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2001, 03-22 Permit App: 01001735 MHProject Number: 01001735 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 3/22/01 Page 1 of 2 Project Information: Permit Use: PLACEMENT OF SINGLWIDE MOBILE HOME Setbacks: Front 25 Left: 5 Right: 5 Rear: NA Site Information: Plat Key: MH002 Name: GOLDEN ACRES MOBILE HOME PK Contact: MICHELBOOK, KENNETH C. Address: 813 N BOWMAN RD C - S - Z: SPOKANE, WA 99212 Phone: (509) 000-0000 Group Name: Project Name: Parcel Number: 35131.1125T Block: Lot: SiteAddress: 813 N BOWMAN RD SPOKANE, WA 99212 Location:: SPO Zoning: UR -7 Water District: Urban Residential -7 District: H Owner: Name: MICHELBOOK, KENNETH C. Address: 813 N BOWMAN RD SPOKANE, WA 99212 Hold: ❑ Area: 0 Sq Ft Width: 40 Depth: 126 Right Of Way (ft): 60 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Department BUILDING Hold Reasons: Permit Conditions: BUILDING Hold Reasons: \Permit Conditions: Perm its: ' Review Site Plan Review Plan Review Released By: Contractor: OWNER Address: 0 000000, 00 000000 Item Description INSPECTION FEE COUNTY SURCHARGE Manufactured Home Firm: OWNER Phone: (000) 000-0000 Units Unit Desc 1 SECTIONS 1 Y OR BLANK Permit Total Fees: Fee Amount $50.00 $11.00 $61.00 Project Number: 01001735 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Summary: Operator: DMD Printed By: DMD Permit Type Fee Amount Invoice Amount Manufactured Home $61.00 $61.00 $61.00 Date: 3/22/01 Print Date: 3/22/01 Notes: $61.00 Amount Paid $0.00 $0.00 Amount Owing $61.00 $61.00 Page 2 of 2 ��--/7S3 !if hill SpoKARE COUNTY 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: / 3 At &, w 112 C* l7L ci 3 Assessor's Tax Parcel Number(s): Legal Description: Project Description: O Building Permit O Change in Use O Grading 171; Manufactured Home Permit O Relocation O Sign O Tenant (New/Change) 0 Other '.�. • Pr. . - 4 . Il it t �S�''''+, 'va Ax" . f.xB' :�^.Gki{j%�• $- lal LL�'z. C � ...'` -4 , y'..Pim• '�'ti- ex'. "e .+' J3... '$- ��k �.xi , Mailing address Heat source (electric, gas, etc.) City, State Zip Spa K .e I &0/4_ , ,i."- + WA State Contractor license tt v -�.^.�-„• &ITP� rontv ,4 ' " wMa, �ha= ,..q 'fit. , y AP t. , `�. .y.• aam if' s. :. �y d ° �. , S°ttIl». 5¢'>~` _. } ,3 ... _-`"'a T3.S' . «""'�' ' .- vE �. � R ki•.l' - '3 -,.�. , o .fl''t ^h: ''� � - - < -$_ _ :':t..s �.. � f€ r .yF,. ^; ,rLer:.�,'P a.., .. -. f .. -fir J<. y' � Vwr� a§. - RI 'v -.. _.a:. 5✓'<„�bos ",a -.�Yz� �:':i- i�..•:` OWNER/APPLICANT INFORMATION El Indicate who should be contacted reearding this Droect 0 Owner: Phone: Keel/26-M. ` t mi (, / (id v liC Fax: 0 Applicant: Phone: Fax: Mailing Address: '/ 3 M v, o w.n_44- 8a Mailing Address: Dimensions City, State, tpCity, ) W� ( ^ q � 7 � State, Zip Finished basement sq. 6. 0 Contractor Phone i:Qq /'e eon 1. Fax 0 Architect/Engineer Phone Fax Mailing dress Mailing address Heat source (electric, gas, etc.) City, State Zip Spa K .e I &0/4_ , City, State Zip WA State Contractor license tt Contact name: PROTECT INFORMATION ..qq,rr.P:�� :._ __ -_ -:B c�tn .:�Inforixf:ator%-. ..� -: °.a= _ m...,,��,, w ?'-=�%s a'A: 5'.<, �i -....''�,`'-i:£z -tea- Zn;a': q'?:::. Building height to peak # of stories Main floor sq. 6. Unfinished basement sq. h. Dimensions Total habitable space 2"d floor sq. ft. Finished basement sq. 6. Occupancy group Construction type Garage sq. 6. Deck sq. 6. Cost of project Heat source (electric, gas, etc.) yy` ,�F111 ALl.1i:.Y�VSL'St, /'��"���}aypp s� ]pp »MTR p..v:�.. ^:�,F.;F�^- �^' bry. ., -.,3'•.�p....�.a'ttei.xa...:.�L'+Y',., `r- f ?� s.si=' ,; �:x„�, - n:'�zist,;e�ifC;Y`,b>•.,�`V =.a:��n'SF��"��r« R,�, y ^•r�� -�;.•,',: 'i� Vii`^'. t_s,� _"s" '''r .`-s'�y'> V �• ^t� � «' ;..,, « .tr"v>•.'� Width: � X / / Length: What is the square footage of the sign face? How high is the sign? Year: 1895 Maki: ehetwt/ o rt - # of signs Area of existing signs Are critical or hazardous materials used or stored -on site? O Pies 0 No .�.x �. Previous address ( A 71405"e3 j wi q q $'37 Fire Sprinkler Paint booth _ Fire Alarm Tent Fireworks display Proposed use Value Firm Name Phone Inspectors: Address Inspector Phone O Concrete 0 Welding 0 Bolting 0 Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? 