2002, 06-21 Permit App: 02005073 MH 1,
Project Number: 02005073 Inv: 1 Ap,licatipn Date: 6/21/2002 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: PLACEMENT OF TRIPLEWIDE Contact: CHD,INC.
Address: PO BOX 13717
C -S -Z: SPOKANE,WA 99213
Setbacks: Front 200 Left: 30 Right: 50 Rear: 300 Phone: (509)926-5229
Group Name:
Site Information: Project Name:
Plat Key: 999999 Name: RANGE District: D
Parcel Number: 35234.9106 Block: Lot:
SiteAddress: 5508 E 8TH AVE Owner:Name: KACHINSKY,D J
SPOKANE,WA USA 00000 Address: 716 S KOREN RD
Location:: SPO SPOKANE,WA 99212-0385
Zoning: UR-7 Urban Residential-7
Water District: Hold: ❑
Area: 4.07 Acres Width: 0 Depth: 0 Right Of Way(ft): 60
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
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Site Plan Review Released =y: ` .e Pt''4..L '[ ;l re.../_,
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Sewer Review Released By:
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Operator: DMD Printed By: DMD Print Date: 6/21/2002 /�/04,2 e
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Project Number: 02005073 Inv: / ' Application Date: 6/21/2002 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Permits: _.
Manufactured Home
Contractor: WES CROSBY Firm: C H D INC
Address: P 0 BOX 13717 Phone: (509)926-5229
SPOKANE,WA 99213
Item Description Units Unit Desc Fee Amount
INSPECTION FEE 3 SECTIONS $150.00
COUNTY SURCHARGE 1 Y OR BLANK $33.00
Permit Total Fees: $183.00
Notes:
Payment Summary: ..;: ..
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $183.00 $183.00 $0.00 $183.00
$183.00 $183.00 $0.00 $183.00
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 he 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: DMD Printed By: DMD Print Date: 6/21/2002
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ii,ci PROJECT APPLICATION WORK SHEET
Ilk SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE,WA 99260 / 3SPOK COLl1�I1'
509-477-3675 6 2 c-' 7
SPECIFIC SITE INFORMATION 6-6 . 1 f
Street Address: 5 50 O
Assessor's Tax Parcel Number(s): 0 35- 2 3t/- 9/04,
Legal Description: ` th. �, n I, l�` ,6 A lI b Y ' /ei live. 'J .30t4// W A
Project Description: 121 0.4.,.....p,,./.42; hf,._&'
L ,Building Permit 0 Change in Use El Grading 0 Manufactured Home Permit
0 Relocation CI Sign 0 Tenant(New/Change) CI Other
Department Use Only
Water District/Purveyor. Sewer District/Purveyor Road width Setbacks
Front Rear.
School District Fire District Zoning
Left Right.
OWNER/APPLICANT INFORMATION
IZI Indicate who should he contacted regarding this pr jes t
❑Owner: - 1l /' Phone: S3 y- 904 CI Applicant: �Q�,��f Phone: it '(9 Z_
d24,-"` r \, /Ahf/ Fax: ` !t D 44,/ b-i—e �Q051/- Fax: 9 Z G—6O Z1 el.--
Mailing
Mailing Address: r Mailing Address: //
7/ 5 kPIA'
City,State,Zip City,State,Zip
5(0 k944/tb-t UiA 91211_
❑Contractor Phone ❑ Architect/Engineer Phone
fi,..ve Fax lax
Mailing address / Mailing address
,9 01.0( (3 )1 2
City,State Zip City,State Zip
&I,-/r7 G� " 397/2
WA S'fiTtt Contractor license# Contact name:
PROJECT INFORMATION
Building Information
Building height to peak #of stun's Main floor sq.ft. Unfinished basement sq.ft.
Dimensions "Total hatable space 2"`t floor sq.ft. Finished basement sq.ft.
Occupancy group Construction type Garage sq.ft. Deck sq.ft.
Cost of project I leat source(electric,gas,etc.)
Manufactured Home Sign
Width: Length: r A3/hat is the square footage of the sign How high is the sign?
*7 _5
face?
Year: Maks;:: #of signs Area of existing signs
144
Relocation Fire Safety
Previous address Fire Sprinkler Tent
Paint booth Fire Alarm Fireworks display
Proposed use Value
Special Inspections Required? Non-Residential Energy Code Compliance?
Firm Name Phone Plans Examiner Phone
Inspectors: Address
Inspector Phone
❑ Concrete ❑ Welding ❑ Bolting ❑ Reinforcement Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? ❑ Yes ❑ No What is the current property size?
Ifyes,identify on site plan (square feet or acres)
Is any part of the property within 250 feet of a shoreline? What is the current use of this property?
Ifyes,idents on site plan ❑ Yes ❑ No
Is your property in a designated wildlife habitat area? Will the site be served by a septic system?❑ Yes ❑ No
❑Don't know ❑ Yes ❑ No
Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property?
Ifyes,identift on site plan Ifyes,identify on the site plan ❑ Yes ❑ No
❑Maybe ❑Don't know ❑ Yes ❑ No
Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property?
Ifyes,identig on site plan ❑ Yes ❑ No ❑ Yes ❑ No
Are there slopes greater than 30%on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site?
( °/) ❑ Yes ❑ No ❑ Yes ❑ No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? Is public sewer available to the site? ❑ Yes Cl No
❑ Yes ❑'No
Is the property inside the ASA? ❑ Yes Cl No Is public water available to the site? ❑ Yes ❑ No
❑ Yes ❑ No
Is the property inside the PSSA? ❑ Yes ❑ No Is the property located within 1000 feet of a Natural Resource Area?
❑ Yes ❑ No
Date Received: Staff Representative:
METHOD OF PAYMENT
'C 4L SUBTOT:Al,
VISA
❑ cAsil ❑ cIIFCK ❑ ❑ ❑ '-
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE: EXPIRES: TOTAL FEE
BANKCARI NUMBER: MINIMUM PERMIT FEE IS$35.00PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
AAUri 10RIZFD SIGNATURE: COUNTY PERMIt CENTER
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REVIEWEDYA-----eLd 1" ' •
This site pian is being submitted far thepurpose of
I: obtaining a b,.ilding permit and is a true and correct
representation of the proposal.All known property
lines/dimensions,curb lines,structures and easements
have been identified. Also in• sated a e wetlands,
bodies of watr steep sl. // r oth- critical areas.
Signed: f. 1,4/ add
Date: ; -- lla f