2002, 04-18 Permit App: 02002719 Relocate MHProject Number: 02002719 Inv: 1
•
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 4/18/2002 Page 1 of 2
Project Information:
.......................... .
Permit Use: RELOCATION OF DOUBLE WIDE
MANUFACTURED HOME
Setbacks: Front 50+ Left: 15 Right: 5 Rear: 20+
Site Information:
............... .
Plat Key: 005114 Name: SP -662-90
Contact: ALLIED CONTRACTORS
Address: 4620 N STARR RD
C - S - Z: OTIS ORCHARDS, WA. 99027
Phone: (509) 928-3003
Group Name:
Project Name:
District:
F
Parcel Number: 45134.2707
Block:
SiteAddress: 604 N SHAMROCK LN
VERADALE, WA 99037
Location:: VER
Zoning: UR -3.5 Urban Residential 3.5
Water District: 107 SPOKANE, CITY OF
Area: 14,616 Sq Ft Width: 87 Depth: 138 Right Of Way (ft): 29
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
ti0n: :.
Lot: 7
Owner: Name: DUFFEY, JOHN
Address: 604 N SHAMROCK LN
VERADALE,W A 99037
Hold: ❑
Review
Site Plan Reviewalb
Released By: :tra 4 .+4,
Plan Reviewvi
Released By
clatAtic.S
44-rs---csZ
Special Inspections
Approach / Drainage
Released By: i.
IS -Ca
Operator: RMB
Printed By: RMB
Print Date: 4/18/2002
Project Number: 02002719 Inv: 1
'Application
THIS IS NOTA PERMIT
Date: 4/18/2002 Page 2 of 2
Penalties will be assessed for commencing work without a permit
Manufactured Home
Contractor: ALLIED CONTRACTORS OF Firm: ALLIED CONTRACTORS OF SPO
Address: 4620 N STARR RD Phone: (000) 000-0000
OTIS ORCHARDS, WA 99027
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Payment Summary::>;::;,
Permit Type
Manufactured Home
Units Unit Desc
2 SECTIONS
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$100.00
$22.00
$122.00
Fee Amount Invoice Amount Amount Paid Amount Owing
$122.00 $122.00 $0.00 $122.00
$122.00 $122.00
$0.00 $122.00
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 contrued 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: 4/18/2002
Department of Labor & Industries
Factory Assembled 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. See list on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.
ALTERATION PERMIT
Do not complete shaded areas
/ Permit #
1502
Invoice #
Insignia #
Owner last name
Address
first name
Day time phone
(fit) C\
City
Date
—State ZIP
Instal ler/Contractor/Dealer
Address.
Phone
c )
...................
City
Contractor's registration number
State ZIP+4
Check the appropriate boxes in section•A and section B.
A ❑ Commercial Coach. B
Serial No.
Mobile Home ,
Serial No.
HUD No.
Recreational Vehicle or ❑ Park Trailer
Serial No.
Model No. or Plan Approval No.
•
•
Alteration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical RECEIVED
Electrical Appliances
Fire Safety APR 18 2002
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove
Plan Review
RV Inspection
Reinspection
echnical Inspection
DEPT. OF L&I
SPOKANE. WA
FEES
Serial No.
Original Permit
No.
$
Note: This permit expires one year after date of purchase. (Non-refundable)
%Signature of applicant or authorized representative " Make check payable to: Dept. of Labor & Industries
X FEES DUE
Department use only
Request approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent, or lease any
non -complying mobile home, commercial coach or recreational vehicle.
CALL 324-2640 FOR INSPECTION
PLEASE LEAVE NAME &
ALTERATION PERMIT NUMBER
included are forms requ'red which must be completed and fees submitted before reinspection.
