2001, 11-29 Permit App: 01010498 MHfikLa
Slow Cowri
t
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 \GEST I3ROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675 6 r I/A'—&t
SPECIFIC SITE INFELATION
Street Address: F V Cr08 .5 UA4
Assessor's Tax Parcel Number(s): 5 5 \-Tas ♦ sfv _ls.-1 0
Legal Description:
Lot 01 \or, (0 6c GCB r YY16\\tic) Yat
Project Description:
CI Building Permit
❑ Chan Sc
ev.c,C\avice
❑ Gnu. mg
XManufactured Home Permit
El Relocation
❑ Sign
❑ Tenant (New/Change)
0 Other
Deparfinent;UseOaly,`:
❑ Apphc•int
Water District/Puneste
.. -
-
L•
Sewer District/Pun-cr or
•
`Fire
(toad width ' .
- -
.
Scibacks
Front:
Left.
Rear
Right' ` :
' Schild District.
Dnmct' -
..
"Zoning
- . . . _
OWNER/APPLICANT INFORMATION
' E lnrin.4e who tu;du led it alIne� Mei prolrJ
0 (),vner .— Phone.
0..v\eMA,, e\-- pa. Qg--T--1 w33Fax
❑ Apphc•int
lihmm
Mailing Addle -'Nailing
• \ S 9 6 R t c4.0-0,____ C, rd e.
Addle,
Dimensions
tit State, Zip
Cin Stam• fp
Fintshed basement sq f t
L4 T,,rislfctnr ThAAspdo r Phone
0 Archnwt/I:ngmu
Phone
1'ac
�� I/�Y lac
Matteisa.Jre..
Pia 132
Nailuit.ittire,
Cn lite'/.i,
F335c�
i:in. Slate ,„
U'A Slate (lintracnn hcome =
oRoAS y 0114 4)f$
ton un n.tina
PROJECT INFORMATION
-, Building Information_
Building height to peal.
#of slimes
Maio dila sq. Fl
Unfinished beta insist sq ft.
Dimensions
It habitable space
2.1t1 door sq ft.
Fintshed basement sq f t
Occupancy gnvp
Co: non type
(3.ir.ige st ft
Deck ft
(;net of project
I lent source (electric, gus, etc)
Manufactured Home
Sign. ;
Width /
Length: IA ^ /
�U(
What is the square footage of the sign
Face?
I low high n the sign?
Year \ c R_
!\ t, 1 t
# of signs
Arca of existing Stymy
pAc:
:Paint broth Bre Alarm
No
fireworks display
_
:..... •
Relocation �
.. :
'..
Fire Safe
..: ty
,Is your property in a designated wildlife habitat arca?
0 Don't know 0 Yes 'o
Previous address
' -
'\re or will there be wells It cated on the pntpert'+
yin.idem ' an the file plan 0 Yes o
, C%T
I -
Fire Sprinkler
r"
'vent
:Paint broth Bre Alarm
No
fireworks display
_
Proposed use
' -
Value
Special Inspections Required?,
,
Non -Residential. Energy Code.Compliance? =
Firm Naine
,Is your property in a designated wildlife habitat arca?
0 Don't know 0 Yes 'o
Will the site c screed by a septic system? pif Yes 0 No
Phone
'\re or will there be wells It cated on the pntpert'+
yin.idem ' an the file plan 0 Yes o
, C%T
I -
Are then: any wetlands, streams or ponds within 3,001: a of doe property?
If'er, tttent�' oil setelll/It ❑ Yes IY IVa
Plans Examiner
Phone
Imp/cum.
No
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No -
Address
Inspector
Phone
❑ Concrete
O Welding
❑
Bolting
❑
Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are thine snT¢tu cs on the property? ❑ Yes 'o
lfyes. tdent�' on silt, plan
What is the current property .sitc? / /`
(square fret or acres) �\_
q 1 p q \ 4 A
Is any part of the property \nthu) 250 net of a shoreline?
If yes, identify 0n We plan 0 Yes f
What is tI(\current use ofrthis J ropcl ?
res \a e'ai` AS
,Is your property in a designated wildlife habitat arca?
0 Don't know 0 Yes 'o
Will the site c screed by a septic system? pif Yes 0 No
Is any pan of the pit perry within a 100 i r Flood plain?
0 I/)'P5, idea/tj' en rete plan /
dl:n'bc 0 Don't know ❑ yes •LnV/Nn
'\re or will there be wells It cated on the pntpert'+
yin.idem ' an the file plan 0 Yes o
, C%T
I -
Are then: any wetlands, streams or ponds within 3,001: a of doe property?
If'er, tttent�' oil setelll/It ❑ Yes IY IVa
Is there evidence of fill or excavation on the property?
