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2004, 04-30 Permit App: BLD-04-04239 MH E f Olt#NalBUILDING PERMIT APPLICATION WORKSHEET FO liane City of Spokane Valley Community Development Department Building Division �+ � 11707 E. Sprague Avenue, Suite 106 .000Vl Spokane Valley, WA 99206 Phone: (509) 688-0036;Fax: (509) 688-0037 REQUIRED SITE INFORMATION Street Address: S/ / 2 F 9 r 4 �/ Assessor's Tax Parcel Number(s): 3 31, /-2? v Legal Description: PERMIT DESCRIPTION: ❑ Building Permit ❑ Change in Use ❑ Grading Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety Other OWNER/APPLICANT INFORMATION ❑ Owner: L7 /e //e ,lS ' kj ❑ Applicant: pi?/e /Y elf-6 14 Phone: a pU 6E`/-3l%Fax: - el 76541349 Phone: be Y-77/2 Fax: Address: le; 2 `/ ..7`'' )el Address: SA -" -e L'e ed.&a(Pic ,,V,e kV 143 fry City State Zip Code City State Zip Code ❑ Contractor: 6)A} kiA ❑ Architect: Phone: Fax: Phone: Fax: Address: Address: City State Zip Code City State Zip Code WA State Contractor License #: Contact: PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: MAIN FLOOR TO SQ. FTG: 2ND FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: #OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? MANUFACTURED HOME Width: 17 Length: bYear: lq? Pit Set: Manufacturer: ,?a A .1%^q' /-'h RELOCATION Previous Address: Proposed Use: FIRE SAFETY Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth: Tent: Fireworks Display: Blasting: Date/Time: Valuation: Above/Underground Storage Tank Size: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Plans Examiner: Phone: Fax: Address: City State Zip Inspector: Phone: Fax: Address: City State Zip SPECIAL INSPECTIONS ❑ BOLTING El CONCRETE ❑ REINFORCEMENT ❑ WELDING Firm Name: Phone: _ Fax: Inspector(s): DISCLAIMER 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. Ownership of resulting development rights granted by any issued per ' 'nure to the prope owner. Print Name Da /e / / (/S d Signature Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard Q VISA El Other Bankcard#: Expires: VIN#: Authorized Signature: Department of Labor&Industries 'MANUFACTURED/MOBILE HOME Factory Assembled structures Section i ALTERATION PERMIT .. K INSTRUCTIONS: Do not iiiR:MH<:>:<.'> ':' . €>»>< ;><> 1. Complete all spaces,including the signature box(marked with an X). - " - P P 8 i8 complete ;.;:.;:i*:::::,,:..#: ::.: :: ..:.:.:. :i*: :.::. :. :. 2. Draw a mapon reverse side of WHITE copyonly. <4::::> Y shaded permitad fees to the nearest L&I office. See list onreverse. 3. Forward completedn areas Iia a ?:::::<:>?;'<::'>s:::>:»<:>:>:>:::<:::>::::::::>::::::`:::<:: 4. Contact and schedule the ins ection(s)with the same L&I office per the checklist. .., . ;:::::::.: :»:::;»::» > »:::»::: P g ;;:::ME:::is : R;ii.;'`N;i.'`i ;'i>>;Gi : Owner last name first name Day time f �/ N4- t pet 1G_ Da i P It ` 7 /.2, I D17_ ? Address .City , I r 7 - tate ZIP ff .torr -..- _ _ / w Installer frac tor/Dealer /1 lir,t,t Phone 1Contractor'sregistrationnwnber I..•-6 e/4 l .,e, .--., 1 77-Fr ,1.'.,+14'r t ( ) Address City State ZIP+4 Serial Number(s) HUD Number(s) Qp'0� .-."ti.. Place tee amount in proper box Place fee amount hi proper box p Q Mechanical j OF LP Heat Pump Electrical vo?pp,1— '1.5) - Air Conditioning Heat pump NOS Furnace Installation(gas-.or electric) Air Conditioner ,.