2005, 06-10 Permit App: 05001987 MH Project Number: 05001987 Inv: 1 Application Date: 06/10/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: DOUBLE WIDE MANUFACTURED HOME Contact: MIKE HURRY
PLACEMENT Address: 34292 HWY 41
C-S-Z: OLDTOWN,ID 83822
Setbacks: Front 25 Left: 54 Right: 50 Rear: 40 Phone: (208)660-5344
Group Name:
Site Information: Project Name:
...x a..,= ate .,.,.::F .;J, v
Plat Key: Name: VALLEY MEADOWS SUB District: Nort
Parcel Number: 45162.2203 Block: Lot:
SiteAddress: 11204 E DEAN AVE Owner:Name: DIONNE LIVING TRUST,THEOD
Address: 916 N WOODWARD RD
Location::CSV SPOKANE VALLEY,WA 99206
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 2,915 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
eNt
Site Plan Review Released By: t 1t
Plan Review ,
Released By: e » r'
c'\/ )0
Sewer Review -Released By: ('3 • —
Permits:
Manufactured Home
Contractor: ALL SEASON CONSTRUCTION Firm: ALL SEASON CONSTRUCTION
Address: 34292 HWY 41 Phone: (208)437-3837
OLD TOWN,ID 83822
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: 06/10/2005
Project Number: 05001987 Inv: 1 Application Date: 06/10/2005 Page 2 of 2
•
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
Payment Summary: y.;. EM,. ... :-M ,..... , VrM
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 $100.00
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 06/10/2005
`1- BUILDING PERMIT APPLICATION WORKSHEET
Can' - City of Spokane Valley Community Development Department
0 ai �.Cl�e� ��� Building Division
11707 E. Sprague Avenue, Suite 106
4(a-c-c--44-ta-d--- ���� Spokane Valley, WA 99206
40,0ValleyxPhone; (509) 688-0036• Fax: 509 688-0D
( ) 37
REQUIRED SITE INFORMATION
Street Address: �� D-P ' `-1
Assessor's Tax Parcel Number(s): ' ) / h j %, 7 %-2- (0 -s
Legal Description:
PERMIT DESCRIPTION:
11 Building Permit (-1 Change in Use ❑ Grading -E Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
U Owner: T- L> D,ONW& ❑ Applicant:
Phone: ; '.14 cis/v Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
n Contractor: A$ke ? W'if 416e Vv ) ❑ Architect:
Phone: . f ‘-'7137 Fax`30 42 ±f Phone: Fax:
Address: 3 �,q L ti
`t {-twy 41 Address:
CV tcdtca`✓A, -.=:i. <3r)--2--
City State Zip Code City State Zip Code
WA State Contractor License #:d/feud vb if Q Contact:
✓VH 4./.] ,i2. r
Spokane Valley Bus. Liscense #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
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: z 6 r Length: 4/ y Year: Pit Set:
Manufacturer: M Ar e. -fit,
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address: _
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
[ I BOLTING I J CONCRETE I I REINFORCEMENT I I WELDING
Firm Name: Phone: Fax:
Inspector(s):
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 /Ili K Q., ,h'L" '),l Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
I Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: