1993, 06-03 Permit App 93004192 MHPROJECT NUMBER= 93004192
APPLICATION
DATE= 06/03/93 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 11119 E EMPIRE AVE
ADDRESS= SPOKANE WA 99206
PERMIT USE= DOUBLE WIDE MOBILE HOME
PLAT#= 001038
BLOCK= 4
AREA=
# OF BLDGS= 1
OWNER=
STREET=
ADDRESS=
PLAT NAME=
LOT=
F/A=
# DWELLINGS=
TOOTHAKER, JOHN R.
11115 E EMPIRE AVE
SPOKANE WA 99206
PARCEL#= 45043.0710
GRANDVIEW ACRES
5 ZONE= UR-3.5
F WIDTH=
WATER DIST
CONTACT NAME= JOHN TOOTHAKER
BUILDING SETBACKS: FRONT= 10-0+ LEFT= 20
DIST#=
DEPTH=
H
R/W= 40
PHONE= 509 928 5363 Li",
99-g-.'7r.
PHONE NUMBER= 509 928 5363
RIGHT= 10 REAR= 20
****************************** REVIEW INFORMATION *****************************
DEPARTMENT
REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
ENGINEER NEW
COMMENTS:
HEALTHDIST
COMMENTS:
COUNTY ROAD APPROACH 3
NEW OR ADDITIONAL WASTE WATER
J'
Cf : 1
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER
YR/MAKE= 93/FLEETWOOD
SERIAL#=
ITEM DESCRIPTION
PHONE=
MODEL=
WIDTH= 44 LENGTH= 64 HEIGHT= 10
INSPECTION FEE
STATE SURCHARGE
COUNTY SURCHARGE
PERMIT TYPE FEE AMOUNT
QUANTITY
2
Y
Y
FEE AMOUNT
100.00
4.50
18.00
AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 93004192 APPLICATION DATE= 06/03/93 PAGE= 02
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MOBILE HOME PMT 122.50 .00 122.50
122.50
PROCESSED BY: DOMITROVICH, ROBIN
PRINTED BY: BARRY HUSFLOEN
.00 122.50
******************************** THANK YOU ************************************
APPLICATION WORKSHEET
LGeneral Information
Job address
-> //9
Parcel number
—Owner t
v,
Mailing address
City
Phone
State
Site ii-rformation
i egal Descnption
Property size
Water llstrict
Numberot:
Dwellings
Buildings
0
Project Information 14
Change of use
Permit Use
New
bgddition
Remodel
Building Information
Dwelling units
Budding dimensions
Occupant load
Budding height
Stories
"total square Iootage
Req'd parlang
Handicap parking
Spnnkler system
Cnttcal Material
uare foota,e breakdown
• ain oor
•t er
inn • •asemcnt
�n ins e• •asemcnt
,
a rage
Contractor Information 1
Heating and insulation information at—values)
Heat source
1-latceiltng
Vaulted ceiling
Above grade wall
Below grade wall
Floor
Slab on grade
Door (u—value)
Window
Furnace etticency
total window area
% of lloor area
t
Building contractor
Plumbing contractor
Phone
License number
Phone
License number
Mailing address
Mailing address
City, state, zip
City, state, zip
Heating contractor
Other/ Lender
• Phone
License number
Phone
License number
Mailing address
Mailing address
City, state. zip
City, state, zip
PROJECT CONTACT
PHONE
Spokane County Division of Buildings
1026 West Broadway Ave * Spokane, Wa 99260 * (509) 456-3675
I
_ADDRESS: I, 1 11
f.
ZONE: H
- ROAD AVIDTH:74t0 I
FRONT: ';,0011-- RANKING:
COMMENTS: II
_REVIEWED BY:
6 zi
APPLICATION FOR CERTIFICATE OF EXEMPTION'
APPLICATION FEE -y.5 t 0 /t -22,2cR g//a/qL
1. Applicant's Name: John Toothaker
Address: 1 1 1 15 E. Empire
APPLICATION NO 64;---5
Home Phone: 928-5363
Business Phone:
City: Spokane State: Wa. Zip:99206
2. Legal descript}gn of property for which this "Certificate of Exemption" is being applied:
Section 4 Township .25—N. Range ,t 4/ within Spokane County, Washington.