\�N rp Gas Piping Furnace Installation(gas c iJ, tIt W P Wood Stove NoWood Stove(if applicab 0,��,'1 Pellet Stove 5enslMo Pellet Stove(if applicablj Gas Room Heater Gas Room Heater Gas Decorative Appliance Gas Decorative Appliance(if applicable) Range:changing from electric to gas Range:changing from gas to electric Gas Water Heater replacement Electric Water Heater replacement Water Heater:changing from electric to gas Electric Water Heater replacing Gas Water Heater Plumbing Each added or modified circuit Fire sprinkler system(also requires a plan review) Hot Tub or Spa(power from home electrical panel) Li Each added fixture Replace main electrical panel Low Voltage Fire/Intrusion Alarm Replacement of water piping system 4`..,, Fire Safety ZO Structural CC IIInspection as part of a mechanical installation U m (cut truss/floor joist,sheet rocking) Miscellaneous Reroofs(may require a plan review)Li Plan review flrimal:Pent[►[......... ...:` • to c6 CL Z Changes to home when additions bear loads on home per Reinspection- ,g z w I-- the design of a professional(also requires a plan review) Insignia Q yirm Other structural changes(may require a plan review) Other 0 ZW mem Fire Safety W D- Z Note: This permit expires one year after date of purchase. (Non-refundable) co w O Work is completed at this time. An inspection is requested.El M w •Work is NOT completed at this.time,I will call when ready. DE Q W JWI— Make check payable to: Dept.of Labor*&Industries I Q J J FEES DUE Signature 9t€olSolleant or orized rese1 ,,a_., U Il Q f LX e ;r>::: <Re; uest a..proved,:::;:or.:;. _,g: :::l equest denied because o specific violations of Washington;.rules and.re ulations.: :Violations:must.be eorrected::and:reinspection re uested wvitltin;24:::da�:s or ttie notice ii violation datea:Failure to com.X. ua result in.: oaltfes.. :.r rba .te;r;.,41,22 i.CW;€;::'A11<vtolatlo.p :npted:`ar..e:shn vn::p. W,i7 llter..attonllaaG .r:;::;:;hermit;: o :> o .. .Goan..�n:.:K...................................... ....................................... ................................................................................................................ .. ... .................... .:.:::::: & 000 ,'artdfees. ubmittedbeforesrettis - ' `:` ::;..;i A:;; : :germ :::>:>< '> :; Irt�lt►ded axt ft7rms xequired�?hteh nnusi be corap:.::0 .:::;:.;. ... . . ....:. .:.:... ..:::.; ;:::�:.;.>:: :.:.:.;:::: . :.... .:.:::...: .:..::.,::.::.....:..:.:.... .: :Ins ctor.:::::::. ::: :::::;:.>:.:: .;.. .'.:::.;';:>:::.»::.;:::>::>::>;:. Total page s >:<:Date....................... .::..,... :.:..:.......................................................... ........... .......:.::.,::::::::,.:::::::::::::..:...:::::::.:::::.::.:.:::::.:..:...:.......::..:........ F622-036-000 mfgd/mobile home alteration permit 11-02 White-Olympia Canary-Inspector Green-Contractor Pink-Purchaser Goldenrod-Purchaser r t RECEIVED Do N r) 2004 DEST ..T SÔkiie DEPARTMENTOCOMITYDLOPSPOKANE VALLEY CURRENT PLANNING DEPARTMENT D ENT O /.',t�fVtt�e 1JN TY DEVELOPMENT Vaile ADMINISTRATIVE EXCEPTION APPLICATION AND DETERMINATION // PART I APPLICANT: Da f e Ne 1d L Li MAILING ADDRESS: /0 o, a 7 /d sir eP CITY: e.c/ eg ahe 4 -e 6 STATE: -+ co�k! 7D ZIP: .e.-,7 Vr PHONE:OME)6 Y WO ( RK) (CELL,..?0 cj gie v ©.7 J NOTE:IF APPLICANT IS NOT THE OWNER,INCLUDE WRITTEN OWNER AUTHORIZATION FROM THE LEGAL OWNER BELOW LEGAL OWNER: Dom`/- ' s' '/," A.-7 MAILING ADDRESS: /v l/ CITY:( ea�1/�44*6 .611 STATE:,--Z-76 4 v ( PHONE:(HOME) .2 04 Gni' l V 7/3 s7 6 V ge/QZ�IP��! L �.J (WORK (CELL) uD �.rZ ,_ TAX PARCEL NO:-35.31. 