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
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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
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Mailing address
Heat source (electric, gas, etc.)
City, State Zip
Spa K .e I &0/4_ ,
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WA State Contractor license tt
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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
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-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',.,
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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
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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
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