19992, 11-12 Permit App: 92010026 MHSPOKANE c OUN1Y bE.PA TMENT OF BUILDINGS
W. 1301 BRbADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER= 92010026
PENALTIES hi:i.f..I. BE G,
APPLICATION
I ra PERMIT • 'j6 tit * i+:
..';:i E D FOR ? i:'s'ii••ih:Ni: i '4; WORK WITHOUT (''( d:'['i r,i l
SITE SIREF' . •r it:; t•¢ MAYE•1E::W RD
PERMIT USE:= INSTALL
RLAT4= 00267
1{I...4'4-
11AREA= OF... t,i...,:::..
f.1u.'i'*I::h'::::
CLASS ;i MOBILE i'-iaMi::
PLAT NAME:,
1...1i'(':::
N.
RAY, BETTY jEAN
E' 1"j Fi i.4127)
SPOKANE WA 9921,4
.i.. ice•'. E:_ i`•t i lel i::.i is i i ORCHARDS
ZONE= 1..1E': 3,5 .II k 1'n: ..
1... WIDTH= DEPTH=
1.H::::
CONTACT
ifiC1rE: GARY i .-:i? :.WN- 1 NUMBER=
"?' y
BUILDING SETBACKS: FRONT( 1'":iqRIGHT=
/'•�)
)I ii • ') 4l) is •)+ i+i: '1•.• h.• inr * :* - :N: '14 ' j!• )r, w.a..+{. 'H R E , .1: E: 11.4I.,1'`•� i'I r' i r'- 1" 1 ION
i
DEPARTMENT
BUILDING
A ENGINEER
`
REVIEW C.:i:'ti `ii°MEN
SETBACK REVIEW REQUIRED
NEW COUNTY ii•J 1...i, :t1:::i('t 4 APPROACH
r rw OR ADDITIONAL. WASTE :. 4J :tll: R
»::,.. •» * :M• •1,: yi; jl• ;il• '1+.' :k w .}(..i .}i. \,.: * * 3l' :'i• tj. "j,l .jlf lA..jj..ij•. ilj P'1 t.: .l:( .1. i... 1::. HOME PE
CONTRACTOR::, OWNER
ITEM .1''E: i.,I ,F' 1.l.ii'4
--
INSPECTION FEE
1:
::::TATE SURCHARGE
COUNTY SURCHARGE
PERMIT TYPE
MOBILE HOME 1-' i"i T
WIDTH L. E G
FEE AMOUNT
122,0
PROCESSED BY1 LARSON
PRINTED f { ! . ., JOHN
L.l s.'� L.. r i S i::; i''J
AMOUNT FAT D
.
........................
56 HEIGHT=
10 6,00
AMOUNT OWING
i?• YP :N: Ni !!• N: Ca: ns,• ;+(• ;>f• * '1(• 9,i 'N: 'H.• 'P: ':'!i :++r 'Pt )r; i,; :i(- .},j ;ii. 4,r ;t• 'Ni :K• Yh i++r THANK ''r• f i U :+b di.* * :K..k * :i+t
Spokane County
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
IN�FOR`MATION WORKSHEET
PARCEL NUMBER: Y l 5ti 3\
STREET ADDRESS: \-\ cD %/k.)‘ \W--\\) 1 D
CITY/STATE/ZIP:
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
OF BUILDINGS:
# OF DWELLINGS: WATER DISTRICT:
OWNER: ,&) D
�� y � G� a ✓L �,� PHONE: ,S 9 - lZJ - Z7L �?
MAILING ADDRESS: t ox /'/ / 2 7/
CITY/STATE/ZIP: S 1oc)( 4 el 9 9 Z f Z' 7/
CONTACT: l\),
PHONE: S - % Z% - 2 7 2_7
SETBACKS: - FRONT: 30/ LEFT : / o / RIGHT: 211/ REAR: y
PERMIT USE: /q/oh,'
******************************************************************************
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
PHONE:
ARCHITECT/ENGINEER: PHONE:
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
PLEASE PROVIDE THE FOLLOWING INFORMATION FOR ENERGY CODE COMPLIANCE:
SPACE HEATING TYPE (Check One)
FORCED AIR ELECTRIC ELECTRIC BASEBOARD OR WALL MOUNT
FORCED AIR GAS HEAT PUMP
PROPANE OTHER:
FLAT CEILINGS R DOORS U
VAULTED CEILINGS R WINDOWS U
ABOVE GRADE WALLS R GLAZING AREA %
BELOW GRADE WALLS , R TOTAL FLOOR AREA OF HEATED SPACE:
FLOOR R
SLAB ON GRADE R FURNACE EFFICIENCY RATING
PLEASE INDICATE ON YOUR PLANS:
The location of the radon vent, and the location of the vent fan area.
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SQUARE FOOTAGE:
MAIN FLOOR
SECOND FLOOR
BASEMENT - FINISHED
UNFINISHED
GARAGE
CARPORT
DECKS
ADDITIONAL AREAS:
******************************************************************************
LENDER/BOND HOLDER:
ADDRESS
CONTACT PHONE
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11114 1‘171'.1 ;J Ai' >111.
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