2001, 05-15 Permit App: 01003621 MHProject Number: 01003621 Inv: 7
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/15/01 Page 1 of 2
Project Information:
Permit Use: RELOCATE DOUBLE WIDE MANUFACTURED Contact: KIRK DOWNING
HOME (REPLACEMENT) Address: 14525 N NEWPORT HWY
C - S - Z: MEAD WA 99021
Setbacks: Front 25 Left: Right: 6 Rear: 85 Phone: (509) 468-1450
Group Name:
Site Information: Project Name:
Plat Key: 000146 Name: BARKER ROAD MOBILE HOMES 1ST ADD. District: G
Parcel Number: 55082.0919
Block: 8 Lot: 19
SiteAddress: 18810 E JACKSON DR
OTIS ORCHARDS, WA USA 990
Location:: OTI
Zoning: UR -7
Water District:
Urban Residential -7
Owner: Name: BRADIER, WILLIS & RUTH
Address: 23815 E TRENT AVE
NEWMAN LAKE, WA 99025
Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 2 Nbr of Dwellings: 1
Review Information:
Department
BUILDING
Hold Reasons:
Permit Conditions:
BUILDING
Hold Reasons:
Permit Conditions:
Review
Site Plan Review
Released -By: --
Plan Review'
HEALTHDISTRICT Septic System Review
Released By:
Released By:
Hold Reasons.
Sewage -system -designed
Permit Conditions: Gq. bedrooms only 7IGiJ_t.C.
BUILDING
Hold Reasons:
Permit Conditions:
Peratits •
Special Reviews
K4J
Released By: / 3' s
Project Number: 01003621 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/15/01 Page 2 of 2
Manufactured Hoare
Contractor: HOMEBOYS Firm: HOMEBOYS
Address: 14525 N NEWPORT HWY Phone: (509) 468-1750
MEAD, WA 99021
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Payment Summary:
Units Unit Desc
2 SECTIONS
1 Y OR BLANK
Fee Amount
$100.00
$22.00
Permit Total Fees: $122.00
Operator: JAS Printed By: JAS Print Dale: 5/15/01
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $122.00 $122.00 $0.00 $122,00
$122.00 $122.00
$0.00 $122.00
Notes• , -
I�I
9
SPOKANE Cowry
PROJECT APPLICATION WORK SHEET,'r
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WESTBROADWAY,AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC S TE INFORMATION
Street Address: /88 � D .6. C 1q'Ces0 d
Assessor's Tax Parcel Number(s): 3bSZ • Q 9 i9
Legal Description:
Ao,46 l -os. t E #.wse `&-r I LI9 , .B g
Project Description: {'LA-C9*r-S- /a-s-7-Gl PeoVc.4
O Building Permit
O Change in Use
O Grading
O Relocation
O Sign
KOManufactured Home Permit
O Tenant (New/Change) ther
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OWNER/APPLICANT INFORMATION
El Indicate who should be contaetpd reeardin2 thist, oiect
0 Owner - 'S PhoneX4pp�i
W,iu4 0 RtJn� 6eA,u44 An -32?-)1-—sC
am: \\',V�.'
r At ri bc,JNl,J6,
Phone t3'' Al
Fax: 1462- -S7
Mailing Address u
a3e1s "'a-nets/4,
Unfinished basement sq. h.
Mailing Address-
2"d floor sq ft
Citys S'1ate, Zip � 99O2
tki
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Ciry, Stare, Zip
/'
Deck sq. ft.
0 ',,CCGrytat�t-ra`yctor Phone
HOltiece,le VFax
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❑ Architect/Engineer
a.'
Phone
Fax
A y. �ad ltd. ' P a it
'mar
Mailing address
City, State•44 99O
r
City, SLUG Zip
WA State0utrat Tor license #
o s<4 e • . 6 3 -3 -Pc
Contact name:
PRO IECT INFORMATION
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Building height to peak
a of stories
Alain floor sq. h-
Unfinished basement sq. h.
Dimensions
Total habitable spare
2"d floor sq ft
Finished basement sq ft
Ocrupamy group
Const 111011011 q'pc'
Garage sq ft
Deck sq. ft.
Cost of project
bleat source (electric, gas, etc.)
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Width: .26 ,....8 �1
Length:
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Wat is the square footage of the sign
How high is the sign?
�/face?
Year: ( 9 9 /
Make: /
: S _
# of signs
Area of existing signs
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t ' ;,
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\ Tent
'7 + "Paint booths • '-Fire AIirm
Welloca 'ions
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Plans Examiner
Previous address,
Inspectors.
: S _
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\ Tent
'7 + "Paint booths • '-Fire AIirm
Fireworks display
Phone
0 Concrete
0 Welding
Proposed use
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Value} '- • f • w;..' a.
