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
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SPOKANE COUNTY UTILITIES/SEWER & GFC
1026 W. BROADWAY, SPOKANE, WA 99260
(509) 477-3604