2002, 09-10 Permit App: 02007811 MHProject Number: 02007811 Inv: I Application Date: 9/10/2002 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 MANUFACTURED HOME
Contact: DAILEY, GAYLE
REPLACEMENT
Address: 2603 N EASTERN #1
C - S - Z: SPOKANE, WA 99207
Setbacks: Front 25 Left: 20+ Right: 10 Rear: 30
Phone: (509) 000-0000
Group Name:
Site Information: :..................:::.::.:::::.::::::::::::::::::::::::::::::::::::::::::::::::::::::.::::::..:::::................
Project Name:
Plat Key: 000146 Name: BARKER ROAD MOBILE HOMES 1ST ADD District: G
Parcel Number: 55082.0817 Block:
Lot:
SiteAddress: 19021 E MONTGOMERY DR
Owner: Name: DAILEY, GAYLE
OTIS ORCHARDS, WA 99027
Address: 2603 N EASTERN #1
Location:: OTI
SPOKANE, WA 99207
Zoning: UR -7 Urban Residential -7
Water District:
Hold: ❑
Area: 0 Sq Ft Width: 70
Depth: 120 Right Of Way (ft): 60
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Riew Information: mations :.
r
_....._......_ _._.
Review
Site Plan Review
L
Permits:
Operator: RMB Printed By: RMB Print Date: 9/10/2002
Project Number: 02007811 Inv: I Application Date: 9/10/2002 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Item Description
INSPECTION FEE
COUNTYSURCHARGE
Manufactured Home —
Firm: OWNER
Phone:
Units Unit Desc Fee Amount
1 SECTIONS $50.00
1 Y OR BLANK $11.00
Permit Total Fees: $61.00
Notes._ _.
Payment Summa
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $61.00 $61.00 $0.00 $61.00
$61.00 $61.00 $0.00 $61.00
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: RMB Printed By: RMB Print Date: 9/10/2002
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 NVEST BROAD\X� -kY .AVENUE
A— Uk
SPO K509-47ANE7W-3, 675 A 99260
SPEUIFIC SITE INPUKNILA I IUIN
Street Address:/ 11�.
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description:
0 Bading Permit 0 Change in Use C3 Grading C3 -Manufactured Home Permit
C3 Relocation 0 Sign C3 Tenant (New/Change) ri Other
Department Use Only
Water District/Purveyor:
Sewer District/Purveyor
Road width.:'
Setbacks
Mailing Address:
Total habitable space
21,11 floor sq. ft.
Front: Rear.
School District:
Fire District:
Zoning
Deck sq. ft.
Cost of project
❑Contrictor— phone
1,e ft: Right:
I
OWNER/APPLICANT INFORMATION
Phone:
❑ Applicant Phone:
# of stories
I Is:
Mailing Add....
Mailing Address:
Total habitable space
21,11 floor sq. ft.
Finished basement sq. ft.
OCCUPMIC" group
Cit", Stats, /,I,
City, State, Zip
Deck sq. ft.
Cost of project
❑Contrictor— phone
Archnect/Fngim- Phone
Fax
I ax
Nlmhng address
Mailing address
CTIA, Stitc Zip
OtY, State Zip
VC A StItc Contractor 11c(Tise IT
Contact name:
PROIFCT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished bascnitnt sq. R.
Dimensions
Total habitable space
21,11 floor sq. ft.
Finished basement sq. ft.
OCCUPMIC" group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
I Icat source (electric, gas, etc.)
Manufactured Home
Width:
Length:
What is the square footage of the sign
face?
I low high is the sign?
Year:
i%lakc:
# of signs
Arca of existing sifms
O Concrete 0 Welding O Bolting O Reinforcement
Address
O Don't know O Yes O No
Is the property located within 1000 feet of a Natural Resource Area?
Relocation
Fire Safety
Precious address
Dire Sprinkler "fent
Paint booth Fire Alarm Fireworks display _
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name ]'hone
Plans ISsaminer Phonc
Inspectors:
Address
I es, ideutift on site plan O Yes O No
Inspector Phone
O Concrete 0 Welding O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes O No
XVhat is the current property size?