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Firm Name
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Phone
ri
Is }rote pcoperiyina designated wildlife habitat ar a?
' "b Don't know , O Yes . o
Plans Examiner
Phone
Inspectors.
: S _
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Are there any wetlands, streams or ponds within 200 feet of the
property?��//
identify on site plan 0 Yes ,IY.No
Address
Is there evidence of fill;oi excavation on the propert>
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Are there slopes greater than 30% on the property? (30 ft rise in 100 h)
�/ %) O Yes L to
Are'critical'or hazardous materials used or stored on si ?z ," ‘,,,i ,2,
r"'' • ' ' a �� �' 0 Yes•` No
Inspector
Phone
0 Concrete
0 Welding
0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? $.Yes 0 No
If yes, ideily non site plan
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What is the current property siz .
(square feet or acres 3 8 co '
Is any part of the property within 250 feet of a shoreline?
If yes, identi%y on site plan 0 Yes I NNo
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What is the current use of this property? Ie.�sl o�,.(t., j'�'(.—.
Is }rote pcoperiyina designated wildlife habitat ar a?
' "b Don't know , O Yes . o
'� .
\ ,'
Will the site be served by a septic system?XYes 0 No
t, -
Is'aui•part;of the property within a4100 yr flo'od'plain?1• ..
Ifyis, idenify on site plan)�//
O Maybe O Don't know O Yes l21s•No
: S _
Are of •ivifftlidie be wells locaredton"ihetprope'rty?-` ' ': •' ''."..-3.4
If yes, identify on the site plan 0 Yes _.�No
= ".'•="-•+,'S:�.,
Are there any wetlands, streams or ponds within 200 feet of the
property?��//
identify on site plan 0 Yes ,IY.No
Is there evidence of fill;oi excavation on the propert>
..;:; \\ ..:in :Ya,No—✓r..••�y -1-.Ifyes,
Are there slopes greater than 30% on the property? (30 ft rise in 100 h)
�/ %) O Yes L to
Are'critical'or hazardous materials used or stored on si ?z ," ‘,,,i ,2,
r"'' • ' ' a �� �' 0 Yes•` No
DEPARTMENT USE ONLY
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Date Received
Staff Representative:
AIETI !OD OF PAYMENT
VISA
9 CASH ❑ CHECK ❑mum 9 tom'` .' ❑
FAXED PERMITS WILL ONLY BE ACEPTED W ITT I PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES.
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DIICCIVER
SUBTOTAI.
:'%::oi,• _ - - OTAE FF.F.''
u'gl;'.. i.:', �,.','; �-'••,,.:°`,:'p=;<.GY£?.3t.;®°.'.
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IIN1MUM PERMITTEE i5535oOPIEASE'';K
if.); AKE CI{ECRS PAYABI•E To SYOILA 4E ‘T:e;r,.'
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Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete all spaces, including the sigqature box (marked with an X).
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fees to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.
ALTERATION PERMIT
Do not complete shaded areas
Permit #
1395?P
Invoice #
Insignia #
Owner last name
i 1!
t r� r
Address
Installer/Contractor/Dealer
••\;,'
Address
first name Day time phone 1 Date
•
1...
..i.i . i i .' (=(d ci
Phone
(I-1 Jt -t,1�,
City
State ZIP
Contractor's registration number
State ZIP+4
Check the appropriate boxes in section `•A and section B.
FEES
A
Commercial Coach B ❑ Alteration Inspection (check appropriate boxes below) $
Air Conditioning/Heat PumpElectrical �c
Electrical Appliances l( 0? V.
& 1tiU`1S�R
PP ce Itis ISR �',J\
Fire Safety
J 6
Serial Ntp oy'‘13\6-,
Serial No.
Mobile Home
Serial No.
HUD No.
Recreational Vehicle or [J Park Trailer
Serial No.
Model No. or Plan Approval No.
Gas Furnace
Gas Piping
Plumbing
'Structural
Wood/Pellet Stove
Plan Review
RV Inspection
Reinspection
Technical Inspection
Original Permit
No.
Note: This permit expires one year after date of purchase. (Non-refundable)
Signature of applicant or authorized representative
•
Make check payable to: Dept. of Labor & Industries
FEES DUE $
Department use only
Request approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent, or lease any
non -complying mobile home, commercial coach or recreational vehicle.
CALL 324-2640 FOR AN INSPECTION
PLEASE LEAVE NAME &
ALTERATION PERMIT NUMBER
jincluded are forms required which must be completed and fees submitted before reinspection.
CDate Area office Inspector XTotal pages
F622-012-000 alteration permit 8-99 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser J
7q
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