2001, 10-16 Permit App 01009152 MHProject Number: 01009152 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Date: 10/16/2001 Page 1 of 2
Permit Use: SINGLE WIDE MANUFACTURED HOME Contact: WESTHAVER, PATRICIA
Address: 21817 N GLEN DR
C - S - Z: COLBERT, WA 99005
Setbacks: Front Left: Right: Rear: Phone: (509) 467-2008
Group Name:
Site Information: Project Name:
Plat Key: 005186 Name: CENTRAL MBLIP
District:
Parcel Number: 35231.6036
Block: Lot:
SiteAddress: 421 S HOWE RD
SPOKANE, WA USA 00000
Location:: SPO
Zoning: UNKN Unknown
Water District:
Owner: Name: WESTHAVER, PATRICIA
Address: 21817 N GLEN DR
COLBERT, WA 99005
Hold: 111
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review
Plan Review
(ti7v0--1( •
Released .
.117i .
Stormwater Control
Released By
Manufactured Home
%- LA.y. r
Contractor: MR B"S MOBILE HOME Firm: MR B"S MOBILE HOME SERVIC
Address: P 0 BOX 796 Phone: (509) 276-2086
DEER PARK., WA 99006
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Units Unit Desc
1 SECTIONS
1 Y OR BLANK
Fee Amount
$50.00
$11.00
Permit Total Fees: $61.00
Operator: MKC Printed By: MKC Print Date: 10/16/2001
Project Number: 01009152 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes: ::>.....................................................................................
Payment Summary:
Permit Type
Manufactured Home
Date: 10/16/2001 Page 2 of 2
Fee Amount Invoice Amount Amount Paid Amount Owing
$61.00 $61.00 $0.00 $61.00
$61.00 $61.00 $0.00 $61.00
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 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: MKC Printed By: MKC Print Date: 10/16/2001
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StreetAddress:
Assessor's Tax Parcel Number(s):
Legal Description:
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SI1E INFORMATION
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Project Description: \Of\0 V \ 1/lc
0 Building Permit
O Change in Use
0 Grading
O Manufactured Home Permit
Relocation
O Sign
0 Tenant (New/Change)
O Other
I pa men Use On
\'ater i)isl ict/p'un .tar. '. , ,
Srwcr I) trtct k'un yor
Road width
Setbacks
ljagtiG
Schont l) stria.
t
u
in Distrtct
Z', i t
iefe
OWNER/APPLICANT INFORMATION
El Indicate who should be contacted renardinn this hro'eeI
C w eer.
tt S
Phone: `q 0
i 1 it j Fax:
0 Applicant
y}Phone:
/1Z}` _/J " Fax:
h,. -a^ili�ng Address:(}
t-^t /
}
1t
Mailing Address:
% t�} l
C') ein \)
ty, St to Ztp /} (
pl /� j� _.
I
City, State, Zip
0 Contractor
Phone
Fax
0 Architect/Engineer
Phone
Fax
Mailing address
Marling address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROJECT INFORMATION
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2"d 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:
/ S
What is the square footage of the sign
face?
How high is the sign?
Year:
M� •
/ �J,,, -
# of signs
Area of existing signs
Relocation
Fire Safety
Previous address
fr 95'1\ sp
Proposed use
Value
Fire Sprinkler _
Paint booth Fire Alarm
Tent
Fireworks display
Special Inspection
qI'
Non -Residential Ei
e Compliance?
Firm Name
Phone
Plans Examiner
Phone
Inspectors:
Address
Inspector
Phone
0 Concrete O Welding 0 Bolting 0 Reinforcement
Address
DITIONAL SITE INFORMATION
Are there structures on the property? ' 0 Yes It(No
Ifyes, identi on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shorelin .
If yes, identi on site plan 0 Ycs 10"—No
What is the current use of this property?
Is your property in a designated wildlife habitat area? /
0 Don't know 0 Yes o
Will the site be served by a septic system? l7 Yes No
Is any part of the property within a 100 yr flood plain?
Ifyes, ident� on site plan
0 Maybe 0 Don't know 0 Yes o
Are or will there be wells located on the property? /
Ifyes, ident on the site plan 0 Yes o
Are there any wetlands, streams or ponds within 200 et of the property?
If yes, ident� on siteplan 0 Yes No
Is there evidence of fill or excavation on the property? ��
0 Yes KJ No
Are there slopes greater than 30% on the property? (30 ft ri5e in 100 ft)
( / %) 0 Yes re o
Are critical or hazardous materials used or stored on site?/
0 Yes n No
DEPARTMENT USE ONLY
1s the property in a designated Sformwater Control Area a
Is pubic sewer av fable to the site? 0 Yes : O No
Is t ie property instcie the ASAP
•.:- ,r.,.>>, ..
O Sees , 0 No
7 Yes'
Ts public water available to the site? t O Yes Cl No
Is `the property inside the
ated.within f feet of a Nato al Resource r'ltes?
Ct Yes
Date Received:
Staff Representative:
METHOD OF PAYMENT
❑ CASII 0 CHECK ❑ ❑ '"*_ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTI IORIZED SIGNATURE:
SUBTOI'AI.