fa`
Mailing Addn%%
//N E shy
Mailing Address:
1)i mvmu WIN
�
Cm, Sun. Yip �
5o04 ec t2%. 992/.2-
ON, State, Yip
Rniahtd basanun sti ft
<innua or / Phone
n'
S Ol tt »a %7ne
F ZirG7
❑ Archut cc/Himmel
Pham
rah
NI mgad es.
s/s s , 6p, a.9u,c
kidding address
1 fru source (electric, gas, etc)
(:n, Stan Lap
0-&>7 a k70,_ 97-2 /,--
t in, Sen. /.q.
//
Stan Contractor liet'r,e n
(:mrtact name
PROTECT INFORMATION
Building Information '
Building height m peak
Si of srtmw
Main Moor sti. It.
Llolintshtd bahemcni sy ft.
1)i mvmu WIN
'Toial habitable space
2"`t floor t9. ft.
Rniahtd basanun sti ft
l lccupanc, nip
Const roc ntnr t t pi
(1 arttc ay n
1)rck a4 it
Cost of proltu
1 fru source (electric, gas, etc)
Manufactured Home
Sign
Width:/ /� /
d o
Len4�� / el
\\'hat is the square footage of the sign
re?
I low high is the sign?
'car.
oZr0002
\lake//
��P�1ffE
# of signs
Arca of existing signs
1 ircworks display
_
Is there evidence of fill or excavation 011 the property?
0 Ycs Jo No
Proposed use
Relocation
Fire Safety,
Firm Name
Pecs unn address
Phone
Fire Sprinkler
Tent
Runt booth Fire Alarm
1 ircworks display
_
Is there evidence of fill or excavation 011 the property?
0 Ycs Jo No
Proposed use
Value
Special Inspections Required? `
Non -Residential Energy. Code Compliance?-_;-.•
Firm Name
Is any part of the poiperty within 250 feet of a shoreline?
If yes. /dentifp on sde plan ❑ yes a. No
Phone
Plan. Fommer
Phone
I nmruors
A rc there any wetlands, streams or ponds within 200 feet of the property?
If yes. Idenij' on R/e plan 0 Yes 0. No
Is there evidence of fill or excavation 011 the property?
0 Ycs Jo No
Are there slopes greater than 30'7, on the property? (30 ft nsc in 100 Ft)
(_-i%) 0 Yes No
Address
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
❑ Reinforcement
Address
ADDITIONAL SITE INFORMATION
Arc there structures on the property? ❑ Ycs a. No
If yrs, ,denb,5' on site plan
What is the current property size?
(square feet or acres)
Is any part of the poiperty within 250 feet of a shoreline?
If yes. /dentifp on sde plan ❑ yes a. No
\\That is the current use of this property?
VV tit.C.-0.-- ---i---
Is pilar property In a designated sr ildlile habitat arca?
0 Don't kinIW 0 Ycs Pi No
Will the sttc be served by a septic .system? 0 Yes O No
Is any part of the prnpci tv within a 100 yr fluid plain?
I fj'PJ. ulPUOfj' on Me plan
0 \lacbc 0 Don't know 0 Ycs A No
Are or will there be wells located on the property?
If yes, al/enab' en the Hie plan 0 \ cs II No
A rc there any wetlands, streams or ponds within 200 feet of the property?
If yes. Idenij' on R/e plan 0 Yes 0. No
Is there evidence of fill or excavation 011 the property?
0 Ycs Jo No
Are there slopes greater than 30'7, on the property? (30 ft nsc in 100 Ft)
(_-i%) 0 Yes No
Arc critical or hazardous materials used or stored on site
❑ Ycs $ No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? -
l -❑ Ycs'•
-
❑'No .
- Is public sewer available to the site? - - ❑ Yes 0 No
Is the property inside the ASA?
❑ :Ycs .
❑Ycs
0 No -
0 N
Is public water available to the.sitc? 0 Yes 0 No
iiii
Is the property inside the PSSA?
i 0 -Yes
.
0 -No -
-
. Is the property Ideated within 1000 Fect of a Natural Resource Arca? .
'.❑Yes.` ❑No... --..
Diu Kr eased
Staff Re present.mte
METHOD OF PAYMENT
VISA
❑ t:.\SII ❑ Ci II!ch ❑I=❑
CHIMER
TOO rt 777.
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DA'I'1 i.
ISAN KCARD NU\IBER-
EXPIRES
A DTI IORMI'.D SIGN:\ 11) ti .
SLOB I'O'I'AI.
TOTAL FEE
. MINIMUM PERMIT FEE IS$3SLOPI•E$SE
M'iKii CI IP.CKS PA) AI31.E TO SPOKANE
C( l UN'O' FERMI'! Cti\'ITR
-
-
Project Number: 02007552 Inv: 1
.�-
Application
Date: 9/3/02 Page 1 of 2
THIS 1S NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: DOUBLE WIDE MANUFACTURED HOME
Setbacks: Front 4 Left: 5 Right. 5 Rear: 5
Site Information:
Plat Key: MH010 Name: MEADOWBROOK VILLAGE
Contact. DURHEIM, DON
Address: 8614 E SHARP AVE
C - S - Z: SPOKANE, LVA 99212
Phone: (509) 926-7349
Group Name
Project Name:
District: F
Parcel Number: 45241.9126
Block: Lot:
SiteAddress: 217 S BLUEBERRY PL #16
GREENACRES, WA 99016
Location:. GRE
Zoning' UR -7
Water Distad:
Area: 0 Sq Ft
Urban Residential -7
Width: 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: L
Owner. Name: DURHEIM, DON
Address: 8614 E SHARP AVE
SPOKANE, WA 99212
Flold: ❑
Depth: 0 Right Of Way (ft): 30
Review
Plan Review
Permits:
Released By:
Contractor: OWNER
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Munufactured Home
Firm: OWNER
Phone:
Units Unit Desc
2 SECTIONS
1 Y OR BLANK
Open atoi: CKF Printed By: CKF
Fee Amount
5100.00
$22.00
Permit Total Fees: S122.00
Print Date: 9/3/02
Project Number: 02007552 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 9/3/02 Page 2 of 2
Notes:
SEE PLAT FILE FOR CONDITIONS -24541-9087-S 205 STEEN RD
Payment Summarr•
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owina
Manufactured Home $122.00 $122 00 $0.00 $122.00
$122.00 $122.00
$0.00 $122.00
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 he construed to he 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: CKF Printed By: CKF
Print Date: 9/3/02