2002, 11-13 Permit App: 02010140 MHProject Number: 02010140 I nv: 1
Application
Date: 11/13/2002 Pagc 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: DOUBLE WIDE MANUFACTURED HOME
Setbacks: Front 25 Leff 31) Right: 30 Rear: 30
Site Information:
Plat Key. 11115799 Name: SP -777-92 District' F
Contact. CHD INC
Address: PO BOX 13717
C - S - Z: SPOKANE, WA 99213-3717
Phone: (509) 994-3972
Group Name:
Project Naos:
Parcel Number. 45134.2604 Block: Lot: D
SilcAddress: 206 N GATEWAY LN Owner Namc: CUD INC
VERADALE, WA USA 99037 Address: PO BOX 13717
Location:: VER SPOKANE, WA 99213-3717
Zoning' UR -3.5
Water Distract
Arca: 14,451 Sy Ft
Urban Residential 3.5
Hold' ❑
Width 97 Depth: 148 Right Of Way (ft) 311
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Released By. U Ql%1 • /,'�• 02.
Plan Review
Released Bc:- S(L
Sewer Review
Permits:
Released:By:
Atruntfactured HOME
Contractor OWNER Firm: OWNER
Phone.
Ilene Description
INSPECTION FEE
COUNTY SURCHARGE
Units Unit Desc
2 SECTIONS
I Y OR BLANK
Operator: RMB Printed By R1\IB
Fcc Amount
$ 100.00
522 1)0
Permit Total Fees: $122 (0)
Print Date. 11/13/2002
Project Number. 02010140 Inv: 1
Notes:
Application
Date: 11/13/2002
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Panne/1t .SUnnnary: .
Permit Type
Manufactured Home
Fee Amount Invoice Amount Amount Paid Amount Owing
$122.00 $122.00 $0.00 $122 00
$122.00 $122.00
$0 00 $122.00
Page 2 of 2
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the inibrmation
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not he construed to be 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. RMB Printed Bv. RMB
Print Date. 11/13/2002
v;�
HU
SPOT Couxr r
PROJECT APPLICATION- WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENPORCE\IEN'1'
1026 \VEST BROADWAY AVENUE
SPOKANE, \\4\ 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
/IP 20(0 9,61-4004 y l 4 -eve -
Assessor's Tax I'arcel Number(s): / 3y 1/2-6-0e(
Legal l)cscripuon. \ t
Z— fi D
S"/, -7 77--9 2—
q,7 X � A—14r4S1
Project Description:
❑ Building Permit
❑ Change in Use
❑ Grading
O Manufactured Honie Permit
O Relocation
O Sign
❑ Tenant (New/Change)
❑ Other
pcpartlncnt'Use.Only ''
Water Dsma/Puri 9 tn>-'Scwcr
.. '
D,a net/Pon cynr -
- ...
,Road width -
-Setback.
j�rnnt " ..ii'ar�.
"
School District
Fire District.
1,71,...6.5
OWNER/APPLICANT INFORMATION
lnd mle n hu ,hnu/l be mnla. id riTintlhzg IN, p77y
0 @, net
Building height to peak
/Yr
Phone: ? /—.j9'rZ
ky-.\pphcant.
Phone
dlad\dJrc..
intai.( /3
-7i7
Tia tlotn sq 0
MailingMailingAddressddress
)ccupancp group
01i:slap, m.'/.1t.,n.
I /4--
-u
Sate.'/.q,
11 ear stturre (elcctnc" gaa" etc.)
0 a
nContv[/ur
( - rr
Phone
Fax
❑ Architect/Engineer
Phone
lin
NIaiItng add re"
Mailing oldie..
Citi , State "/.ip
Gn. Stam GP
\\ A state Cnnrractor keens =
contact n.,,n,
PROJECT INFORMATION
• Building information -
Building height to peak
/Yr
# of stones
\lam flour sq ft.
Llntin' hid basement sq ft
Dunensnnn
a -V Li 30'
I rnai habitabh spec
Tia tlotn sq 0
Fuushed basement sq ft
)ccupancp group
Construction �
str,u,ction type
f�i /d
Garag, sq. It
72_0
Deck sq. fl.
cc,. of project
11 ear stturre (elcctnc" gaa" etc.)
Manufactured Home Ar.e
'Sign.'
\%hdth:
t--- 7
1.cngth0//
lio
\Xrhat is the square footage of the sign
face?
I lure high is the sign-,
Year:
Nlakt:
# of signs
Arca of c\ sting signs
'runt
Fire Alarm
Fireworks display
Relocation ".
c.Non=Residential Energy.- Code' Compliance?
Fire' Safety.
\Vhat is the current use of this property?
Phone
Prcvu nus address
- _ - -
!mixt int,
Paint booth
Piro Sprinkler
'runt
Fire Alarm
Fireworks display
Proposed use-
r
Value
0 Welding
0 Bolting 0 Reinforcement
Address
Special Inspections Requiied?
c.Non=Residential Energy.- Code' Compliance?
firm Name
\Vhat is the current use of this property?
Phone
Plans Rsaminer
Phone
!mixt int,
Ate there any wetlands, streams or ponds within 200 feet of the property?
If yes, nlentify on site plan 0 Yes 0 No
Address
Are critical or hazardous materials used or stored on site?
0 \'cs 0 No
Impcanr
Phi me
0 Concrete
0 Welding
0 Bolting 0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there stmctures on the property? 0 Yes 0 No
If yes, Idenbfj, on sone plan
\Vliat is the current property size)
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
If yes, identify on site plan 0 Yes 0 No
\Vhat is the current use of this property?
Is your property in a designated wildlife habitat arca?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
If ye,I, Idennfir on Me plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
I,fjer, ulenh(' on the site pLm O yes 0 No
Ate there any wetlands, streams or ponds within 200 feet of the property?
If yes, nlentify on site 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 nse in 100 ft)
( �%) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 \'cs 0 No
DEPARTMENT USE ONLY
Is the property in Ua designated Stoiniwater Control Arca?.: • '<`. . ..
0 Yes ' O No ' ._.
t
Is public sewer available to the site? 0 Ycs ' O No •
. • _ , " ...
Is the property inside the ASA? ', , _ . 0 Yes •?. 0 No ' "
. O'.Yes' • O No '
`"
cIs public water available to the site? • . - • " ' 0 Yes -' 0 No
...
Is the property inside the PSSA? ' O `Yes-• 0 No
.. .. - ...
Is the property located_ within 1000 feet of a Natural Resource Area)
O Yes' O No •
Due Rcttned
starrItrpre.cnraue
METHOD OF PAYMENT
VISA
0 r..\SI1 0 CI m:c: 0 ❑' > 1 ❑
DUCOVER
ws- ,
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
P112.1.:S
BANKCARD NUMBER:
:\UTI Il1RI/NI) SIGNATURE.
Sl1B'I c71'A1.
•
- TOTAL FEE
MINIMUM PERMIT FEE ISS S..00PLEA\SE
M ASE CI PECKS PAYABLE 10 SPOKANE
r:ouxn PIIR.\II r CI_. IER .
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This site plan is being submitted for the purpose of
obtaining a building permit and is a true and correct
representation of the proposal. All known property
lines/dimensions, curb linos. structures and easements
have been identified, Also indicated am wetlands,
bodies of water sjeep slopes ' critical areas
Signed.
Date:
A6bRES5_N 2
ZONE
ROAD WIDTH
FRONT FLANKING
COMMENTS r
c.
REVIEWED BY C.. 44-64,` .i4Je
•