2003, 03-11 Permit App 03001522 Relocate MHProject Number: 03001522 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: RELOCATION OF SINGLE WIDE
MANUFACTURED HOME
Date: 3/11/2003 Page 1 of 2
Contact: MEYER, WILLIAM D.
Address: 11303 E JACKSON RD #58
C - S - Z: SPOKANE, WA 99206
Setbacks: Front 5 Left: 5 Right: 5 Rear: 5 Phone: (509) 921-9351
Group Name:
Site Information: Project Name:
Plat Key: 005922 Name: SONRISE PLACE MHP MFG HOME PK District:
Parcel Number: 45092.9014 Block: Lot:
SiteAddress: 11303 E JACKSON RD #002 Owner: Name: MEYER, WILLIAM D.
SPOKANE, WA 99206 Address: 11303 E JACKSON RD #58
Location:: SPO SPOKANE, WA 99206
Zoning: UR-7 Urban Residential-7
Water District: 999 UNKNOWN
Hold: EI
Area: •,505.00 Acres Width: 53 Depth: 85 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Plan Review
Special Reviews
Permits:
L
Released By: e91(___
3 - t I -0 f)eif
Releised Bv:.
Contractor: OWNER
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Manufactured Home
Firm: OWNER
Phone:
Units Unit Desc
1 SECTIONS
I Y OR BLANK
Fee Amount
$50.00
$11.00
Permit Total Fees: $61.00
Operator: RMB Printed By: RMB Print Date: 3/11/2003
r
Project Number: 03001522 Inv: 1
Application Date: 3/11/2003 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary: . .
Permit Type
Manufactured Home
Fee Amount Invoice Amount Amount Paid Amount Owing
$0.00 $61.00
$61.00 $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 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: RMB Prinlcd By: RMB
Print Date: 3/11/2003
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Street Address:
// 307 67, .774 c evtl #�2
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: "MAIL( /`4 -7 1Q tr7 H
❑ Building Permit
O Change in Use
0 Grading
'Manufactured Home Permit
O Relocation
❑ Sign
0 Tenant (New/Change)
0 Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front Rear.
Left: Right.
School District
Fire District:
Zoning
OWNER/APPLICANT INFORMATION
Indieale who should be tonlaeied re2anlin2 !iris Artriea
a(hvncr
74)/LL Li AIM D.
Phone. QF ( - 4 3 S'
/ rEri y Fax: 3-34/`C? ?9Rnt�-
0 Applicant
Phone:
D Fax:
Mailing Address:
//303 F
Ti4r_ f45dL S"g'
Mailing Address:
City, State, Zip -
---57/on,� 4 '
- U 14 9 92-a
City, State, Zip
❑ Contractor
% Phone
Fax
❑ .\rchitect/linginecr
Phone
I ax
Mailing address
Mailing address
City, State Zip
City, State Zip
.\ \ State Contractor license #
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Hain floor sq. ft.
Unfinished basement sq. ft.
1)imcnsions
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
pleat source (electric, gas, etc.)
Manufactured Home
Sign '
Width: Iii.
Length:
a#
What is the square footage of the sign
face?
How high is the sign?
Year:
119q
Make:
CI4A-04p'f0,d
of signs
Area of existing signs
Relocation
Fire Safety
Previous address
Fire Sprinkler
Tent _
Fireworks display
Paint booth _ Fire Alarm
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
Phone
Plans I xaminer
phone
Inspectors:
Address
Inspector
Phone
D Concrete
D Welding
0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes $ No
If yet, identii on site plan
What is the current property size?
(square feet or acres)
Is any part of the property within 250 feet of a shoreline?
If yes, identf on site plan 0 Yes o
What is the current use of this property?
Is your property in a designated wildlife habitat ar a?
0 Don't know D Yes rNo
Will the site be served by a septic system? D Yes pi \ 0
Is any part of the property within a 100 yr flood plain.
If yes, identi fjt on sate plan
0 Maybe 0 Don't know 0 Yes N%No
Are or will there be wells located on the property?
If yes, identify on the site plan 0 Yes 1701No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, ident6, on site plan 0 Yes NO/No
Is there evidence of fill or excavation on the property?
0 Yes VigNo
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( — %) 0 Yes i i No
Are critical or hazardous materials used or stored on site.
❑ Yes No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
❑Yes
CI No
Is public sewer available to the site? ❑ Yes 0 No
Is the property inside the ASA?
❑ Yes
❑ Yes
0 No
❑ No
Is public water available to the site? 0 Yes 0 No
Is the property inside the PSSA?
0 Yes
0 No
Is the property located within 1000 feet of a Natural Resource Area?
❑Yes DNo
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASH ❑ CHECK ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE.:
EXPIRES:
BANKCr1RD NUMBER:
AU'1'IIOR1ZI'D SIGNATURE:
SUBTOTAL
TOTAL FEE
MINIMUM PERMIT FEE IS $ SAADPLEASI
MAKE CHECKS PAYABLE TO SPOK.A\P.
COUNTY PERMIT CENTER