I Des, ideuti , on site plan
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
XX/hat is the current use of this property?
I es, ideutift on site plan O Yes O No
0 No
Is your property in a designated wildlife habitat arca?
V ill the site be served by a septic system? O Yes O No
O Don't know O Yes O No
Is the property located within 1000 feet of a Natural Resource Area?
Is any part of the property within a 100 yr flood plain?
,Arc or will there be wells located on the propem?
If yes, identifi, on site plan
Ifjes, ident�b, on the .rite plan 0 Yes 0 No
0 Dlavbc 0 Don't know 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the properry?
Is there evidence of fill or excavation on the property?
Des, idenli , on .rite lan 0 Yes 0 No
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
.Are critical or hazardous materials used or stored on site?
O Yes 0 No
0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
0 Yes
0 No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Yes
0 No
Is public water available to the site? 0 Yes 0 No
0 Yes
0 No
COUNT1 PER11ITCENITA
Is the property inside the PSSA? 0 Yes
0 No
Is the property located within 1000 feet of a Natural Resource Area?
O Yes 0 No
Uate Recciced: Staff Representative
METHOD OF PAYMENT
❑ CAslI ❑ CIwCK ❑ ❑ C ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
BANKCV2D NU\1BI`R:
%U1'I I()RIXI?1) SI GN.NTURI-::
I?XNIZI{S:
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS $35.040 P1,P.:1SE
MAKE. CI IP;CKS PAYABLE TO SPOKANE
COUNT1 PER11ITCENITA
Fasf 6-¢ 3, �'� 25.40'
a- - - --- - - - 9lose
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ADDRESS: E t 0 a !�'� o N i UCm
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ROAD WIDTH: a
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Department of Labor & Industries MANUFACTURED/MOBILE HOME
Factory Assembled Structures Section ALTERATION PERMIT
4
Serial Number(s) : HUD Number(s)
Place fee amount in proper box Place fee amount in proper box
Mechanical
Heat Pump Electrical
Air Conditioning Heat pump
Furnace Installation (gas or electric) Air Conditioner
Gas PipingSerial No. Furnace Installation (gas or electric)
Wood Stove ---- Wood Stove (if applicable)
Pellet Stove ---- Serial No. Pellet Stove (if applicable)
Gas Room Heater Gas Room Heater
Gas Decorative Appliance Gas Decorative Appliance (if applicable)
hanging
gas
Gaange: changing s Water Heaterfrom electric replacementto gas Range:
l cgriccWater Heater treplan el '_0
&\NO�S�('��ES
Water Heater: changing from electric to gas Electric Water Heater replacater Heater
Plumbing Each added or modified ,�,l O1
Fire sprinkler system (also requires a plan review) Hot Tub or Spa Wo`m ho ieV&tzI panel)
Each added fixture Replace main el=al paneaT
Replacement of water piping system Low Voltage Fire/Intrusion Alarm
Structural Fire Safety
7_71111Inspection as part of a mechanical installation �Q®�
(cut truss/floor joist, sheet rocking) Miscellaneous
Reroofs (may require a plan review) Plan review
Changes to home when additions bear loads on home
per Reinspection - - - - Original Permit the design of a professional (also requires a plan review) Insignia No.
Other structural changes (may require a plan review)
Fire Safety
Note: This permit expires one year after date ofpurchase. (Non-refundable) CALL 324-2640 FOR INSPECTION
Work is completed at this time. An inspection is requested. PLEASE LEAVE NAME &
Work is NOT completed at this time, I will call when ready. ALTERATION PERMIT NUMBER
Make check payable to: Dept. of Labor & Industries
CZS_ignaiu-_re�of,'apb1icant or a thorized representative
1
FEES DUE
way result het penalties per Gblapter 43.9 Re € fota olrl<s steel are own onl alrr< "AI#e>rationlFactory Permit
Cflutinuation Form".
�oxs xtt'y e .n x c;E s wt�Total pages
�„
F622-036-000 mfgd/mobile home alteration permit 7-02 White -Olympia Canary -Inspector reen-Contractor Pink -Purchaser Goldenrod -Purchaser