2000, 10-04 Permit App: 00009061 MHis .;-.
Project Number: 00009061 Inv: I AppllCation Date: 10/04/2000 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
Permit Use: SINGLE WIDE MOBILE HOME Contact:m ENNIS, JERRY D & DELORES J
Address: 17411 E 32ND AVE
C - S - Z: GREENACRES, WA 99016
Setbacks: Front 43 Left: 35 Right: 19 Rear: 44 Phone: (509) 924-0659
Group Name:
Site Information: Project Name:
Plat Key: 000146 Name: BARKER ROAD MOBILE HOMES 1ST ADD. District: G
Parcel Number: 55082.0814 Block: Lot:
SiteAddress: 19009 E MONTGOMERY D Owner: Name: ENNIS, JERRY D & DELORES
OTIS ORCHARDS, WA USA Address: 17411 E 32ND AVE
Location:: OTI GREENACRES, WA 99016
Zoning: UR -7 Urban Residential -7
Water District: Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Department Review
BUILDING Site Plan Review
Hold Reasons:
Permit Conditions:
BUILDING Plan Review
Hold Reasons:
Permit Conditions:
HEALTHDISTRICT Septic System R
Hold Reasons:
Permit Conditions:
PLANNING
Hold Reasons:
Permit Conditions:
Landuse/Zoning(y-C") Released By:
Permits: M. - V-'A�Awsm
c Ar
Project Number: 00009061 Inv: 1 Application Date: 10/04/2000 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Address: 0
000000, 00 000000
Item Description
INSPECTION FEE
COUNTYSURCHARGE
Manufactured Home —
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc Fee Amount
1 SECTIONS $50.00
1 Y OR BLANK $11.00
Permit Total Fees: $61.00
A"n,
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
SPOxAI�E COLITY 509-477-3675
Project Description:
TYPE OF APPLICATION
❑ Building Permit
❑ Change in Use
❑ Grading
Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change) 10
Other
SPECIFIC SITE INFORMATION
OWNER/APPLICANT INFORMATION
❑ Owner: Phone: qz -(— '(<' fir/
v��� '
Fax:
❑ Applicant: Phone:
Fax:
Mailing Address:
Mailing Address:
City, State, Zip `, I ^
q�
City, State, Zip
❑ Contractor Phone
Fax
❑ Architect/Engineer Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license N
Contact name:
PROTECT INFORMATION
,1+� eiK+,,.t.. �.. �'
What is the current property size?
(square feet or acres)
Width: /
(C
Length: _7 I
What is the square footage of the sign
face?
How high is the sign?
Year:
Make:
# of signs
Area of existing signs
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
the property Icxcatkd within iH)q feet of a Natural Restiur
Axea>es
Previous address
Fire Sprinkler
Paint booth Fire Alarm
Tent
Fireworks display
Proposed use
Value
Firm Name
Phone
Plans Examiner
Phone
Inspectors:
Address
Inspector
Phone
O Concrete O Welding O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? l3Tr Yes 0 No
If yes, identify on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
If yes, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
If yes, identify on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located 011 the property?
If yes, identify on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the
property?
If yes, identify on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
the ,,it, sn de tg akt d S.0.
r o�zr �l Areal
Yes D l,No
Is pukrh sever' air t E rrr rhe tte> e
h property inside flip
Yes
Q Yes -
, ID I [o
ID No
is public s a'atlable ra the skte? s , D, es ; l
r
a,
Ts the pr operty ixtsade the PSSA?
0Yes
D No ,;
the property Icxcatkd within iH)q feet of a Natural Restiur
Axea>es
Date Received:
Staff Representative:
METHOD OF PAYMENT
V/SA
0 CASH 0 CHECK 0 Ma. 0
0
:f09V1.
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
BANKCARD NUMBER:
EXPIRES:
AUTHORIZED SIGNATURE:
SUBTOTAL
'TOTAL IiEJ
MIMMVM PERM1TFEEIS $35 OoPLEASE
MAKE CiIECitSPAYABLE"TO SPOKANE
CO i5 TYPERMIT'CENCER'
144U�(�pW1�Vt�j �✓'1V�
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