2000, 03-14 Permit App: 00001594 Relocate MHProject Number: 00001594 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/14/20 Page 1 of 2
PPOIeCt Information: 3 r "
`"aa; �,3. ..=,,a�,. .APP,.PraPh� SSI :� �a�.. ,P x ,.. ,�,T*
Permit Use: RELOCATE SINGLE WIDE MANUFACTURED Contact: COURCHAINE, GEO
HOME (REPLACEMENT) Address: 217 N FLORA RD
Setbacks: Front 70+ Left: 5 Right: 14 Rear: 40+ C - S - Z GREENACRES, WA 99016-93
Phone: (509) 927-9049
Site Information:
Plat Key: 002265 Name: RIVERVIEW MOBILE HOME SU District: G
Parcel Number: 55071.0408
SiteAddress: 2926 N RIVISTA DR
OTIS ORCHARDS, WA USA
Location:: OTI
Owner: Name: COURCHAINE, GEO
Address: 217 N FLORA RD
GREENACRES, WA 99016-9393
Zoning: UR -7 Urban Residential -7
Water District: 008 CONSOLIDATED IRRG #1
Hold: ❑
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Department
BUILDING
BUILDING
tVPMVMELVMKWZSAIEZtWgaiZEttlWAVZMgiWNTMKtW
Comments:
Review
Site Plan Review
Plan Review
omments: e_
4.14
RICT 1 Sep is ys eml�ewe
BUILDING
Permits:
Comments:
Comments:
Special Reviews
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Contractor: OWNER
Address: 0
000000, 00 000000
Manufactured Home
Firm: OWNER
Phone: (000) 000-0000
Item Description Units Unit Desc
INSPECTION FEE 1 SECTIONS
COUNTY SURCHARGE 1 Y OR BLANK
Fee Amount
$50.00
$11.00
Permit Total Fees: $61.00
Project Number: 00001594 Inv: 1
Application
THIS IS NOT A PERMIT
(r Penalties will be assessed for commencing work without a permit
Payment Summary as. �n MIL x "_ ra _ -xWeat% V,-,1000-w.-SPMAYZOINWeNMEM,-
Operator. JAS
Date: 03/14/20 Page 2 of 2
Permit Type
Manufactured Home
Notes P a = ,... :ry.m xi.: .,••
Printed By: JAS
Fee Amount
$61.00
$61.00
Print Date:
Invoice Amount
$61.00
$61.00
03/14/2000
Amount Paid
$0.00
L & I SAFETY INSPECTION SHALL BE CONDUCTED AND CORRECTIONS MADE, IF
ANY, PRIOR TO OCCUPANCY
Amount Owing
$61.00
$0.00 $61.00
PROJECT APPLICATION
SPOKANE COUNTY DIVISION OF�WAY AVENUCODE ENFORCEMENT
1026 WEST BRO
E
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
y
Project Description:
0 Building Permit
0 Timber Harvest
O Other
0 Owner:
It �
Mailing Ad ss:
City, State, Zip
0 Contact:
Mailing Address:
City, State, Zip
/ r/
TYPE OF APPLICATION
0 Grading
elocation
0 Manufactured Home Permit
0 Change in Use
OWNER/APPLICANT INFORMATION
Phone: 4' Z % —gam y
-KJ) Fax:
J
Phone:
Fax:
0 Applicant:
Mailing Address:
City, State, Zip
bra
Phone: 9 2 % —.9 o y
Fax:
i
El Indicate who should be contacted regarding this project
ee`644.ed-7-t-Q
ADDITIONAL INFORMATION
es O No
Are there structures on the property? P"
I es, identi on site Ilan
Is any part of the property within 250 feet of a shor line)
'
I es, identi� on site � Ian Yes o
Is your property in a designated wildlife habit habitat o
0 Don't know
Is any part of the property within a 100 yr flood plain?
If yes, identify on site plan Yes n0 Ma be 0 Don't know
Are there any wetlands, streams or ponds within 200 feet of the
1
0
property? p Yes 1.
I es, identi on site ,Ian
Are there slopes greater than 30% on the prropee y? (30 fto e in 100 ft)
%
0
What is the current property size?
s uare feet or acres
What is the current use of this property?
