2005, 05-27 Permit App: 05001823 MHProject Number: 05001823 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 05/27/2005 Page 1 of 2
Project Information:
Permit Use: SINGLE WIDE MOBILE HOME PLACEMENT
Setbacks: Front 30 Left: 10 Right: 10 Rear: 26
Site Information:
Plat Key: 001146 Name: HATHERLYS SUB
Contact: AYERS, TROY & PAM
Address: 11518 E DISHMAN MICA RD
C - S - Z: SPOKANE VALLEY, WA 99206
Phone: (509) 924-3896
Group Name:
Project Name:
District: Sout
Parcel Number: 45334.0206 Block:
SiteAddress: 4110 S HATHERLY CIR
Location:: CSV
Zoning: B-3
Water District:
Regional Business
Area: ;,600.00 Acres Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Lot:
Owner: Name: AYERS, TROY & PAM
Address: 11518 E DISHMAN MICA RD
SPOKANE VALLEY, WA 99206
Hold: Lil
Depth: 0 Right Of Way (ft): 0
Review
Site Plan Review
Released By:
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Plan Review
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Released By: CA SfIket1
Flood plain
Permits:
Contractor: OWNER
Flood Plain
Firm: OWNER
Phone: (000) 000-0000
Item Description Units Unit Desc Fee Amount
FLOOD PLAIN PERMIT 1 NUMBER OF $50.00
Permit Total Fees: $50.00
Operator: K_C Printed By: K_C Print Date: 05/27/2005
Project Number: 05001823 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 05/27/2005 Page 2 of 2
Manufactured Home
Contractor: OWNER Firm: OWNER
Phone: (000) 000-0000
Item Description
INSPECTION FEE
Units Unit Desc
1 SECTIONS
Fee Amount
$50.00
Permit Total Fees: $50.00
**TAKE NOTE OF THE SPECIAL PLACEMENT SPECS WITHIN THE FLOOD PLAIN**
Payment Summary
Permit Type
Flood Plain
Manufactured Home
Fee Amount Invoice Amount
$50.00
$50.00
$50.00
$50.00
Amount Paid
$0.00
$0.00
Amount Owing
$50.00
$50.00
$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: 05/27/2005
Spoukane
jUailey
BUILDING PE - IT 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: 1 ) 1 d S 44 a -'e r t C i
Assessor's Tax Parcel Number(s): H 533 L) , G
Legal Description: � V1e Y ILS �c h LT _S L 3 -?)LK
I
i
PERMIT DESCRIPTION: PAC) V cvl 6
❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
1
OWNER/APPLICANT INFORMATION
❑ Owner:1) .
,,r, e I IA K5 ❑ Applicant:
Phone:q,A q- 3i.Nci Fax: Phone: Fax:
Address: ) IS I S c sk wtaA � G vo Address:
City I State Zip Code City State Zip Code
❑ Contractor:
Phone: Fax:
Address:
0 Architect:
Phone: Fax:
Address:
City State Zip Code City State
• WA State Contractor License #: Contact:
Spokane Valley Bus. Liscense #: Contact:
Trp Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"u 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 -SI SEPTIC
SYSTEM? .1
MANUFACTURED HOME
Width: 1L
Manufacturer:
ength: 70
(-) Iv.
Year: \C 1-7 Pit Set:
RELOCATION
Previous Address:
Proposed Use:
LI »0 E ) 1,1/41the 0,30410k6
-�sL Llai
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:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
nspector(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 inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check 0 Mastercard 0 VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
••••"*a...,
si�i;41lIr.mi
11707 E Sprague Ave Suite 106 ♦ Spokane Valley WA 99206
509.921.1000 • Fax: 509.921.1008 • cityhall@spokanevalley.org
Address:
,q1,0
Hatherly Circle, Spokane Valley, Washington.
This is acknowledgement of information received concerning the floodplain and
the installation of a manufactured home in the Hatherly Circle Manufactured
Home Subdivision.
Spokane Valley Municipal Code Article VI. Floodplain Hazard Areas allows the
installation of a manufactured home in an existing approved manufactured
home park or subdivision located within a floodplain by elevating the home 36"
above surrounding grade on reinforced concrete piers or the equivalent of
those piers.
This installation procedure does not provide the same level of safety from
floods in these areas as elevating the structure above the base flood elevation
of 2009 ft.
Signing this form indicates that the owner is aware of this condition and
recognizes that flood insurance, if desired by the property owner or
required by a lender, may be unavailable or extremely expensive.
Furthermore, the property owner recognizes that they are fully aware of
the base floodplain elevation and that this home is being installed below
that elevation.
By signing this form the property owner(s) acknowledge that the City has
supplied the owner(s) with the information concerning the flood hazard in
this location and the financial implications concerning floodplain insurance
when one does not raise the elevation of the structure above the base
floodplain elevation.
eIKI
Print Name
K)
PROPERTY OWNERS:
il
Signature
Date
Print Name
Signature Date
0
8
2
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
tines/dime ions, curb lines, structures and easements
have been identified. o ind d are wetlands,
bodies of ater, steep s p's o of r critical areas.
j;
Signed. .�„ n xc. 6e ft>
Date• 5 _D. - S
O
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