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2008, 01-02 Permit App: 07004957 MH Project Number: 07004957 Inv: 1 Application Date: 1/2/2008 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: NEW 2008 27 X 44 CLAYTON MANU HOME Contact: 3D EXCAVATION INC Address: PO BOX 990 C-S-Z: NEWPORT WA 99156 Setbacks:Front Left: Right: Rear: Phone: (509)447-5419 Group Name: Site Information: Project Name: Plat Key: Name: Range District: East Parcel Number: 55064.0916 Block: Lot: SiteAddress: 3325 N VELOX ST Owner:Name: SEIFER,CHRISTIE Address: 3325 N VELOX ST Location::CSV SPOKANE VALLEY WA 99216 Zoning: I-2 Light Industrial Water District: 134 CONSOLIDATED ID#19 Hold: ❑ Area: 10,230 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information Review Building Plan Review Released',By: PER MANUFACTURED SPECS Originally Released: 12/26/2007 By: JLMain Septic Sys Review Released By; Originally Released: 12/26/2007 By: LHALSEY Landuse/Zoning/HE Conditions Released By: Originally Released: 12/31/2007 By: mpalaniuk Permits: Operator: jmm Printed By: JD Print Date: 1/2/2008 Project Number: 07004957 Inv: 1 Application Date: 1/2/2008 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Manufactured Home Contractor: 3D EXCAVATION INC Firm: 3D EXCAVATION INC Address: PO BOX 990 Phone: (000)000-0509 NEWPORT WA 99156 Item Description Units Unit Desc Fee Amount INSPECTION FEE 2 #SECTIONS $100.00 Permit Total Fees: $100.00 No occupancy until septic approved.2 bedrooms only. Payment Summary• Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Manufactured Home $100.00 $100.00 $0.00 $100.00 $100.00 $100.00 $0.00 $100.00 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: jmm Printed By: JD Print Date: 1/2/2008 Permit Center RECEIVED BY I 'Y OF SPOKANE VALLEY PERMITNUMBER:4 °T7 11703 E Sprague Ave,Suite11 .je Spokane Valley,WA 992069E� PERMIT FEE: Valley- (509)688-0036 FAX:(509)688-003 2 2001 www.spokanevalley.org `E`MIT CENTER Community Development BY Manufactured Home Permit Application OTHER SITE ADDRESS: 53a5 tJ• \I e\ox Si- 'Don W c od East S tA, LT 'lo BLV 8 ASSESSORS PARCEL NO: • , , ©• , LEGAL DESCRIPTION: & ) 3(7 F T O ' VAC 'KO RAS T O Building Owner: Contractor: 3 a Ex ea v Gc i on , --roc EEIEISEINIEFIFPZIIIIIIIIIIIIII Name: c -- 6, c. ct.0 It.0'IS Address: 33 ` - Address: v .0 . ZOX CYC D City: State: , Zip:•• City: .K.)Quo vo r 4_, tState: Go, Zip:,9 la Phone: Il -q . . r yy . Fax: ® Phone:9.. 9(17-6c/19Fax�O� ' W7-6 yic Contracto LLLic No: Exp Date: .AD xCIE4q lk-Z X5•0 —O$ Contact Person City Business Lic.No: Name: �)1 4M p flet. a U\5 . Phone: 505 - 4q-7_ 54 lei Describe the scope of work in detail: Ple<lndve ex•1cl4►na S;nsp, D.31 cif , 'CNeplr .e e w•1T-)n o eu) d d Ltbl'e Ln'► (l e . MANUFACTURED HOME Width: a 7 . Length: U y i Year: (7?OQ 8 Pit Set: PS ( p e e�e Q C/!P J Manufacture: C l a +o r l �� V Previous Address: Proposed Use: -- ie5 i Cloflee. The permitee verifies,acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This 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 '•• Date (._./Zoi,s Method of Payment: 0 Cash 0 Check ❑ Mastercard 0 VISA Bankcard#: Expires: VIN#: Authorized Signature: REVISED 8/2372005 • APPLICATION FOR ON-SITE SEWAGE SYSTEM Client Copy Application No. 07-9707 • SPOKANE REGIONAL Area Tract: M