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2001, 11-14 Permit App: 01010091 MHO v;;vi_ SpoicANE Cowry PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOICANE,SVA 99260 •/ 509-477-3675 SPECIFIC SITE INFORMATION d Street Address: kin iv 0/2- O loon. 0 Assessors Tax Parcel Number(s): Legal Description: .1,10t /lQ B/ask 6 Lab e'73 /yoat l e Roil( Project Description: O Building Permit ❑ Change in Use O Grading O Manufactured Home Permit O Relocation O Sign O Tenant (New/Change) O Other •Department Use'Only: 0 Apprirant. Phone Fa,. \\'atcr D,>Inet/Puncyur Sen cr Dt.Inct/Puneyot.., - Road ,vidlh- '-'1. -Setbacks ' Front.' ' L:fe. i. " Rear't . .. Right: - .School Di. trier Fire District .. , .. Zoning .. I loll aturcc (chitties Gan, etc) OWNER/APPLICANT INFORMATION 12I /rid: le oho Jwn/d be .,rile. Teel nranon : iN, frriea 0 corner Phone 509-q 21/-2/6 2 L EIviS flU/if 'iv 0 Apprirant. Phone Fa,. Nailing AJdrn, /q 012. cforlrn Circle Mailing Address - Dorn1asums are ug ,tate, /ip Grerlifln's)WA 9761 Cm•State, Zip Fmished basement sq. it ❑ c„,,,,,,„„ I'Imnc F.a. 0 :\relines./Itng neer Phone I,,, Mailing address Mailing address I loll aturcc (chitties Gan, etc) Cit,, State %ip 11n, Suit. Vii \\'A State Contract,. license # Comm nano PROTECT INFORMATION Building Information:, Building eight to peak I) -=t #.d so pries I Main Choir ski6 linlnuahod basun: si ft Dorn1asums are ug Total habitable space a''I floor sq fl. Fmished basement sq. it Occupancy group Const maum ripe Garage ski 1.1 Dc ck ski It Gott 'f protect I loll aturcc (chitties Gan, etc) Manufactured Home „ - •, Sign \CSdth.Length. a()Q r / ( l6 2 What is the square footage of the sign face? flow high is the sign? ''carr. i 9 `d 5 Make. Candler/J001 # of signs Arca of evsting .signs Fireworks display _ Address Proposed use Relocation ' : ". Fi're Safety:;` Finn Name What is the current use of this property? Previous address Will the site be served by a septic system? ❑ Yes ❑ No Paint booth Fire Spnnkler Tent Fire Alann Fireworks display _ Address Proposed use value Special Inspections Required?, Non -Residential Energy Code Compliance?,'; - Finn Name What is the current use of this property? Phone Will the site be served by a septic system? ❑ Yes ❑ No Pas liitmintner Phone Inspesmrs Is there evidence of fill or excavation on the property? 0 Yes 0 No Are there slopes greater than 30% on the property? (30 ft rise to 100 ft) ( /°o) 0 Yes 0 No Are critical or hazardous materials used or stored on site? 0 Yes 0 No Address O 'No Is the property located within 1000 fectof a Natural Resource Area? ❑Yes 0 N -. , Inspector Phone 0 Concrete 0 Welding 0 Bolting 0 Reinforcement Atkins.; ADDITIONAL SITE INFORMATION Are there structures on the property? ❑ Yes ❑ No If err, /deutif en .r/te plan What is the current property sin? (square feet or acres) Is any part of the property within 250 feet of a shoreline? If yes, i//eldlif'ensire plan ❑ Yes ❑ No What is the current use of this property? Is your property in a designated wildlife habitat area? ❑ Don't know ❑ Yes ❑ No Will the site be served by a septic system? ❑ Yes ❑ No Is any part of the property within a 100 yr flood plan? Des. Iden/(fr 0// siteplln 0 Maybe to Don't know 0 Yes 0 No Are or will there be wells located on the property? Des, Jden//6' on the Ilse plan 0 Yes 0 No Are there any wetlands, streams or ponds within 200 feet of the property? 1f ye.i, o/eubf' on ole plan 0 Yes 0 No Is there evidence of fill or excavation on the property? 0 Yes 0 No Are there slopes greater than 30% on the property? (30 ft rise to 100 ft) ( /°o) 0 Yes 0 No Are critical or hazardous materials used or stored on site? 0 Yes 0 No DEPARTMENT USE ONLY Is the property m a designated Stormwater ControlArea? 