2004, 07-28 Permit App BLD-04-07183 MH n��� Penalties willTHISIS beNO assessedTAPERMIT
for
1 '' ' commencing work without a permit
alley MANUFACTURED HOME
11707 E. Sprague Ave., Suite 106
Spokane Valley,WA 99206 Application #: BLD-04-07183
Job Address: 1109 S DISHMAN RD Applied: 07/28/2004
SPOKANE WA 99212 Issued:
Description: REPLACEMENT OF SINGLE WIDE MOBILE HOME Expires: 01/24/2005
Subdivision: Lot: Blk: Parcel No: 45203.0517 Zoning:
Owner: THOMSON, PATTY
Applicant: THOMSON, PATTY Phone: (509)928-0691
Address: 1320 S SIESTA DR
SPOKANE,WA 99206-3106
Contractor: Phone:
Address:
Lic No:
General Information: Fees:
SECTIONS 1w PER SECTION FEE 50.00
YEAR BUILT 1967
DIMENSIONS 12 X 60 Total Calculated: 50.00
#OF STORIES 1 Deposits/Receipts: 0.00
#OF BEDROOMS 1 Total Due:
FRONT SETBACK 40 50.00
REAR SETBACK 40
LEFT SETBACK 20
RIGHT SETBACK 20
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
Initials/ Date
Building CV _ ),/C &dee A �
Pla ning ç &C)
014 .6s2-1 atadit9t-
o2.
THIS IS NOT A RECEIPT
:l
Street Address:fl,
*BUILDING PERMIT APPLICATION} WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688=0036; Fax. (509) 688-0037
REQUIRED SITE INFORMATION
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
❑ Building Permit
Relocation
Owner:
Phone: G�
Address:
Sfb IKw_tV
city
❑ Contractor:
Phone:
Address:
city
%>O
L Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Fax:
T'i't /)
ate Zip Code
Fax:
State Zip Code
WA State Contractor License #:
❑ Applicant:
Phone: Fax:
Address:
city State Zip Code
❑ Architect:
Phone: Fax:
Address:
city State Zip Code
Contact:
PERMIT/BUILDING, INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
:2'FLOOR SQ. FTG:
GARAGE SQ. FTG:
# OF STORIES:
UNFIN BASEMENT SQ. FTG:
DECKtCOV. PATIO SQ. FTG:
MAIN FLOOR TO SQ. FTG:
FWISHED BASEMENT SQ. FTG:
OCCUPANCY GROUP:
# OF BEDROOMS:
CONSTRUCTION TYPE:
TOTAL HABITABLE. SPACE:
HEAT SOURCE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED' HOME
Width: / 2,.. ength: 6P Year: 67 Pit Set: Al0
Manufacturer: I i pie
RELOCATION
Previous Address: `l1& . .i - d' " : {11'6 e
Proposed Use: c -rt , 4,... _
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 watery 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)
❑ Cash ❑ Check 0 Mastercard 0 VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature: Cr' ; ,. -
Department of Labor&Industries MANUFACTURED/MOBILE HOME
Factory Assembled Structures Section
ALTERATION PERMIT
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INSTRUCTIONS .. N. iit•,•• •••:,i•••••••,•:,•:•,.•,•.•••0•••••••e-*,:v:ierl•.:e• kt:i•:.a•i:: :.l::i.:aii•,•,• :i:.:K.,i•:ia::aii,i,,:]:,:,.
:iiu::,iiiiiiiiyAia--.,":•ir It-,..:***.: .,..7.-:.: -.:. .,:. .:.. ,....,.:.,,,,,.:.,
Do not _..............„. .........V.C.U.. .!,,..................„.
1. Complete all spaces,including the signature box(marked with an X). ...................................„„.........„........ „..... „.
complete '•i ::Tt.t.*0.iC*ICi:MME:i.i.aiaiMAiiii:Mi],pAr.:E
2. Draw a map on reverse side of WHITE copy only.
shaded
3..Forward completed permit and fees to the nearest L&I office. See list on reverse.
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4. Contact and schedule the inspection(s)with the same L&I office per the checklist. areas insignia#
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Owner last name first name Day time phone Date
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. , ,.
Address
City State ZIP
4' , e ./ ,,_ ( ir)1.." .'2: 4,i .'''. ','. '
Installer/Contractor/Dealer Phone ..- Contractor's registration number
. ,.....,. .