/41 .G J c /22
Will the site be served by a septic system?
Yes
r'r:... s
Are or will there be wells located on the property? es
If yes, identify on the site plan
Is there evidence of fill or excavation on the 0petroperty? T T
Yes
Are critical or hazardous materials used or stored on site.
0 Yes 6.-1>I
J
Project Number:
FOR STAFF USE ONLY
Is the property in a designated StormwateraControl
Yes e ?No
Is the property inside the ASA?
Is the property inside the PSSA?
Yes O No
O Yes O No
Yes O No
Is public sewer available to the site? 0 Yes ' No
School District: \/
•
Date Received:
Water District_ Yom
Is the property inside a Joint Planning Area? Yes 0 No
What jurisdiction? tA.j2 %` i'I
Is public water available to the site?
Yes O No
Is the property located within 1000 feet of a ONatural ` Noce
Area?
Yes
What is the zoning for the property?
W
Fire District:
-ice 1
Sewer District/Purveyor:
PROJECT APPLICATION -
Detail Information
SPOKANE COUNTY DIVISION OF BUILDING VENUE
ENFORCEMENT
1026 WEST BROADWAY
SPOKANE, WA 99260
509-477-3675
Project Number:
Contractor
Contractor
Architect / Engineer
Mailing address
Phone
City, State Zip
City, State Zip
Contact name:
`3/A State Contractor license #
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"d floor sq. ft.
Finished basement sq. ft.
Occupancy group
Cost of project
Construction type
Garage sq. ft.
Deck sq. ft.
Manufactured Home
Width:
/-
Length:
Sign
What is the square footage of the sign
face?
# of signs
How high is the sign?
Area of existing signs
Fire Sprinkler
Tent
Paint booth _ Fire Alarm
Fireworks display
Value
Firm Name
Inspectors:
0 Concrete 0 Welding, 0 Bolting 0 Reinforcement
Plans Examiner
Address
Inspector
Address
Phone
Phone
S 6
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Department of Labor & Industries
Fac`bled Structures Section
INSTRUCTIONS:
1. Complete all spaces, Including the signature box (marked with an X).
2. Draw a map on reverse side of WHITE copy only. ^
3. Forward completed permit and fees to the nearest L&I office Jea Blit onpreverse.
4. Contact and schedule the inspection with the same L&I offt thin 15 days.
`ALTERATION PERMIT
Do not complete shaded areas
Owner last name
first name Day time phone
r
Date
Address City
/
Installer/Contractor/Dealer
Phone
( )
Address
State ZIP
Contractor's registration number
City State ZIP+4
Check the appropriate boxes in section A and section B. FEES
A
rj
Commercial Coach B ❑ Iteration Inspection (check appropriate boxes below) $
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — -
Plan Review
RV Inspection
Reinspection
Technical Inspection
Note: This permit expires one year after date of purchase. (Non-refundable)
?Signature of applicant or authorized representative 1 Make check payable to: Dept. of Labor & d tries
.. ,1-': f , FEES DUE $ , 5'_
Mobile Home
Recreational Vehicle or ❑ Park Trailer
Serial hi0;>;
Model No'i : Plan'Approval No
Department use onlp
❑ Request approved or �`�'yRequest denied because oP specific violations'of Washington rules and regulations Violations must
t.r.l <
be;corrected and' reinspection requested within 10 days for recreational vehlcles and 20 days for mobile houses add commercial coaches
oP
*he notice of violation date. (1'Itis does not apply to :technical Inspections) It is unlawful' to offer Por sale, rent, or tease any
non -complying mobile home, commercial coach or recreational vehicle.
ALTERATION PERMIT
CALL 324-2568 FOR INSPECTION
PLS GIVE PERMIT NUMBER
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} } 1 h l 1.Y 4 1 1 .1 I Y } 1;�1 ! ♦ 'l.1 f 1: 1 Y:f
included are fo ms required which must be completed and fees submitted before reinspection
Date Area office Inspector Total pages
F622-012-000 alteration permit
10.96 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser