2002, 07-16 Permit App: 02005983 MHProject Number: 02005983
Inv: /
t
Application
Date: 7/16/02 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project In foronition:
Permit Use NEW DOUBLE NIDE MANUFACTURED HOME Contact: CHD INC
Address: BOX 13717
C - S - Z: SPOKANE.W A 99213
Setbacks. Front 46 Left: 26 Right: 5 Rear: 76 Phone: (509) 926-5229
Group Name:
Site Information: Project Name:
Plat Key: 005253 Name: SP -T77-92
Parcel Number: 45134.2602 Block: Lot: B
District: F
SiteAddress: 220 N GALLWAY LN Owner Name CHD INC
VERADALE, SVA USA 99037 Address: BOX 13717
Location:: VER SPOKANE,W A 99213
Zoning UR -3.5 Urban Residential 3.5
Water District 010 VERA Hold. ❑
Area:
0 Sq Ft Width: 97
Depth: 148 Right Of Way (ft): 21
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: r -
Review
Site Plan Review
Releaseul By:
-/4 _
Plan Review
Released By: of SPC��
S b✓►�I' e6L 74, /7 -02 -
Approach/ Drainage
Sewer Review / I" -/..ALJ fir/1-9
Released By.
Permits:
Released By:
C \�o, tSstt€ ((' utl�.rnalT rmtivtll�t.s&txi Yearn CkSE
rariot beI4CL
tj A Tt seweA- ce.e-s ant. 1 �Qo M) �/i 4,I fi Z
Operatoi JAS Printed By: JAS
Print Date: 7/16/02
Project Number: 02005983 Inv: 1
Application
Date. 7/16/02 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Manufactured Home
Contractor: WES CROSBY Firm: C H D INC
Address. P O BOX 13717
SPOKANE, WA 99213
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Phone: (509) 926-5229
Units Unit Desc
2 SECTIONS
1 Y OR BLANK
Fee Amount
$100.00
$22.00
Permit Total Fees: $122.00
Notes:
WATER SYSTEM TO BE INSTALLED PRIOR TO ISSUANCE OF PERMIT. DRAINAGE
EASEMENTS REQUIRED PER SHORT PLAT, UTILITY EASEMENT HAVE BEEN GRANTED,
THE LOWEST BUILDING OPENING, INCLUDING BASEMENT OPENING FOR ANY
BUILDING ON PARCELS A, B, & C SHALL BE HIGH ENOUGH
TO ALLOW A MINIMUM SLOPE OF 3% AWAY FROM THE BUILDING IN 10 FEET. ALL
DRAINAGE SHALL BE ROUTED AWAY FROM THE BUILDING TO NATURAL DRAINAGES
OR OTHER LAWFUL DRAINAGE FEATURES.
Payment Summary'
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
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 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 contrued 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: JAS Printed 13y: JAS
Print Date: 7/16/02
a
1000
SPOT CouriTr
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 \C-T,SI' BROADWAY AVENUE
SPOKANE, \VA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: /Y 2c) t4//�,p._ �4e
Assessor's Tax Parcel Number(s): "_h1'/C
134 3 4
Legal Description: //�-277—n
•..7 C/��
7 P�1G% - s/ —277— (�-
Project Description: �J17Oaiu
Gilding Permit
O Change in Use
O Grading
%Innufactured Home Permit
0 Relocation
O Sign
O Tenant (New/Change)
0 Other
Department Use.O inlV ; ... • .. ..
0 Applicant. /////�qq /�/��// //JJ pppOp Mimic
c6--^r'/t &'41 . �/tEf, Fay
Abding Address
/o52 S-- % 9&'
Mailing Address
5 -.. -
' Water Untnctl'un C) -- •. .
^ ^
n%er
' Se.; cr District/Puyn
Road kith
, Scrbacki .
Pr tit•
- -
,-, -
Riad
Y ..
Niglm-. _ .
'
lira
..
School Dntnct •
Fire District-. -
' - /J
44 I
Zonuig� q�
C.L./ )- 3. j:IArt.
OWNER/APPLICANT INFORMATION
led, alr ulin ,hntdd Gz,oula ltd r',,rdmp this P01, /
0 (lnnee Phot.. �a Y -3i re_
4t /14 44SON Fa`"
0 Applicant. /////�qq /�/��// //JJ pppOp Mimic
c6--^r'/t &'41 . �/tEf, Fay
Abding Address
/o52 S-- % 9&'
Mailing Address
5 -.. -
9 Co -:/CZ
DI iensiom -
(:m, Stare, %q,
v din ,--.-- tot- `z9 z o(,....
Cie, Som, tip
1,n -tidied basement sq tt.
