2005, 03-01 Permit App: 05000602 MHProject Number: 05000602 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/01/2005 Page- of 1
Project Information:
Permit Use: REPLACE MANUFACTURED HOME- 14 X 66
Setbacks: Front 5 Left: 4 Right: 4 Rear: 4
Site Information:
Contact: LOCKERT, RONALD AND LINDA
Address: 4211 S HATHERLY CIR
C - S - Z: SPOKANE VALLEY, WA 99206
Phone: (509) 928-8497
Group Name:
Project Name:
Plat Key: MH002 Name: HATHERLY TRAILER PARK
District: Sout
Parcel Number: 45334.0331
Block:
SiteAddress: 4211 S HATHERLY CIR
Location:: CSV
Zoning: UNKN Unknown
Water District:
Area: ;,565.00 Acres
Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Inform i; n:
Permits:
Lot:
Owner: Name: LOCKERT, RONALD AND LINDA
Address: 4211 S HATHERLY CIR
SPOKANE VALLEY, WA 99206
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Contractor: OWNER
Item Description
INSPECTION FEE
Manufactured , ' ome
Firm: OWNER
Phone:
Units Unit Desc
1 SECTIONS
Permit Total Fees:
Notes:
Payment Summary: zinetzantemearmanusnalmegussan
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $50.00 $50.00 $0.00 $50.00
(000) 000-0000
Fee Amount
$50.00
$50.00
$50.00 $50.00 $0.00 $50.00
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. i 0 \ r�,X
Signature:
Operator: DMD Printed By: DMD Print Date: 03/01/2005
4000Valley
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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
"I Street Address: g21l , H4 TJ Che" �¢
Assessor's Tax Parcel Number(s): / 533 y . 0 3.31
Legal Description:
14, PERMIT DESCRIPTION:
❑ Building Permit ❑ Change in Use 9 Grading 9 Manufactured Home
[] Relocation 9 Tenant Improvement 9 Fire Safety 9 Other
OWNER/APPLICANT INFORMATION
-i-❑ Owner: 10A/4-eZ ,4i jJ.b R- ,L'C'6,'27 ❑ Applicant:
Phone: 9, V -VW? ' Fax: Phone: Fax:
Address: y,c. S. ii-h/7,9-6,�� �r,� . Address:
SPPPA 4-4/ Hi 4- -3,'.9.7-t)
City State Zip Code City State Zip Code
9 Contractor: ❑ Architect:
Phone: Fax: Phone: Fax:
Address:
City
State
Zip Code
Address:
City -
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2111' FLOOR SQ. FTG:
UNFIN BASEMENT SO. 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: / 17/
Manufacturer:
Length: Go Co
Year: / % g Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
Paint. Booth:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
Q BOLTING 0 CONCRETE
Firm Name:
0 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 inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard).
0 Cash ❑ Check 0 Mastercard ❑ VISA 0 Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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