H LT H Environmental Public Health Divisi Date of Application: 12/12/2007 1101 West College Avenue DISTRICT Spokane, WA 99201-2095 Daily Inspection Announcement: 324-1581 Inspection Call In: 324-1560 ------------- ------------------------ Site Address/Legal Description of Property/Town: Parcel #: Lot/Block/Subdivison Property Size: 3325 N VELOX ST SPOKANE WA 99216 55064.0916 L 16 B 8 Legal Owner of Property: Owner Address: Owner Phone: CHRISTIE SEIFER 3325 N VELOX ST SPOKANE,WA 99216 Property Use: Single Family Residence No.of Bedrooms: 2 Additional bedrooms wiil require a larger system New System: No What is proposed? Septic Tank No. 1 Size: 1000 Source of Water: Public Water System: CID Replacement/Alteration: Yes Relocating System Public sewer svc area? No Property Located In: / Contact: RAMONA DAVIS Mail Correspondence to: Phone No.(s) (509)447-5419 PO BOX 990 NEWPORT WA 99156 Signature of Authorized Representative: ATTACHED PLOT PLAN DESIGNED BY: STEVE SCHNEIDER (509)993-6568 Inspection Call-In Dates Testholes Partial You may use this call-In Dates section to track when you Final_ --, called our office for inspections. Reinspection Exp-osure__ Other — — Followup Date 11/11/20081ZAVj 7 W ., A proposed plot plan is to accompany this application, along with any other f information, such as legal description of property. This application and pern approval is contingent upon meeting requirements set forth in the SPOKAN► RULES AND REGULATIONS FOR ON-SITE SEWAGE SYSTEMS. Approval is b; accuracy of the information supplied by the applicant. If you are dissatisfi decision of the Health District, you may APPEAL to the Health Officer with. DAYS of denial of this application (see APPEAL PROCEDURE). • ` SPOKANE REGIONAL H LTH D%tS-TRtCT: December 17, 2007 1101 West College Avenue Spokane,WA 99201-2095 Ramona Davis 509.324.1500 TEL PO Box 990 509.324.1464 TDD Newport WA 99156 www.SRHD.org RE: SEWAGE DISPOSAL REPORT FOR PARCEL NUMBER 55064.0916 IN SPOKANE COUNTY, WASHINGTON APPLICATION NUMBER: 07-9707;ADDRESS: 3325 N. Velox St. SITE EVALUATION DATE: December 14,2007 NOTE: THIS IS NOT A PERMIT. PLEASE READ THE FOLLOWING INFORMATION CAREFULLY. As required under the Washington State Rules and Regulations for On-Site Septic Systems, WAC 246-272A- 0260,the Spokane Regional Health District has completed a site evaluation inspection at the above location. This agency has reviewed the proposed OSS design submitted by your Licensed Design Professional for the above referenced project. We have found the design to be acceptable. Contact your Design Professional for any additional soil or design requirements which may apply. The following information is required before our office can issue the septic permit: LAND USE Submit land use/building permit application or septic tank informational review form from the appropriate building department. FEES Submit the additional fees of $410 for installation permit or$150 for installation permit with designer inspection and$40 for system design review. NOTE: Preceeding your project,you must contact your local building and planning department to determine if Critical Areas Ordinance,Flood Zone,etc. could impact your property development.' INFORMATION SUBMITTED CANNOT BE APPROVED WITHOUT REVIEW FROM A HEALTH SPECIALIST. Your