2013, 09-17 Permit App: FAS-2013-0015 MHSpokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenterPspokanevalley.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
❑ OTHER
SITE ADDRESS: \ 3 111 .) _ \ Q L 1
ASSESSORS PARCEL NO.:,, 1---)D,_,;(.../ IJ%LEGAL DESCRIPTION:
BUILDING OWNER NAME: L E(1C)\.. 30<,, ‘
NAME: L e n cA OD, Q
ADDRESS 1S-`� ) Lol 3
CITY: ii ,T U1 t l 9 STATE:
PHONE: SC �— Cc' --1 %FAX: CELL:
CONTACT NAME: Le vac
PHONE:5(D q 1 r2 FAX: CELL:`
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ZIP: c \
!Project
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CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
`'7?013
OSV PE�PMIT CENTEf?
STATE: ZIP'
PHONE:
FAX: CELL:
HEIV
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
MANUFACTURED HOME WIDTH:
CL.
MANUFACTURED HOME LENGTH:
YEAR OF MANUFACTURED HOME: ()
PIT SET: SEPTIC/SEWER:
MANUFACTURER:
PREVIOUS ADDRESS: 11.10 Of\ t_)/J--SCk C_ -C---<A- 1 CY-1 e
PROPOSED USE: VAc-y,f
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitted and subsequently approved before this application can be processed.
Signature
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Pk("N , X.k ,i DateI) / )��
Updated 1-11-11
http://www.spokanevalley.org/filestorage/124/938/210/948/ 1496/Manufactured_Home_Permit_1-11-11.doc
Page 1 of 1
REINSPECTION FEE RECEIPT
Date
Transmittal No. Application No B 301
OWNER INSTALLER
Mailing
Address Phone
OWNER
Mailing
Address
INSTALLATION PERMIT RECEIPT
Transmittal No.
Pho
1.
Date
plication No B 3011
INSTALLER Jer.e.e/0---,t/
Phone Phone
Transmitt No
SPOKANE COUNTY HEALTH DISTRICT
W. 1115 Mallon 456-2340
Spokane, Washington 99201
Date –4/5/477 Application No B 3011
37, 7 APPLICATION TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES
-6 ti
, d..
i i (.. Mailing
OWNE , • - t 1/4;_,.„, Address
Phone Address/Legal
Description Cast- t83413
Type . : No. of
Of Use '1 14 ' (--•', i-,;' V.–).-4.2—. Bedrooms ...-- Basement? Yes (No; Sewer .. ,
Discharge? Yes ' No
OR Private Source
Water Supply: Public (Name)
Replacement? Yes No Fill Approval Date
Building Sewer Elev.
Ft. Below Finished Grade
-
Septic Tanli7<0 Length of - Drywell
Capacity 1 Gals. Dispersal Piping /.1-16, Ft Drywell? Yes ' Capacity Gals.
Other Flow/Day Gals.
Management
Systems? Yes No
REMARKS
No. Of No. Of
Acres Dwelling Units Mgt Name
Projec
521; tcOf3
APPLICANT:
477
RECEIVED
CSV PFRMITrPUTER
S Ll F3
, Mailing
APPLICATION BY )r- • /Address
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Application: Approval/Date
Expiration Date
Phone
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11
Project
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S.7? 2 7 2013
CSV PERMIT CENTER
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AEPLEWAY HOMES INC
11400 N. WARREN ST
HAYDEN, IIS 83835
(208) 772-3538
The Karsten McKenzie • 1600 Sq Ft • 3 Bedroom, Breakfast Nook, 2 Bath
,o 1
PLANNING DEPT. A
Karen Kendall
From: Copley, Don [DCopley@srhd.org]
Sent: Monday, October 14, 2013 10:40 AM
To: Karen Kendall
Subject: east 18316 Liberty
Hi Karen,
The Health District received a proposed plot plan for the above address showing a replacement of a single wide mobile
home with a double wide mobile home in-kind. The maximum number of bedrooms approved on Application B 3011
Dated 2/15/77 is for two bedroom . If the applicant wants to increase the sewage flow to three Bedrooms they will
need to contact a licensed designer or engineer and pay an application fee of 300.00 permit fee of 130.00 and test hole
fee of 180.00 min. The health district will approve the use a two bedroom home. If you have any questions please call
me at 324-1584.
Don Copley
Spokane Regional Health District
1101 W College Ave, Ste 402
Spokane, WA 99201
phone: 509-324-1584
www.SRHD.org
Always working for a safer and healthier community.
1