2014, 04-17 Permit App: BLD-2014-0806 Mechanical FixturesCommunity Development Project #
cm or Permit Center
Spokane 11703 E Sprague Ave, Suite B-3 RECEIVED
Spokane Valley, WA 99206
Valley PHONE: (509) 720-5240
FAX: (509) 688-0037 APR 1 7 20'
PERMIT FEE:
Mechanical Permit Application ❑ Commercial Residential
SITE ADDRESS: 24 U JG I�
Building Owner
Name:
Address:(
Contractor
1
Phone: Fax:
State: Zip:
C'ty0llk
Name: C
Address: �"ly
�Phne:`'� fro _,?z UFax:
G I State k4 Zip: 2
License No: - C p CFM_3
Contact/Project Manager:
City usiness Lic:
Name:
Phone:
# UNITS
FURNACES & SUSPENDED HEATERS -INSTALLATION OR RELOCATION
U to & including 100,000 BTU
FURNACES & SUSPENDED HEATERS -INSTALLATION OR RELOCATION
Over 100,000 BTU
DUCT WORK SYSTEM
HEAT PUMP/AIR CONDITIONER
0-3 TON
AIR CONDITIONER
Over 3-15 TON
AIR CONDITIONER
Over 15-30 TON
AIR CONDITIONER
Over 30-50 TON
AIR CONDITIONER
Over 50 TON
GAS WATER HEATER
GAS PIPING SYSTEM each outlet
GAS LOG, FIREPLACE, & GAS INSERT
APPLIANCE VENTS INSTALLATION, RELOCATION, REPLACEMENT
REPAIRS OR ADDITIONS
BOILER, COMPRESSORS, ABSORPTIONS SYSTEM
0 to 3 hp -100,000 BTU or less
BOILER, COMPRESSORS, ABSORPTIONS SYSTEM
Over 3 - 15 h —100,001 to 500,000 BTU
BOILER, COMPRESSORS, ABSORPTIONS SYSTEM
Over 15 — 30 h - 500,001 to 1,000,000 BTU
BOILER, COMPRESSORS, ABSORPTIONS SYSTEM
Over 30 h —1,000,001 to 1,750,000 BTU
BOILER, COMPRESSORS, ABSORPTIONS SYSTEM
Over 50 h — over 1,750,000 BTU
AIR HANDLER DOES NOT include ducting)
Each unit up to 10,000 cfm, including ducts
AIR HANDLER DOES NOT include ducting)
Each unit over 10,000 cfm
EVAPORATIVE COOLERS other thanportables)
VENTILATION AND EXHAUST
Each fan connected to a singe duct
VENTILATION AND EXHAUST
Each ventilations stem
VENTILATION AND EXHAUST
Each hood served by mechanical exhaust
INCINERATORS
Installation or relocation of residential
INCINERATORS
Installation or relocation of commercial
APPLIANCES
Range, Clothes Dryer
UNLISTED APPLIANCES
Under 400,000 BTU
UNLISTED APPLIANCES
Over 400,000 BTU
HOOD
Tvnpl
HOOD
Type II
L P STORAGE TANK
WOOD OR PELLET STOVE INSERT
WOOD STOVE SYSTEM — FREE STANDING
Signature
CURRENT FEES AVAILABLE AT: http://www.spokanevalley-org Quick link to forms, then Master Fee Schedule
n USU- CLOSING rG SERI CES
708 North Argonne Rd, Ste 11
Spokane Valley, WA 99212
"�arDi`��
ElTATrOrWA'3HINCJC7 )NT MANUFACTURED HOME
L47 '
. XTITLE ELIMINATION
IkEnSinG APPLICATION OTRANSFER IN LOCATION
OREMOVAL FROM REAL PROPERTY
Anyone who knowingly makes a false statement of a material fact is guilty
of a felony, and upon conviction may be punished by a fine, imprisonment, or both. (RCW 46.12.210)
MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
MAKE
LENGTH/WIDTH(FEET)
VEHICLE IDENTIFICATION NUMBER (VIN)
%48707
1981
BUDDY
160 X 28
04980543ABP
LAND LEGAL DESCRIPTION ON PAGE -2
MANUFACTURED HOME WILL BE (J AFFIXED F -I REMOVED
REAL PROPERTY TAX PARCEL NUMBER
55082.1404
LOT
BLOCK
PLAT NAME OR SECTION/TOWNSHIP/RANGE
QUARTER/QUARTER SECTION
4
1
COACH -LITE ESTATES
EF GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
NUMBER OF LEGAL OWNERS
Spokane
1
1
NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
Gary L. Catlett
NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
2910 North Joel Road Spokane Valley WA 99027
NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Wells Fargo Bank, NA
NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
ADDRESS CITY STATE ZIP CODE
1 Home Campus Des Moines IA 50328
GRANTEE
NAME
Gary L. Catlett
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IF APPLICABLE
Signature of Additional Registered Owner and Title, IF APPLICABLE
P NOTARIZATION/CERTIFICATION FOR REGISTERED OWNERS) SIGNATURE
State of Washington Signed or attested
County of 0L before me onby
L
7�,
Signatu
PRINT NAME O GISTERED OWNER N ARY OR AGE
Co
I PRINT NAME OF REGISTERED OWNER PP1Yt TED NAME OF NOTARY
County/Office No. ORI
4
Title i
AND: Dealer No. OR DEALERSHIP POSITION/AG4--T/NOTARY Notary Expiration Date
IME-MMPA-MCERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME (TYPED OR PRINTED) TITLE COMPANY J PHONE NUMBER
SIGNATURE / POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
I Certify that: 0 the manufactured home has been affixed to the real property as described.
El a building permit has been issued for this purpose and the attachment will be inspected upon completion.
(TYPED OR PRINTEDZ BLDG PERMIT OFFICE/PHONE #
BLDG PERMIT #
r C- '-'' C -
/t LI��A� t'�
LNAME
SIGNATURE / PO ITI°/� DATE
TD -420-729 MANPF HOME APPL (R/2/OfOR (W)Page 1 of 2