0 Yes O No If yes, idents on site plan What is the current property size? (square feet or acres) Is any part of the property within 250 feet of a shoreline? If yes, identib, on site plan 0 Yes 0 No What is the current use of this property? Is your property in a designated wildlife habitat area? O Don't know 0 Yes 0 No Will the site be served by a septic system? 0 Yes O • No Is any part of the property within a 100 yr flood plain? If yes, identz on site plan 0 Maybe 13 Don't know 0 Yes 0 No Are or will there be wells located on the property? If yes, identify on the site plan 0 Yes 0 No w. Are there any wetlands, streams or ponds within 200 feet of the property? If yes, ident f on site plan 0 Yes 0 No Is there evidence of fill or excavation on the property? 0 Yes . O No . Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) (/ %) 0 Yes 0 No Are critical or hazardous materials used or stored -on site? O Pies 0 No 4 DEPARTMENT USE ONLY Isih�ti , r. P E u, .. s�z� < � na 'e ° �� ie.F ~. A j��mh e : a i e d ^� �1 N �, •� �'le�i• .�-ara y liStii� k X"d�i` w t" •�- - B _.n .�.x �. e 'to . �'].a � ° ' 5 vi9 .�. 'P..•-..- 's "+�� - �."-,.. "i'�' 'wF.-F` °' .Y'S .a '- Y pex a ivi uiI: 3'��-'-,<i, rr "ky Js yM-- --' Yf "`i S o-'Y.a'-'3' a,u: ire.,_,.m.,jy4 ef: �A. a="•k .;✓.,,": >s2- Date Received: Staff Representative: METHOD OF PAYMENT VISA ❑ CASH ❑ CHECK D UMW❑ - FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: SUBTOTAL A E144tJM'PF,iatt7'FEEIss3S.o0PLEAS •-_ MAKE.GFi£CKS f'AYABIA SPOT ANET : •COUNTY -PERI IT:CEN Department of Labor & Industries Factory Assembled Structures Section INSTRUCTIONS: 1. Complete all spaces, Includingthe slgna pre.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&1 office within 15 days. ALTERATION PERMIT Do not complete shaded areas f Permit # Invoice 0 1506 53 Insignia # t .. J Owner last name first name Day time phone ' Address �_t-.. _�'_v........._....................�...i...r.':..::..1:.�.:............_ City Installer/Contractor/Dealer N Phone i— •/ •7 Date State ZIP r �{ 2 / wi ) ........................................ City 1-1 LContractor's registration number State ZIP+4 / I / /l Check the appropriate boxes in section A and section B. A❑ Commercial Coach Serial No. Mobile Home Serial No. HUD No. ❑ Recreational Vehicle or ❑ Park Trailer Serial No. Model No. or Pint Approval No. FEES B ❑ Alteration Inspection (check appropriate boxes below) $ Air Conditioning/Heat Pump Electrical PAID Electrical ApplianceUEPARTMENT OF LABOR & INDUSTRIES Fire Safe} GasFurnace MAR 2 2 2001 Gas Piping Plumbing REGION 6 Structural Wood/Pellet Stove ——nSPOKANi'.WA Plan Review $ RV Inspection $ Reinspection $ Technical Inspection $ Note: This permit expires one year after date of purchase. (Non-refundable) /Signature of applicant or authorized representative f ' Make check payable to: Dept. of Labor & Industries \X .. , J'. = . ' :.r f; `;` i-/ J FEES DUE $ ::-4:; Original Permit No. Departmait ase only ❑ Request approved or [3 Request denied because of specific violations of Washington rules and regulations. VMiatlons est be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and continental coaches of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent, or lease any non -complying mobile home, commercial coach or recreational vehicle. CALL 324-2640 FOR AN INSPECTION PLEASE LEAVE NAME & ALTERATION PERMIT NUMBER ❑ Included are forms required which must be completed and fees submitted before reinspection Area office Inspector Notal pages CDSte F622-012-000 alteration permit 8-99 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser • - - -I - -,- : - -1,--)L - i- ! c',:•,_,,f, 1-:-",-- 4-'"---1 ; -I 4 ' i - ; - I -.4 j-- I ! '; . 1 ` -1 I--- I 4 1 . , , • -I-- 1- 7" i - i - 4 T-;----1--11-711111-7-41--;; -"- - -- -. -----t-'-'-' -t- --L-- - - - --I- -I - ; -; : -1--, -: :- "; --;-4- - 1 --4 - t - -:-.- •,- - • , , 1 , , , „ . • • .1 . • - -;-. - ; - 4-- i _ 4_-;_44 _ _ ' j i • , ' • . __ 4 ____;__. ,__,_ _ --4 - __ * '''''; - ,- +--- .: _ .,.. 4 - .4-- 4. ..--;-- ,jiii... - --r- -4-- • - ' ', i 1 • ; •,_ ; i ! 111.1' .., ...;, 4 , ' ; ' , , 4 • ' ' 1.k.,...." \ , I . 'VA•__. P^ I : -4-Li .1. : _ _ :_ . 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