CDate
Area office Inspector
XTotal pages /
F622-012-000 alteration permit 8-99 White -Olympia Canary -Inspector Green-Contrac* Pink -Purchaser Goldenrod -Purchaser
APPLICATION #: NOT ISSUED YET
Date of On -Site Sewage Application:
Property Owner Name:
IBROADWAY
Property Owner Address:
-SEPEPATION,
BETWEEN
Applicant Name:
DAN HULTQUIST
,Applicant Signiture
and Date:
Z 0
Site Parcel #:
Site Address:
604 N. SHAMROCK LN
Testhole Evaluator:
CJ FELLMAN
Testhole Evaluator Dat211 1/1193
yCC,EANCUTX/
Site Evaluator:
Site Evaluator Date:
U)
Drinking Water Supply:PUBLIC
Parcel Size,
14616 SQ FT
STANDARD DRAINFIELD
System Type:
Sewage Source: [ X ]residential
[ ]commercial
Tank Size:
1000 GAL, 2 COMPARTMENT
I Drainfield Size: 200' or, leach
bed:
sLR:
ELEVATIONS
Stub out: i,' ", t'
Septic Tank
Inlet:
Outlet: /c(135 -
"D" Box
Inlet:
Outlet:
'INSTALLER CERTIFIES THAT HE/SHE HAS READ AND
COMPLIED WITH DESIGNER DRAWINGS, LOCAL AND
STATE CODES, AND INSTALLED THIS SYSTEM IN
ACCORDANCE WITH DESIGNER'S MANUAL, STATE
AND LOCAL CODES, AND HAS NOT ALTERED OR
CHANGED THE INSTALLATION THEREOF, WITHOUT
NOTIFICATION, AND APPROVAL OF THE DESIGNER,
AND/OR STA, OR LOCAL AUTHORITIES.
SIGNITU
PRINT NAIE,,
,TIC #(IF 'LICENSED INSTALLER)
Reviewer Name: —
Reviewer Signiture: —
Date of Design Review:
Installation Notes: Modifications of this desing during
installation are not authorized without advance approval by the
designer. Changes in installation depth, system configuration,
or substitution may render the installation unacceptable.
CONTACT THE DESIGNER FIRST AND THEN THE
DESIGN REVIEWER PRIOR TO CONTINUING
CONSTRUCTION.
Designer Name:
Designer Signiture-
Date of Final Design Submittal:
(print)
This proposal meets or exceeds all applicable State and Local
Regulations for on-site sewage systems and conforms to
BEST PRACTICE as outlined in the applicable Standards and
Guidance documents.
This site flan is being submitted for the Purpose
of
U g,
representation of the pro-cs@l. All known prope rt
lines/dimensions, curb lines. structures and easements
have been identified. Also indicated are vveVands,
bodies -of-viStLeP steep sjozes or other critical areas.
Signed'
Date:_
ADDRESS'
ZONE
ROAD WIDTH
F1R0NT__".1_7__ FL NKIING
COWIvIE,
REVIEW IIED
::u
Z
0
0
W
Site Plan
LEGEND
EEN::H, %IAMR
ELEVITQN 11R'R,Si,rE
TFPC'NS
'E
'EPT!". TAP
'1STR;RUTCR V,�X
-C"IER POLE
• RESERVE ONES
WATER UNE
PROPERTY UTNE
TOPOGRAPHY ELEVAPONS
4' MIN
BETWEEN
DRAINFIELD
AND TANK
A
rj
- LOT IS PRIMARILY FLAT
- NO RECORD OF LOCATION OF PREVIOUS TEST HOLES
T -W
Z
... . ... ..
TEMPORARY
TURN 5'-0114"
AROUND I
!,10 FRC"11Y
1Y
MN'
IBROADWAY
-SEPEPATION,
BETWEEN
Z
HOUSE A��&/
10' UTILITY EASEMENT 1600 GAL, TANK,
2
Z 0
COMPARTMENT
<
yCC,EANCUTX/
U)
A
rj
- LOT IS PRIMARILY FLAT
- NO RECORD OF LOCATION OF PREVIOUS TEST HOLES
T -W
Z
... . ... ..
TEMPORARY
TURN 5'-0114"
AROUND I
I
zo
—
1Y
MN'
-SEPEPATION,
BETWEEN
HOUSE A��&/
10' UTILITY EASEMENT 1600 GAL, TANK,
2
COMPARTMENT
yCC,EANCUTX/
water. ---------------------
-
-;?-
25'BUILDING SETBACK FROM ROAD
----------------- ---------
I, 25'-0"
7
,GARAGE N
power
SCALE: 20:1
LU
0
.N
yj1, AI -1
ry / b � Ztn
.` I � - - -
'
F-
100111oa
p QLo
_j to
tY :::
:Dco
LL ...
U_ ..
ul Z <
X/ ......... �M
..........
5' PROP RTY I N
13!_O