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2005, 04-07 Permit App: 05001098 MHProject Number: 05001098 Inv: I IApplication Date: 04/07/2005 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Revi Site Plan Sewt Item Description Units Unit Desc Fee Amount INSPECTION FEE 2 SECTIONS $100.00 Permit Total Fees: $100.00 Operator: K C Printed By: K_C Print Date: 04/07/2005 Project Number: 05001098 Inv: I Appiiiatlon Date: 04/07/2005 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes , . ALL PERMIT APPLICATIONS IN MISSION MEADOWS MHP MUST HAVE PLANNING DIVISION REVIEW BY MICKI HARNOIS OR GREG MCCORRMICK Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Manufactured Home $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00 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 be 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: K C Printed By: K_C Print Date: 04/07/2005 .: 1 t3UILDING PERMIT APPLICATION WORKSHEET City of Spokane Valley Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Phone: (509) 688-0036; Fax. (509) 688-0037 REQUIRED SITE INFORMATION Street Address: /7/7 /Y �-�'Q C�✓� L4/i Assessor's Tax Parcel Number(s): Legal Description: /df SZ dlc ^5jb'ol AedyI)5 /y%p PERMIT DESCRIPTION: ❑ Building Permit ❑ Change in Use ❑ GradingManufactured Home ElRelocation ❑ Tenant Improvement F1Fire Safety 15 Other I OWNERIAPPLICANT INFORMATION I ❑ Owner: —g& Re- kihA e c _ Phone: Fax: Address: city State Trp Code ❑ Contractor: %kvf& Phone: 535=0661 F 535- 5��Z7 Address: v &/ City State Zip Code ❑ Applicant: PKI c Phone: 3`7Z- 3 Fax: Address: SzI/�h .A `/. (�Z Ci State ' Zip Code ❑ Architect: Phone: Fax: Address: City State Zip Code WA State Contractor License #: Contact: Spokane Valley Bus. Liscense #: Contact: PERMITIBUILDING INFORMATION HEIGHT TO PEAK. /-3/ DIMENSIONS: z7 X &O # OF STORIES: I MAIN FLOOR TO SQ. FTG: _2'FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: # OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? MANUFACTURED HOME Width: Z7 Length: Year: 2-00 5— Pit Set: Manufacturer: Previous Address: Proposed Use: _ RELOCATION FIRE SAFETY Fire Sprinkler: # of Heads: Fire Alarm: Tent: Fireworks Display: Blasting: Valuation: Above/Underground Storage Tank Size: Paint Booth: Date/Time: E --WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Address: Phone: Fax: city state Zip Inspector: Phone: Fax: Address: city State Zip SPECIAL INSPECTIONS ❑ BOLTING ❑ CONCRETE Firm Name: Inspector(s): ❑ REINFORCEMENT Phone: Fax: ❑ WELDING DISCLAIMER The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. Ownership of resulting development rights granted by any issued permit inure to the property owner. Print Name Signature Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard K VISA Bankcard #: Authorized Signature: Expires: VIN#: ❑ Other wolf Me k ' Zo� 372, X 717 Al � �� �ur�, ••,.. I a s�►�rwttww•w••�ww� 711 n is being submitted 10r the Purposo 01 This site permit and is a true and Correct obtainiea building P proposal. All known Property s ntation of the prop° es and easements Indica • tlaw�e'► have b� identified• Also her critical areas. bodies of water,Ste • �ie•ww wwrww•••;�dw••••••w•• 1-000, 51 ZONE 1� ROAD WIDTH FRONT 1, '•� � COMMENTS FLANIQNG AEVJEwED ft t 17 1 IDY LA M E V* 1722��' ADE U ' Ty 1716 rte/ ► EMEND' .)0 tr,� CJ n �" 4 � 0 0 CD � V* 1722��' SPOKANE COUNTY UTILITIES/SEWER & GFC 1026 W. BROADWAY, SPOKANE, WA 99260 (509) 477-3604