( )ccupanec group
0 Contractor Phone 945,-35 7Z.
GHo /Rete Fa\
0 Archnrct/I'ngmer
Ucck sq. (t.
Phone
Fa.
Mailing add IC,
JP' a' b -i 13717
Alading address
(:n. . Sa,n Lap
`7ovCCi71-dc---"' /144— 49 z./ 3
Cm, State Mi.
\\A Slat e'Contractor license = /
contact name
PRO IEar INFORMATION
• Building Information
Budding height to peak
# u( stones
\lam Moor s5,. It.
Unfinished basement sq. 0.
DI iensiom -
'final habitable :1,2a
2nd Floor .L.1 0
1,n -tidied basement sq tt.
( )ccupanec group
(i matruch in 1' pc
Garage s5,. it
Ucck sq. (t.
Cost of project
I kat anurce (i•nt et nc. gas, etc)
Manufactured Home : ; I ".
Sign•
Width:
02‘-G
Length:
le L-
What is the square footage of the sign
face?
I low high is the sign
Year
1.06 t-
Nlakc�7
/i%ii 7,..."
# of signs
Area of existing signs
Fireworks display
Are critical or hazardous matenals used or stored on site?
O Yes O No
Proposed use
Relocation
-
Fite.Safety ..
Finn Name
What is the current use of this property?
Previous address
Plans E'ammer
Paint booth
Foe Sprinkler
'fent
Fire Alarm
Fireworks display
Are critical or hazardous matenals used or stored on site?
O Yes O No
Proposed use
Value
Inspector
Phunc
O Concrete
,Special;Inspections'Required? _
Non-Resideritial Energy Code Compliance?
-
Finn Name
What is the current use of this property?
Phone
Plans E'ammer
Phone
_--
Inspectors
Inspectors
Are there any wetlands, streams or ponds wAthol 200 feet of the property?
If yes, Mein* on sitepl011 O Yes O No ..
Is there evidence of fill or excavation on rhe property
O Yes O No
Address
Are critical or hazardous matenals used or stored on site?
O Yes O No
Inspector
Phunc
O Concrete
O Welding
O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes O No
Iyer, itenn i' on the plan
What is the current property site?
(square feet or acres)
Is any part of the property withm 250 feet of a shoreline?
Ifyet,idenli on site plan O Yes O No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
❑ Don't IUIO\y ❑ Yes ❑ No
Will the site be sen"ed by a septic system> O Yes O No
Is any part of the property within a 100 yr flood plain?
fryer, identifr on stteplln
O Maybe O Don't know O Yes O No
Are or will there be wells locoed on the property?
Ifyer, ,dent6on the site p1ssi ❑ \es ❑ No
Are there any wetlands, streams or ponds wAthol 200 feet of the property?
If yes, Mein* on sitepl011 O Yes O No ..
Is there evidence of fill or excavation on rhe property
O Yes O No
Are there slopes greater than 30% on the property? (30 ft nse in 100 ft)
( .--.---"--.%) O Yes O No
Are critical or hazardous matenals used or stored on site?
O Yes O No
DEPARTMENT USE ONLY
Is'the propeity iii a'liesignat_ed Stortitwatei Control Area? .
• ,. • ' "1-' - 2' '.t, - - fl Yes - 0 No
' Is public sewer available to the site? - ". • O Yes O No'
-
Is the pfoperty inside the ASA? . - - O Yes O No
... O -Yes " IJ -No
Is public water a4ailable to rhe site? - - " • O YesO No
_ . .
Is the property inside the PSSA? ' - • • O ;Yes O No,
- - .. ..
Is'the propeity located within 1000 feet of a Natural Resource Area?
'O Yes O No -' -
One Itcru% rd
Stn Pi Itt pnsentatn s
METHOD OF PAYMENT
VISA
❑ CASII ❑ CIIItCK ❑
411COVER
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DAI'I1:
RAN KCARD NUN 1151'11 -
ISSPIRI-S:
AUTHORIZE') SIGNATURE
SUBTOTAL
TOTAL FEE
MINIMUM PERWTFEEfS$3AltlPI E SE
MAKE CI CIIECKS PAYABLE 10 SPOKANE
COIF ry I'itR\II r CENTER
os�
Ibis site P`an 1s being submaK a Sot the and correct
3 building permit and All known property oments
obtaining {ton o1 the b \M nds,
raPrese°� ions, curbllnes.suuct,rer
rP_a Indicate Ii►' 1 areas
tinealdfine^ 11den i -d. � ` Ps or
,, M
have bodies wale , � e P sloP-
bodlesct
Signed
Date'.
Not L t
9/rte 11141-e_
Cff / Yc
Sf 7-7-7_,z_M
PN, S73 �/ Z4,az-