2003, 09-06 Permit App: BLD-03-02424 MH1
SPOKANE Cotte
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
. - SPECIFIC SITE INFORMATION
Street Address: i p (} o f 1 o'- r c r..7.Q
SCEP t31 OD 1 Gv0 Ap
Assessor's Tax Parcel Number(s): b ) LJQ ton war„"
Legal Description:
001 MOD LL(
Project Description: j--\-
L I(YjS F,r iii L4 \ l N k / 7 C� 1 y 1,�f ®t t ?- � 3
❑ Building Permit
❑ Change in Use
❑ Grading
Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
.tJ*Je Qnly
Road tvidda
Setbacks
Front
Left
OWNER/APPLICANT INFORMATION
IL
Inazca[e JY/JI/ Ju!/ulU ric «1 u u :.xu. us",,; .,,.., t,. ,.....
# of stories
*Owner Phone: y, 5
(Lys a-rei, kop Fax:
- co -1 I
`-'j a
/Apppli�cantC: �,, 1y^` Phone: /
c� Ct I 1 I Nr� L; sr� 1 1 -'1 tSU�� Fax
7 -O` 7 O pC
t 1l 1 !
Mailing Address.
to ID 1X9e.e
Finished basement sq. ft.
Mailing Address: .
- v`' D 05 (heti es (Q,L 1 14-13
Construction type
,),7
City, State, Zip
\1a Klma
Deck sq. ft.
City, State, Zip
Dti'.> 0 rc_lick,rcl 3 c,JP9
ggva1
ni r' 20
`�
Phone
❑ Arch tect/Engineer
Fax
Phone
❑ Contractor
anr_
LL(O(�
Mailing addrU
Mailing address
City, State Zip
a5 D r)- 1 Wil°. X1)
City, State Zip
WA State Co tractor license #
Contact name:
n�iiiafitOn
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2nd floor sq. ft.
Finished basement sq. ft.
OccuP an cYgrouP
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
Heat source (electric, gas, etc.)
Manufactured Home
Sim,
Width:
Length:What
5d
is the square footage of the sign
face?
How high is the sign?
Year:
BOO 1
Make:
moot -t_ Lt rm e
# of signs
Area of existing signs
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( %) ❑ Yes 0 No
Proposed use
Value
Is'the property inside the P$.\?
0 Yes, :i7,:'No :`::` `°;>
Relocation
Fire Safe ty
Firm Name
Previous address
Phone
Fire Sprinkler
Tent
Paint booth _ Fire Alarm
Fireworks display
Is there evidence of fill or excavation on the property?
❑ Yes , No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( %) ❑ Yes 0 No
Proposed use
Value
Is'the property inside the P$.\?
0 Yes, :i7,:'No :`::` `°;>
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
What is the current use of this property?
Phone
Will the site be served by a septic system? Yes ❑ No
Plans Examiner
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
❑ Yes , No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( %) ❑ Yes 0 No
Are critical or hazardous materials used or stored on site?
❑ Yes 0 No
Address
Is'the property inside the P$.\?
0 Yes, :i7,:'No :`::` `°;>
ti
is roped coca 1,000 feet ofa Natut
p':AQP
t� *j
W
Inspector
Phone
❑ Concrete
❑ Welding
❑ Bolting
❑ Reinforcement
Address
Are there structures on the property? ❑ Yes J No
Ifyes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a sh r line?
Ifyes, identi on site plan ❑ Yes No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
❑ Don't know ❑ Yes No
Will the site be served by a septic system? Yes ❑ No
Is any part of the property within a 100 yr flood plain?
Ifyes, idents on site plan
❑ Maybe ❑ Don't know ❑ Yes No
Are or will there be wells located on the property?
Ifyes, identOt on the site plan ❑ Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, idents on site plan ❑ Yes No
Is there evidence of fill or excavation on the property?
❑ Yes , No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( %) ❑ Yes 0 No
Are critical or hazardous materials used or stored on site?
❑ Yes 0 No
fs;_:
Is the property in a ctesigssate.d Stosrnvitater Ciintzol. Atea7: °; - -
O Yes.
s
. L se
I publtC' available taiie7'
❑
it tine property inside the ASA?
0 Yes ,0 2di
❑ Yes=r' .u'`fi%i
_
tzbhc availabl t the sits'
❑
fs;_:
Is'the property inside the P$.\?
0 Yes, :i7,:'No :`::` `°;>
ti
is roped coca 1,000 feet ofa Natut
p':AQP
t� *j
W
Date Received:
Staff Representative:
METHOD OF PAYMENT
1111111111111
PISA
0 CASH 0 CHECK ❑ 111111111111111 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
BANKCARD NUMBER:
EXPIRES:
AUTHORIZED SIGNATURE:
SUBTOTAL
09/09/2003 12:47 FAX 509 477 4703
SPOKANE 'CO BLDG.
r
1,4] 001
Atiotipii4£ j,js BL
ZONE
ROAD WIDTH
FRONTqOp
COMMIES.,
REVIEWED BY
cC
qP13 A6 213 13:49
This site plan is t.,eing submitted for the purpose of
obtaining a building permit and Is a true and correct
representation of the proposal. M known property
lines/dimensions, curb lines, structures and easements
have been identified. Also indicated are wetlands,
bodies of wale steep slopes or other critical areas.
Signed: •
Date: /7-q7
Iu
509 477 4703
PAGE.01
09/09/2003 14:15 5093241567
SEP 06 2003 14:02 FR
01 • 4dley
11707 E. Sprague Ave., Suite 108
Spokane VaNsy. WA 99208
SRHD EHS PAGE 01
TO 3241567 P.01/02
MANUFACTURED HOME
Job Address: 18904 E BLOOM CIR
GREENACRES WA
Dsseriptton: REPLACEMENT OF DOULBE WIDE MANUFACTURED HOME
Subdivision:
Owner.
Applicant:
Addrtrse:
Contractor:
Address:
MARGARET AL6UP
MARGARET ALSUP
105 W WASHINGTON AVE
YAKIMA, WA 98903
YUKON TRANSPORT
PO BOX 1330
RATHDRUM ID 83888
Lot Blk:
THIS IS NOTA PERMIT
Penalties wIU be assessed for
commencing work without a permit
Application a: BLD -03-02424
Applied:
Issued:
Expires:
Parcel No: 55173.2509
Phone: (509) 452-0071
Phone: (208) 6233432
Lia No: YUKONT'O44DH
09109/2003
D3107!2004
General Information:
SECTIONS
YEAR BUILT
DIMENSIONS
*OF STORIES
*OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
MANUFACTURER
2w
2001
27 X 67
1
3
40
13
40
1e
MODULINE
Fees:
PER SEC
FEE
Total Calculated:
Deposits/Receipts:
Total Due:
100.00
100,00
0.00
100.00
rro roc .nnm-z 1.4!17
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMri'AL
Building
Planning
Public
!J
dr
4;
S NDga systam dCc
5093241567 PAGE.01