2005, 07-01 Permit App: 05002255 MH Project Number: 05002255 Inv: I Application Date: 07/01/2005 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW DOUBLE WIDE MANUFACTURED HOME Contact: ROWLEY CONSTRUCTION INC
PLACEMENT Address: PO BOX 296
C-S-Z: LOON LAKE,WA 99148
Setbacks:Front 32 Left: 15+ Right: EX Rear: 73 Phone: (509)251-1026
Group Name:
Site Information Project Name:
Plat Key: 002704 Name: UNIVERSITY PLACE District: Sout
Parcel Number: 45204.3236 Block: Lot:
SiteAddress: 10401 E 15TH AVE Owner:Name: SHEPARD,KERRY
Address: 10401 E 15TH AVE
Location::CSV SPOKANE VALLEY,WA 99206
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: .00 Acres Width: 150 Depth: 150 Right Of Way(ft): 60
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
\ -
Site Plan Review Released By:
Plan Review Released By:
Sewer Review Released By: 0 --- 1i7
Manufactured Home
Contractor: ROWLEY CONSTRUCTION Firm: ROWLEY CONSTRUCTION
Address: PO BOX 296 Phone: (509)251-1026
LOON LAKE,WA 99148
Item Description Units Unit Desc Fee Amount
INSPECTION FEE 2 SECTIONS $100.00
Permit Total Fees: $100.00
Operator: K_C Printed By: K_C Print Date: 07/01/2005
Project Number: 05002255 Inv: I Application Date: 07/01/2005 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
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: K_C Printed By: K_C Print Date: 07/01/2005
r�_ ..Y
s BUILDING PERMIT APPLICATION WORKSHEET
tica. City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
401064Valley Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION __i
Street Address: / /7/ � /5 Sr- . )v/41_rte Uz_fL, (t)i q`7,4_ 6
I
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: ?'-( (r-�� c,r.A,i,r.._„, -'L , j
❑ Building Permit ❑ Change in Use ❑ Grading anufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner 5k.c` �-t (-4 ❑ Applicant:
Phone: Fax: Phone: Fax:
Address: /& y ( '_ ( .s / Address:
� 'o1(eiz-�- ('E' (/tI�'" Lc4 -
SS G
efty Mate Zip Code City State Zip Code
❑ Contractor: 4G&vc-ec: /c,,7i 1-n�ic -bvl��7c ❑ Architect: &,(u i 4-\-140,4--kr,re,)
'
Phone: 5 (_-, Fax: 73 ._c,:-3-(' Phone: Fax:
Address: lam.;, , fix, 2-f . Address:
(.J�,�;� Cry 4i. - v4 Irl/4Zi'' "
pity State p Code City State Zip Code
• WA State Contractor License #:,io,,,, �
C l(A A- L contact:
Spokane Valley Bus. Liscense #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2""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: Len the b q ' Year: , Ov,� Pit Set: �-
Manufacturer: Irk ,c r �j e, - "1-r) rv\.L-$
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 ❑ 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 permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Li Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
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��tvQ This site plan is being submitted for the purpose of
t/' 1 r zbtaining a budding permit and is a true and correct
presentation of the proposal. All known property
lines/dimer Bions,curb lines,structures and easements
have been identified. Also indicated are wetlands,
I bodies of , steep s1.. • /-r i ••=i areas.
eZ 7 / Signed: 4/-WL '
C_ Date:
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