0 Yes - 0 No Is public sewer available to the site? 0 Yes 0 No Is the property inside the ASA? .- . 0 Yes •❑, Yes' ❑ No ❑ NO. -. Is public water available to the site? ❑.Yes 0 No Is the property inside the PSSA? °, ❑ Yes - O 'No Is the property located within 1000 fectof a Natural Resource Area? ❑Yes 0 N -. , Date P. wird Staff Represematn e - METHOD OF PAYMENT VISA :_i-�dC'k ❑ (:-\sll ❑ (.nf.(ti ❑ ❑ _. *t +r` ❑ FAXED PERMITS WILL ONLY RE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DIJCSVER I'It It.\NKt:ARD NUMBER .\UI 1 I( )RIZI':D SIGN:\'PURI?: SURI O'I':\I. TOTAL FEE MINIMUM PERMIT FEE 15 f3500PI.E \AE ..\I \KE ti II CIS 1' WADI E 10 SPOKANE COLIN IS 1'LR\I11 Q'_\I ER Project Number: 01010091 Inv 1 Application Date: 11/14/2001 Page 1 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: EXISTING DOUBLE WIDE MANUF HOME, STGE ADD, COV DECK, & COV PORCH Contact: HUNT, ELVIS Address: 19012 E BLOOM CIR C - S - Z: GREENACRES, WA 99016-9686 Setbacks: Front 72 Left: Right: 5.6 Rear: Phone: (509) 924-2622 Group Name: Site Information: Project Name: Plat Key: 001407 Name: LABERRY MOBILE PARK ADD District: G Parcel Number: 55173.2516 Block: 6 Lot: 16 SitcAddress: 19012 E BLOOM CIR GREENACRES, WA USA 990 Location:: GRE Owner: Name: HUNT, ELVIS Address: 19012 E BLOOM CIR GREENACRES, WA 99016-9686 Zoning UR -7 Urban Residential -7 Water District 008 CONSOLIDATED IRRG #1 Hold: ❑ Area: 10,780 Sq Ft Width: 0 Nbr of Bldgs 2 Nbr of Dwellings: 1 Review Information: Depth: 0 Right Of Way (ft): 50 Review Site Plan Review Release Special Inspections s "11'L1, i Released B}: oft Gi(P6 Permits: t. 11 Sys a m' eview P 3i - :Released By:.:. G/J //—/c/—.c Operator: JAS Printed By: DMD Print Date: 11/14/2001 Project Number: 01010091 Inv: 1 Application Date: 11/14/2001 Page 2 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Building Permit Contractor: OWNER Firm: OWNER Address: 0 Phone: (000) 000-0000 000000, 00 000000 Building Characteristics Const Category. Addition Group: R-3 Type: VN Nbr Of Dwellings. Occupant Load: Building Height: Stories: Bldg W x D: x Building Sq Ft: Sprinklers: ❑ Req Parking: Handicap Parking: Critical Materials: ❑ This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation COV DECK R-3 VN INCLPORC 256 $2,421.76 256 $2,421.76 H RES ADD R-3 VN Item Description RESIDENTIAL VALUATION STATE SURCHARGE RESIDENTIAL SURCHARGE 208 $12,896.00 208 $12,896.00 Totals: 464 $15,317.76 464 $15,317.76 Units Unit Desc 1 Y OR BLANK 1 Y OR BLANK 1 Y OR BLANK Fee Amount $238.00 $4.50 $52.36 Permit Total Fees: $294.86 Manufactured Home Contractor: OWNER Firm: OWNER Address: 0 Phone: (000) 000-0000 0000110, 00 000000 Item Description INSPECTION FEE COUNTY SURCHARGE Units Unit Desc 2 SECTIONS 1 Y OR BLANK Operator: JAS Printed By: DMD Fee Amount $100.00 $22.00 Permit Total Fees: $122.00 Print Date: 11/14/2001 Project Number: 01010091 Inv: 1 Notes: Application Date: 11/14/2001 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: Permit Type Building Permit Manufactured Horne Fee Amount Invoice Amount Amount Paid Amount Owing $294.86 $294.86 $0.00 $294.86 $122.00 $122 00 $0.00 $122.00 $416.86 $416.86 $000 $416.86 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 laws and/or regulations governing this type of work will he 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: JAS Printed By: DMD Print Date: 11/14/2001 rhis si,e. plan n Is being i l brn ded for thep urpose o obtaini correct f Aermand is a true andreAresen of the proposal, Afi known property curblnes. structures easementshaep nidEnii , o indiDated are weipate:Sign,bodies°f water,steep slopes or other cnticat wetlands, and 1/ Oerrj Lot Ito lock 4 t.a- 810011; CLQ' �q�(2