( -..--y
Address .... City State ZIP+4
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Serial Number(s) HUD Number(s) ,,. - .. - _
_ _,
Place fee amount In proper box
Place fee amount in proper box -
Mechanical
Heat Pump Electrical • . • . ,: : :: •
Air Conditioning Heat pump
Furnace Installation(gas or electric) Air Conditioner
Gas Piping Furnace Installation(gas or electric)
scoAsor.::,.:.:::.:.,:.:,?::,,,::::::::::]::,.::.,::::.?:: ::::..,--:,.,:::-:-::::.
Wood Stove----
. ;;,,,,..:..;.;.,.:::;.....;.., ... ... . . Wood Stove(if applicable)
Pellet Stove ---- :::1- : : : ]] :. :: Pellet Stove(if applicable)
Gas Room Heater Gas Room Heater
i
Gas Decorative Appliance Gas Decorative Appliance(if applicable)
Range:changing from gas to electric
Range:changing from electric to gas
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)
Li
Each added fixture Replace main electrical panel
Replacement of water piping system Hot Tub or Spa(power from home electrical panel)
Low Voltage Fire/Intrusion Alarm
Fire Safety
Structural
E:j1 Inspection as part of a mechanical installation
(cut truss/floor joist,sheet rocking) Miscellaneous
Reroofs(may require a plan review)
, • Changes-. to home when additions bear loads on home per
Lii Plan review
biiginitr>eiiiic:,.: ::;.:Z. , ::-:::;a1::;:;i:
Reinspection- --- ..i .: : ::',2; : .• ,,,N. ,':;;M:,. :::::]E:
the design of a professional(also requires a plan review) Insignia
1 Other structural changes(may require a plan review)
L..
Fire Safety .. Other
Note: This permit expires one year after date of purchase. (Non-refundable)
Work is completed at this time. An inspection is requested.
Work is NOT completed at this time,I will call when ready. ..,-
..
Make check payable to: D,..pt.of Labor&Industries
(-Signature of'applicant or authorized representative, \
FEES DUE $ .
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F622-036-000 rnfc,! -i! ,‘;.'permit -. - . •qiiite-Olympia Canary-Inspector Green-Contractor Pink-Purchaser Goldenrod-Purchaser
0(/26/2004 11:58 5093241567 SRHD EH5 -Mut ui/ni
JUL 26 2004 11:37 FR I TO 3241567 P•t62/605
THIS IS NOT A PERMIT
Penz itle*will be assessed for
�i I�, , t e commencing work without a permit
� #
/� • eyMANUFACTURED HOME
1 i707 E.Sprague Ave.,Suite 106 Spokane Volley,WA 99206 pppli:anon>I: BAD-04-071e3
Applied: 07/2812004
Job Address: 1109 S DISHMAN RD
SPOKANE WA 99212 issued:
I
Description: REPLACEMENT OF SINGLE WIDE MOBILE HOME Expires: 01/24/2005
Subdivision: Lot: BM: Parcel No: 45203.0517 Zoning:
Owner: THOMSON,PATTY
Applicant: THOMSON,PATTY Phone: (509)928-0691
Address; 1320 S SIESTA DR
SPOKANE,WA 99206-3106 j
I
Contractor: Phone:
Address: Lie No:
1
I
General Information: Fees:
SECTIONS iw PER SECTIll0N FEE 50.00
YEAR BUILT 1967 Total Calculated: 50.00
DIMENSIONS 12 X 60 I Depoaita/Recolpts: 0.00
#OF STORIES 1
#OF BEDROOMS 1 i Total Due: 50.00
FRONT SETBACK 40
REAR SETBACK 40
LEFT SETBACK 20 i
RIGHT SETBACK 20
I
1
CM OF SPOKANE VALLE L
APPROVED FOR SUBNIITT
c I . :
Sulidin� tti. �"ICetA k)
Pla ring
..., 1 _ 00,44
<el4Q4S
- G,,d ) ,1-7,-errrpi-s- ow•I'
r
THIS IS NOT A RECpPT I
JUL 28 2004 13:00 5093241567 PAGE.01
11 1
:,e4 11Z9
7—T4L FLANKING
ThIS SUS OM is being U&Mftd for the purpose of
*btakft 4 bkftft POMW and is a true and correct
repmentallon of the propow. AN known propertyIWOO/dInmulom. curb lifts. WUdMM and eavenionts
have been WOMHI&d
. A, Pip MmUcaled an waftnds,
bodies of we* Steep OOM ormcal areas.
Slhqpnm"d:!—,M'!, 7v=\o r 0
Date: 7 -- � C) y
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