4022 STREET ADDRESS OF SITE: SI+Z- / f / LEGAL DESCRIPTION: SECTION(S) TOWNSHIP RANGE ZONING CLASSIFICATION: Li R- 7 COMPREHENSIVE PLAN CATEGORY: TYPEOFADM S TIVE EXCEPTION REQUESTED: 13+ O T_ �� Q � �� f �cr c � S N S�Pd�l EXPLAIN REASON FOR REQUEST: /1 K S" /yt u i ti 7ea. i .'MI u // APPLICABLE SECTION(S)OF ZONING CODE: NOTE: A SITE PLAN AND SUPPORTIVE DOCUMENTS SHALL BE INCLUDED WITH THIS APPLICATION PART II LEGAL OWNER SIGNATURE (Signaturereof legal owner or representative as authorized by legal owner) I, Pit (6 /tien , (print name) SWEAR OR AFFIRM THAT THE ABOVE RESPONSES ARE MADE TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE. I FURTHER SWEAR OR AFFIRM THAT I AM THE OWNER OF RECORD OF THE AREA PROPOSED FOR THE ABOVE IDENTIFIED LAND USE ACTION, OR, IF NOT THE OWNER, ATTACHED HEREWITH IS WRITTEN PERMISSION FROM THE OWNER AUTHORIZING MY ACTIONS ON HIS/HER BEHALF. ADDRESS: /O r `S.ff P74 PHONE: l)' "(% 2 /� C Gl/li` Ql!P'� 1= �a ZIP: ,142' City)) (State) de_ Li- 36- ov (Signature) (Date) NOTARY (For Part II above) STATE OF WASHINGTON ) ss: COUNTY OF SPOKANE ) SUBSCRIBED AND SWORN to before me this 3 ) day of M/ ,20 d/ NOTARY SEAL e�.�``'r��"����� NOTARY SIGNAT E ��••• SON � • Washing on %►i� Notary Public in an fort State of � �NoTAR)' �tResiding at: (/^ d /644_, i V:V a'''. I i i s O•►r ca--62/77 • My appointment expires: �? yi PfiW PART III (To be completed by the Planning Staff) DATE SUBMITTED:/ Os .� 0�• oq RECEIVED BY: � Q1-/ (+4f'1n ir.6s FEE: /VA FILE No.: ,4E /g-.) / PART IV DETERMINATION File No: AE- /i? - £2 f The Department of Community Development finds that the information provided by the applicant and required compliance with the City of Spokane Valley Zoning Code and all other development regulations, does/ does not adverse affect on the adjacent properties nor the public's general health, safety and welfare. The Department of Community Developmen approves denies this"Administrative Exemption" as conditioned below,for the property described in Part I,purs ections 14.506.000 and 14.506.020 of the Zoning Code. This administrative exception is subject to the following conditions of approval: 1) This administrative decision shall apply to the subject property indefinitely and may be transferred to future property owners, heirs or any successor in interest to the property subject to the conditions of approval contained herein. 2) The applicant and property owner shall comply with all requirements and regulations of the Zoning Code. 3) The applicant shall comply with all applicable development regulations and standards. 4) The applicant and property owner shall comply with the following additional conditions: 1. S - e-t t n ✓ �.�.� t —670— tr-P-a-c-�� s 413 1 3 .S r � s i ULew fv VA! i:Tr4e,vi, .7. t C. .. Yds t S 'tom/ irA2 t S r1-e & + L ... '� 1 ' t(6&44- 't� �G,cv��-h.t.vim- MK!.� S� �:E ��1'� G2�'r�-Se.�` MAMA T li•.e i � U12-1 tAtteld 11? This administrative -xception is hereby ..proved this 4 day of 'G'-- 4 ,20 Approved by: ir, v ', ' Title: C Y 0.y,b„ Under Section 14.412.041 of the City Zoning Code,any person aggrieved by this administrative determination has the right to appeal this administrative decision to the City of Spokane Valley Hearing Examiner. An appeal must be filed by submitting the appropriate appeal application together with the required fee to the Department of Community Development Current Planning,within fourteen(14) calendar days after the decision is issued. Upon receipt of a complete appeal application,a public hearing will be scheduled. For information or questions,please call(509) 921-1000 Rev 6/03 property corner property corner Q 0 property line 87'-6" —\----- 1 6'-6„ - _, 50' This site obtaining Plea au �..� ildi ADDRESS +�eP�resentation of m an4 is dirnen PtOPonW P :: ::7:1141411122! ZONE � � havef been�entii�rb tl rdPos�t. Ap s...--Int. p ROFRONO � FtANK84 �— 20' bodies o1 r st , etn • COMMENTS Signed:_�� oro her • 4e REVtEVVED—- j Dere: r cal�+sM. i • io t 50' 16'-6„ - cpc L PLANNING DEPT.APPROVED N----1---�-- 0 o ( EXISTING SEPTIC TANK a a / By. -...,i L..i:, ,.�. _ 1 . DATE. D It. -, lvt51)(% - (c3\-------\\ / 11 • / a •Qine05€, :),......... > > f 14 66 X14 MOB LE HOME {