2003, 02-28 Permit App 03001199 MHProject Number: 03001199 Inv: 1 Application Date: 2/28/2003 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Parcel Number: 45083.0128 Block: 1 Lot: 6
SiteAddress: 9710E KNOX AVE Owner: Name: URIBE, VENCESLAO
SPOKANE, WA USA 99206 Address: PO BOX 141444
Location:: SPO SPOKANE WA 99214
Zoning: UR -3.5 Urban Residential 3.5
Water District: 011 MODERN Hold: ❑
Area: 12,618 Sq Ft Width: 90 Depth: 140 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site
Plan
Approach / Drainage
Released B
Sewer Review/�� Rcicatccl B L*7�t rC�vf—
L.0
Permits: .
Operator: JAS Printed By: JAS Print Date: 2/28/2003
Project Number: 03001199 Inv: I Application Date: 2/28/2003 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: YUKON TRANSPORT
Address: PO BOX 1330
RATHDRUM, ID 83858
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Notes:
Payment Summary
Permit TN pe
Manufactured Home
Manufactured Home
Firm: YUKON TRANSPORT
Phone: (208)699-1204
Units Unit Desc
Fee Amount
2 SECTIONS
$100.00
1 Y OR BLANK
$22.00
Permit Total Fees:
$122.00
Fee Amount Invoice Amount Amount Paid Amount Owing
$122.00 $122.00 $0.00 $122.00
$122.00 $122.00 $0.00 $122.00
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: JAS Printed By: JAS Print Date: 2/28/2003
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
9116 SPECIFIC SITE INFORMATION
Street Address:
Assessor's Tax Parcel Number(s): eUKQ3� Q�<8
Legal Description:
Project Description: /CCE L6=
O Building Permit O Change in Use O Grading Manufactured Home Permit
O Relocation O Sign O Tenant (New/Change) O Other
Department Use Only
Water Di tract/Purveyor.
Sewer District/Purveyor
Road width
Setback
F.
Mading Address:
Front Reat
School District
Fire District
Zoning
Deck sq. ft.
Cost of project
I Teat sconce (electric, gas, etc.)
Left Right
OWNER/APPLICANT INFORMATION
® Indsw, ahn vi ld M mnta*d rbir howl
'® 0T .rc
Phone ,� ..a02' ��S
❑ Applicant Phone.
,f p p�
(/ /e4/dG
Fax:
F.
Mading Address:
Mailing Address:
fin', State, Zip
Construction type
Cin', Stare, Zip
Deck sq. ft.
Cost of project
I Teat sconce (electric, gas, etc.)
❑ C tractor
Phona
❑ Architect/Fngineer Phone
K / 7
Fax
Medi Wares
Mailing addmss
330
City 'tare %ip
City, State Zip
uy'A/,State (:ontractor licrnse/#/
�S�r,�.F
Contact name:
Building Information
Building height to peak
# of stories
Main Floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2nd Boor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
I Teat sconce (electric, gas, etc.)
Y
Manufactured Home
Sigh
Width:
I Anigth: //
What is the square footage of the sign
face?
I low high is the sign?
Year/
Make:
# of signs
Area of existing signs
O Don't know O Yes R No
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
Relocation
Fire Safety
Previous address
Piro Sprinkler "fent _
Paint booth _ Fire Alarm _ Fireworks display
Proposed use
Yalu,
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name Phone
Plans Examiner Phunc
Inspect..:
Address
Ifyes, identify on site plan O Yes krN,
Inspector Phone
O Concrete O Welding O Bolting O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? O Yes Pr No
What is the current property size?
I x, idenjify on rite plaor
(square feet or acres
Is any part of the property within 250 feet of a shoreline?
What is the current use of this property?
Ifyes, identify on site plan O Yes krN,
O No
Is your property in a designated wildlife habitat area?
Will the site be served by a septic system? O Yes 19- No
O Don't know O Yes R No
Is any part of the property within a 100 yr flood plain?
Are or will there be wells located on the property?
IJye , idents on tete plan
Ifyer, idtnti on the site plan O Yes W No
O Nfavbe O Don't know Cl Yes XNo
O Yes O No
Are there any wetlands, streams or ponds within 200 feet of the property?
Is there evidence of fill or excavation on the property?
1
Ifyes, identify onsite plan O Yes M No
❑ Yes No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
Are critical or hazardous materials used or stored on site?
0 Yes O No
1 ❑ Yes No
DEPARTMENT USE ONLY
Is the property in a designated Storrawater Control Area?
Is public sewer available to the site? O Yes O No
O Yes
O No
Is the property inside the ASA? O Yes
O No
Is public water available to the site? O Yes O No
O Yes
O No
Is the property inside the PSSA? ❑ Yes
O No
Is the property located within 1000 feet of a Natural Resource Area?
O Yes O No
Umc R"'., 1
Staff Repro antatn c
METHOD OF PAYMENT
V
❑ CASH ❑ CHECK ❑ ❑ ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE.:
EXPIRES:
SUWFOTAL
TOTALFEE
MINIMUMPE fMFEEISMWPUAASF.
M.1k(i C11F.CA.S P4Y.181P.'f0 $POA.ING
COUNT]" pl. _le I"I' C6:!YI'ER
ADDRESS ` C (6
ZONE
ROAD WIDTH 56
FRONT_3a _'_
COMMENTS_
REVIEWED
Pa. GE
'to
Y
UP 64460
I
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