application is valid for one year from the application date of December 12,2007. If the above items are not accomplished within that time period,the application will be voided. The application can be renewed one time for a$100.00 fee if accomplished within 2 years of the original application date. For safety reasons, please fill in the testholes if additional inspections are not required. Please contact me at(509) 324-1458 if you have any questions concerning your project. Sincerely, Wilfred D. Little III Environmental Health Specialist II Environmental Public Health Division 206 revised 7/10/07 C.\nr\ski e 5 e:A ec 3`.‘a epcc+ ) 33a5 N. \J el ox Si W9. 3� .w.qc #55o(oy.o9!( �i L. ir'' /N A ''' a8, 6 la,a3o. oo sP v Ni i r4 '+ rdc,ote c1 0?InVill 'I a Ib�-kh w/ 1)v\ �,, I , 0'1`7 XyU \ '`''--,,,, , , / \ \ / I ' o / <VC I 00 V `` t\ \ \ ,/ d ' ' \ ai 5 t �/ \ , , 65.41. ___ / \ \ V : 70, <cS / `c LI 0% . A 7 ,,o y' cAse fix',U-,.r) a3 t<I / V / 3a_ih \ `1 , / Gos nEXiS1�, 1o0\ ` SYNo p Ey.,4“4 <approx. a y x 30) A•PROVED \./ -Dc',4eway P��DEPT. f ?owe{"'' cne)ter ^ � �I BY- %%' � S, Dwci( . (921.q7 ' DATE: /z-/3i/z(7 l a5 RETURN ADD, S ...S r.*_.Se/2(i/Cer3 _ t 7g0 ✓ 1 - c "0 ile i / J Manufactured Home PLEASE CHECK ONE WASHINGTON STATE DEPARTMENT OFManufacturedELIMINATION �• LICENSING Application ❑TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty ❑REMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LHM/IDTH(F ) VEHICLEIDENTIFICATION (VIN) es01 M0 4iXZgrO? OR f © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE [)1 AFFIXED 0 REMOVED REyLPPIrY1QAROEYL.[Jri t LOT ' BLOCKS PLAT NAME SECTI�N/TOWNSHI� N GE �� , ; ^ QUARTER/QUARTER SECTION 011 © GRANTOR(S)REGISTERED/LEGAL OWNER(S)–U`C tG �ADDI}1T/IIOONV1AL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NA OF REGISTVED O NER y DOL CUSTOMER ACCOUNT NUMBER \n r 15Il e) Sei {=ems NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMERACCOUNTNUMBER ADDRESS 25 N . \e 10 x S-\--, ne Na1 I(.\I STAT � ZIP C IE 1 L-4'to NAME OF LEGAL OWNER DOLYYCUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED SWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE'_ — - -.....< - c � . – Signature of Additional Registered Owner and Title,IF APPLICABLE No`kivil T MPM)P/�i NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE - 4F �! � State of Washington Signed or attested t/ .<a (ij ..'''t4 Ekp;+.�T0 y1 �lJ �Q- y.. q� 2 1 County of r '��–� �•2 before eon S 'f NO1PPV ' Z. y C�t,2�s-i-.e. • c.-���- Signatureiij ,/ G 'j' k791.0-`'' (� PRINT NAME OF REGISTERED OWNER 1. ,NAPY OR AGENT sbY r��••°° U/?...... +\;e°�I PRINT N ME OF REGISTERS OWNER RINTED NAME OF NOTARY ✓1 .& cj \\ ,/1 County/Office No.OR .L.y/ rf/ OF W� 1�� i Title �iVu ae-e.-� AND: Dealer No.OR i'(J./G'� 8 10 011 t t1'� DEALERSHIP GENT/NARY Notary Expiration Date 4 TITLE COMPANY CERTIFICATION `J I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 9 BUILDING PERMIT OFFICE CERTIFICATION I certify that: ID the manufactured home has been affixed to the real property as described. 0 a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAVE(TYPED OR PRINTED) LDG PERMIT OFFICE/PHONE# BLDG PERMIT# \L'Y 10._ O0.)..).i c aft)(0.55C.---- �G, 01 49 S-1 SIGURE/POSITION a-A* ATE V L.i0' 61.1-- U rTE(ass TO-424-9-(R/6/06)W Page 1 of 2