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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 \S9 :alea .pau5ig 'wale leollJ3 laylo Jo'sa is daals 'lole'jo salpoq 'spuepam aye paleplpu! CS(.pal;iluap! uaoq eney s;uawasea pue sawnpnils 'sauiI q.no 'suoleuawlpjaaull 4padoid uwoul Ily .lesodo,d egl;o uopeluasaldli pat= pue anal e s! pue ipwJed 6uTllnq a eru,ule�ga esod.rndayl lo; paulwgne @u}uq el ut3ld (pa Vita 1