I r ` 0 Yes f tI .s /
Are rhetc slopes g,cate, than 30° o o11 the propert r (30 ft ase 100 ft)
( /"s.) ❑Yes �]�Nn
Are corral or 11/ardrus maten:ds tiscd or stored 00 site? ,�
❑ Ve. J n
DEPARTMENT USE ONLY
Is the property uh a designated Stonnwater Control Area?:
❑Ycs
❑
No
Is public sewer available tri the site? 0 Yes 0 No ; 2„
Is the property inside the ASA?
0 ,Yes
- 0 Ycs
0
0
No
No
Is public water available to the site? 0 Yes `❑ ,N16-1
- _ -
Ts the property inside the I'SSA?
0 Yes
0
No
Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No -
Dore Ite need
Staff R( present au.c
METHOD OF PAYMENT
VISA
❑ c.\sI I ❑ CI o K ❑ firM❑ =! ❑
DIJCOUER
.c-sa ss
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
B \NKC \It l) N1.151131':It
I -S I'1 RI:S
:\ LI I I It)ItIZI' 1) SI(1N'\'I'Ifitli
SLB J (1l'.\I.
TOTAL FEE
,IIIN/.IIUII PERMIT FEF /S hci,00P1.1_UC
\I \K I; CMJ N: P WADI 1.'I (1 SI` )K 14L
C( PUN i1' 1'611\111 (FN ITT
Project Number. 01010498 Inv: /
I
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 11/29/2001 Page 1 of 2
Project Information:
Permit Use: REPLACE DOUBLE WIDE MANUFACTURED
HOME
Setbacks: Front 35 Left: 29 Right: 14 Rear. 27
Site Information:
Plat Key: 000498 Name. CORBIN ADD TO GREENACRES District: G
Contact: YUKON TRANSPORT
Address: P.O. BOX 13311
C - S - Z: RATHDRUM, ID 83858
Phone: (208) 623-3432
Group Name:
Project Name
Parcel Number: 55173.2510
Block: Lot:
SiteAddress: 18908 E BLOOM CIR Owner: Name: MILLER, E D/ALDERMAN, J W &
GREENACRES, WA USA 990 Address: 18908 E BLOOM CIR
Location:: GRE GREENACRES, WA 99016
Zoning: UR -7
Water District.
Urban Residential -7
Area: 7,810 Sy Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Jnformation:
Review
Site Plan Review
Special Inspections
Hold. ❑
Depth: 0 Right Of Way (ft): 0
Gla( «4* *
C eleased Bv.
Septic System Review
ScwogLe system da:igned
For l bedrooms only.
Permits:
Released By:
k1
Operator: DMD Printed By: DMD
Print Date: 11/29/2001
Project Number: 01010498 Inv: 1
Application
Date: 11/29/2001 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Manufactured Home
Contractor YUKON TRANSPORT Firm: YUKON TRANSPORT
Address: PO BOX 586 Phone: (208) 623-4092
RATHDRUM ID 83858
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Notes: ....,
Payment Summary:
Permit Tvpe
Manufactured Home
Units Unit Desc
2 SECTIONS
1 Y OR BLANK
Fee Amount
$100.00
$22.00
Permit Total Fees: $122.00
Fee Amount Invoice Amount
$122.00 $122.00
$122.00 $122.00
Amount Paid
$0.00
Amount Owing
$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 he true and correct, and agrees that all provisions of Imus and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not he contrued 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: DMD Printed By DMD
Print Date: 11/29/2001
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete all spaces, including the signature box (marked with an X).
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fees to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.
Owner last name fast name
Address
\
Day time phone
( )
City
ALTERATION PERMIT
Do not complete shaded areas
Installer/Contractor/Dealer'
Address
.,)
!, C)
Phone
( )
City
Contractor's registration number
State ZIP+4
Check the appropriate boxes in section A and section B.
A ❑
Commercial Coach B ❑
❑ Mobile Home
Serial No. •
-HUD No.
❑ Recreational Vehicle or ❑ Park Trailer
Serial No:
Model No. of Plan Approval No.
a,!r
Alteration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — —
Plan Review
RV Inspection
Reinspection
Technical inspection
FFFS
Original Perm•
No::'=
Note: This permit expires one year after date of purchase. (Non-refundable)
�Signature of applicant or authorized representative Make check payable to: Dept. of Labor & Industries
X FEES DUE $ -
-Department use'oaly. . ..,
❑'Request approved or ❑ Request denied because of specific violations of1Washington rules and regulations.'.,Violatlons must
`be corrected and reinspection requested; w. „ ..O days for vehicles end 20 days for mobile homes and rnmmereial coaches.
•
:-of the notice.of violation date. (Thisldoes; not, apply to technical inspections).;SIt, k unlawful to offer for sale, rent,�or lease; any.,
' 'non -complying mobile home, commercial, coach' or recreational vehicle.;',, : ' ; ;`''z; ''
CALL 324-2640 FOR INSPECTION
PLEASE LEAVE NAME &
ALTERATION PERMIT NUMBER
Included are` forms required Winch must be completed Mid fres submitted before reinspection
:;%
F622-012-000 alteration permit 7-01
White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
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