2005, 01-03 Permit App: 05000003 MHProject Number: 05000003 Inv: 1
Apphcation
Date: 01/03/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW TRIVET WIDE MANUFACTURED HOME Contact. RICHARD MASON
y1inAddress: 15918 E CAMERON CT
0«� C C - S - Z: VERADALE, WA 99037
Setbacks: Front 6 Left: 7 Right: 20 Rear: 5 Phone: (509) 953-3923
Group Namc:
Site Information:Project Name:
Plat Key: Name: MISSION MEADOWS MHP MFG HOME PK 123 UNITS District: East
Parcel Number: 55083.9601 Block:
Lot: 61
SiteAddress: 1610 N GRADY LN Owner: Name: ROBINSON, ROLAND & CHERYL
Address: 13920 E 28TH AVE
Location:: CSV SPOKANE VALLEY, WA 99037
Zoning: UR -7 Urban Residential -7
Water District:
Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 35
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: ..
Review
Site Plan Review
Plan Review
Permits:
Released By: ai
Manufactured Home
Contractor: MOBILE CORRAL HOMES INC Firm: MOBILE CORRALL HOMES INC
Address: 15906 E SPRAGUE AVE
VERADALE, WA 99037
Phone: (509) 928-3003
Item Description Units Unit Desc Fee Amount
INSPECTION FEE 7n SECTIONS _$4-50-00" /00, 60
Operator: K_C Printed By: DMD
Permit Total Fees: -3-1-543-c /00. 00
Print Date: 01/03/2005
Project Number: 05000003 Inv: I
i Application
Date: 01/03/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary: : . .. . .
Permit Tvpe
Manufactured Home
Fee Amount Invoice Amount
$150.00 $150.00
$150.00 $150.00
Amount Paid
$0.00
Amount Owing
$150.00
$0.00 $150.00
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 he
complied with. Subsequent issuance of a permit shall not he construed to he 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: DMD Print Date: 01/03/2005
Spokane
Valley
05-- 0005
BUILDING 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:
/(v/D 4 c ady% La/ie.
(;
Assessor's Tax Parcel Number(s): 550 03 . 90(6- v� UD `
Legal Description:
zO $ (o/ e isinz an 0/ Li 76, 1,1,5»v1 )Ve i%uls
PERMIT DESCRIPTION: set files homt
❑ Building Permit
❑ Relocation
❑ Change in Use ❑ Grading Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: £lam/ *Chet. / 44n,,Vl
Phone: 9Z2..--lp5/ Fax: 2...7-3557
Address: /3 ZO E.. ZSR five
c,mks,, I/%"1 ui/4 €792)37C State / Zip Code
❑ Contractor: AZ, (-p' {t{
Phone: ?ZS-30°3Fax: g9/ -/3/4f
Address: /5-''040 8.4tra .e9
Spo /6.*2„t Vu l/r,� Wil- 9903?
CSS oo State Zip Code
WA State Contractor License #:
❑ Applicant: vfi1a///CYSoW1
Phone: 6/53-39Z9 Fax:L
Address: /S9/off.srnarC
/ �v 9yo)7
State Zip Code
44,
Architect:
Phone:
Address:
Fax:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: %�f-,,
DIMENSIONS.
30 >c <oif
# OF STORIES:
/
MAIN FLOOR TO SQ. FTG:
2N0 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: �
J
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON- ITE EPTIC
SYSTEM? /a !Z
MANUFACTURED HOME
Width: 30 Length: Coq
Manufacturer: /Ua546(4
Year: ZOOS" Pit Set: X
RELOCATION
Previous Address:
Proposed Use:
r
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone:
Fax:
City
Phone:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
Inspector(s):
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 inuree propert owner
//
Print Name �i[/j dtl�I f5(If Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard X VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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