2002, 12-18 Permit App: 02011110 MHProject Number: 02011110 Inv: 1
•
Application
Date: 12/18/2002 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: DOUBLE WIDE MOBILE HOME (EXISTING Contact: SMITH, THOMAS & MARYANN
SINCE 1985) Address: 602 S TSCHIRLEY RD
C - S - Z: GREENACRES, WA 99016-9322
Setbacks: Front 23 Left: 30+ Right: 30 Rear: 5 Phone: (509) 922-2965
Group Name:
Site Information: Project Name:
Plat Key: 000078 Name: APPLE VALLEY EST 2ND ADD District: G
Parcel Number: 55192.1921
Block: 4 Lot: 21
SiteAddress: 602 S TSCHIRLEY RD
GREENACRES, WA USA 990
Location:: GRE
Zoning: UR -7 Urban Residential -7
Water District:
Area: 11,742 Sq Ft
Owner: Name: SMITH, THOMAS & MARYANN
Address: 602 S TSCHIRLEY RD
GREENACRES, WA 99016-9322
Hold: El
Width: 90 Depth: 110 Right Of Way (ft): 40
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review
Site Plan Review
Released By:
L
Plan Review
Releas d B : ktt,t6t 04-- au.--
.
01.4et
OE ', d &)5pit_c4/1
Ofeptic System Review
Released By:
1&CtLpc
Landuse/Zoning Released By:
-og )
Operator: CKF Printed By: CKF Print Date: 12/18/2002
Project Number: 02011110 Inv: 1
r
•
Application Date: 12/18/2002 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
COUNTY SURCHARGE
Notes:
Payment Summary:
Permit Type
Manufactured Home
Manufactured Home
Firm: OWNER
Phone:
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
$122.00 $122.00
$0.00 $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 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: CKF Printed By: CKF
Print Date: 12/18/2002
Project Number: 02011110 Imv: 1
Application
Date: 12/18/2002 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Pennit Use: DOUBLE WIDE MOBILE HOME (EXISTING
SINCE 1985)
Setbacks: Front 23 Left: 30+ Right: 30 Rear: 5
Site Information:
Plat Key: 000078 Name: APPLE VALLEY EST 2ND ADD
Contact: SMITH, THOMAS & MARYANN
Address: 602 S TSCHIRLEY RD
C - S - Z: GREENACRES, WA 99016-9322
Phone: (509) 922-2965
Group Name:
Project Name:
District: G
Parcel Number: 55192.1921
Block: 4
SiteAddress: 602 S TSCHIRLEY RD
GREENACRES, WA USA 990
Location:: GRE
Zoning: UR -7
Water District:
Area: 11,742 Sq Ft
Urban Residential -7
Lot: 21
Owner: Name: SMITH, THOMAS & MARYANN
Address: 602 S TSCHIRLEY RD
GREENACRES, WA 99016-9322
Hold: ❑
Width: 90 Depth: 110 Right Of Way (ft): 40
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Released By:
Plan Review
Released By:
t
ans
Septic System Review
Landuse/Zoning
Permits:
Operator: CKF Printed By: CKF
Print Date: 12/18/2002
2
1 T
SPOK I\T Cotte
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address: Go -L__ 6. t
SC1,1 � IC -
Assessor's
LL_ Cl�lc.
LC -
Assessors Tax Parcel Number(s):
Legal Description:
Project Description: (TKI EE 7.&)
Building Permit
O Change in Use
O Grading
0 Manufactured Home Permit
0 Relocation
O Sign
O Tenant (New/Change)
0 Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Rear:
Left Right:
School District:
Fire District
Zoning
OWNER/APPLICANT INFORMATION
Indicate who should be onlacied re ardinIT
0 (Tuner: Phone:
(t,?°rn,gA' 611r)au fax 7
1. — V1 U y
0 Applicant
Phone:
Fax:
Mailing Address:
(o0Z f. '730-11eL .-/ Q.7 -
Mailing Address:
Dimensions
Ore, State, Zip
Cit}, State, Zip
Finished basement sq. ft.
Occupancy group
0 Contractor Phone
Fax
i
❑ Architect; L-:nl,nne•er
Phone
Fax
Mailing address
Mailing address
Ciq', State Zip
City, State Zip
WA State Contractor license #
Contact name
PROTECT INFORMATION
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
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
1 leat source (electric, gas, etc.)
Manufactured Home
Sigh
Width:/
Z
Length'
Se
What is the square footage of the sign
face?
I low high is the sign?
Year:
Iql--8
Make:
51-..fil-.A,1 o
# of signs
Arca of existing signs
Fireworks display
Are critical or hazardous materials used or stored on site?
0 Yes WNo
_
Proposed use
Relocation
Fire Safety
Fimi Name
What is the current use of this property?
1 LCSf 17-0,1/43 7-4...___.
Previous address
Will the site be served by a septic system? Yes 0 No
Paint booth
Fire Sprinkler
Tent
Fire Alarm
Fireworks display
Are critical or hazardous materials used or stored on site?
0 Yes WNo
_
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Fimi Name
What is the current use of this property?
1 LCSf 17-0,1/43 7-4...___.
Phone
Will the site be served by a septic system? Yes 0 No
Plans Ixaminer
Phone
Inspectors:
Is there evidence of fill or excavation on the property?
0 Yes A No
Are there slopes greater than 30°'0 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 WNo
Address
Inspector
Phone
O Concrete
O Welding
0 Bolting
El Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
Ifyes, dent. 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?
Ifyes, ident fy on site plan El Yes No
What is the current use of this property?
1 LCSf 17-0,1/43 7-4...___.
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes At No
Will the site be served by a septic system? Yes 0 No
Is any part of the property within a 100 yr flood plain?
Ifyes, identifi, on site plait
El Maybe Don't know El Yes 0 No
Are or will there be wells located on the property?
I f yes, ident,5, on the site plan 0 Yes .....,„No
Are there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, identi.fr on site plan 0 Yes No
Is there evidence of fill or excavation on the property?
0 Yes A No
Are there slopes greater than 30°'0 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 WNo
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
OYes
0 N
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA?
0 Yes
O Yes
0 No
0 No
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA?
0 Yes
0 No
Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Date Received:
Staff Representative:
METHOD OF PAYMENT
X(:ASI I ❑ (:III?CK0 MEM
VISA
❑ ❑
C`v
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATI
EXPIRES:
B:ANKC:VRI) NUMBER:
\UTI [ORI/,l I) S1GN:V11TRI{:
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS $35.Q%PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER
This site plan is being submitted for the purpose of
obtaining a buil in •ermit an
represen _ on of the proposal. All known property
lines/dime ions, curb lines, structures and easements
have been •entified. Also indicated are wetlands,
bodies of w ter, steep slopes or other critical areas.
Signed:
Date: \ !.1 \9109---
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