The Easterly one half Lot 5, Rlnrk 4 South of the R R RJW
and the Northerly 11S feP+ of the Easterly 19 Feat of the
Westerly one half of Lot S. Block 4. Sonth of the RAT_ R/W.
in t.randview Aortas as rernrded in Ronk "R". page 19 of Plats
in Spokane rnnnty Wn
3. Tax parcel number L/ 5.0 Y3, 07/9 Oki /04. Property size: (sq. IL or acres) SS A r
5. Zoning: //2 7• .5., Comprehensive Plan category: tne84� •
7. Intended use of property: csr
3. For all 3.3(b)(2) and 3.3(c)(d) exemptions, the Spokane Co • ty Health District must complete the following:
A preliminary consultation has been ma. ... rscuss the Certifi ate f E emption. The applicant has been
informed of applicable requirem - d standards. U0 /eV
—ire u
azure Date
9. I, the undersigned, swear under penalty of perjury that the above responses are made truthfully and to the best
of my knowledge. I also agree to furnish any further documentation that may be required by the Subdivision
Administrator. I also understand That, should there be any willful misrepresentation or veillful lack of full
disclosure on my part. Spokane County may withdraw any approval that it might issue iniieliance on this
applicati
Ntnc SIGNLDee Ctx itA %
51er4e D
Notary Publi(in and for the S of Washi n
Residing a: � c* c D Vc NM -
My appointment expires IQ
— zes fr.Z-,
t;\E SUE1
sir`eJ• °e 'yg9.9
Date :H )•
NOTARY SEAS2 ^.FS;wA O:-"cj
STAFF ONLY
SUBDIVISION
RATOR FINDS
IS
APPROVED/DENIED NIED FOR SAIID PROPERTY D EACRIBED ABOVE, URSUANT TT THIS "CERTIFICATE OF O EXEMPTION"
COUNTY SUBDIVISIONS) SECTION 3 • 3.D
THIS CERTIFICATE OF EXEMPTION SHALL BE SUB_ECT TO THE FOLLOWING CONDITIONS
AND/OR FINDINGS:
1. The applicant shall comply with all requirements and regulations of the Spokane County Zoning Code.
2. The applicant shall comply with all requirements of the Spokane County Health District and/or Utilities
Department regarding wastewater disposal and on -site water or public water systems.
3. The applicant shall comply with the following additional conditions:
THIS CERTIFICATE OF EXEMPTION IS AND SHALL RUN :tfl! I rE r Ai n,, a ND SHALL BE
APPLICABLE TO THE APPLICANT, OWNER, THEIR HEIRS, SUCCESSORS OR ASSIGNS.
:LtL ,za , I9 ea
/DENIED THIS 7D DAY OF
THIS CERTIFICATE MUST ACCOMPANY YOUR BUILDING PERMIT APPLICATION
SPOICA*rc COUNTY PLANNING DEPT.. 721 N. JEFFERSON, SPOKANE, WA 99260 (509)456-2205
CERTIFICATE OF EXEMPTION ISSUED BY SPOKANB COUNTY, WASI GTON
SbP-13-'93 09:09 ID:UTILITY SPO TEL NO:509-456-4715
09/13/S3 oe:32 Q809 324 1604 SP CT-Y $EALTA
SPECFICATI
TYPE OF SEWAGE SYSTEM:
LINEAL OR SQUARE JGE,
'ANC %Y,D''1.
OF SE F!iii':A :, E tO 60TTO
OF SEWGE $Y T, vi.�
OMBERI
iF YUCU CANNOT FNSTALI. THIS SYSTEM FCC° pE B,�Q
TO THIS APPROVED PLAN. YOU MUST GALL TN PC PEPS $
PRIOR TO INSTALLATII pt�Cr��NGEF789 D30$4'
�'M+r Ai 2-. sLaFE
1 as,wa amour
#141 P02 - - "
It 002
TOOIj HEIVEEI A-ZO dS L9ST i'ZC 60S$ LT:60 C6/CT/60