2002, 07-18 Permit App 02006034 Relocate MHProject Number: 02006034 Inv: I
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: RELOCATE DOUBLE WIDE MANUFACTURED
HOME
Setbacks: Front 4 Left: 5 Right: 5 Rear: 5
Site Information:
Date: 7/18/02 Page 1 of 2
Contact: WOLD, SEAN
Address: 11303 E JACKSON, #35
C - S - Z: SPOKANE WA 99206
Phone: (509) 893-1541
Group Name:
Project Name:
Plat Key: 005922 Name: SONRISE PLACE MANUFACTURED PARK District: H
Parcel Number: 45092.9014
Block: Lot:
SiteAddress: 11303 E JACKSON RD #035
SPOKANE, WA 99206
Location:: SPO
Zoning: UR-7
Water District:
Urban Residential-7
Owner: Name: WOLD, SEAN
Address: 11303 E JACKSON, #35
SPOKANE WA 99206
Hold: ❑
Area: .00 Acres Width: 53 Depth: 84 Right Of Way (ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Special Reviews
Permits:
Contractor: OWNER
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Released By:
co (i
Manufactured Home
Firm: OWNER
Phone:
Units Unit Desc
2 SECTIONS
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$100.00
$22.00
$122.00
Operator: JAS Printed By: JAS
Print Date: 7/18/02
Project Number: 02006034 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/18/02 Page 2 of 2
Notes:
L & I TECHNICAL INSPECTION MUST BE CONDUCTED AND CORRECTIONS MADE, IF
ANY, PRIOR TO OCCUPANCY
Payment Summary:
Permit Type Fee Amount Invoice Amount
Manufactured Home $122.00 $122.00
$122.00 $122.00
Amount Paid
$0.00
$0.00
Amount Owing
$122.00
$122.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and f►nds 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: JAS Printed By: JAS
Print Date: 7/18/02
J
equest dented because of specific violations of Washington rules and regulations.
nspectian requested within 20 days of the notice of violation date. Failure to comply
43.22 «CW.. Al( violations noted are shown on a "Alteration/Factor Permit
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete all spaces, including thesignature box (marked with an X).
2. Draw a map on reverse side of WHITE copy only.,
3. Forward completed permit and fees to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection(s) with the same L&I office per the checklist.
MANUFACTURED/MOBILE HOME
ALTERATION PERMIT
Owner last name
Address
first name
Day time phone
)
City
Do not
complete
shaded
areas
Date
State ZIP
Installer/Contractor/Dealer‘
Address
Phone
City
Contractor's registration number
State ZIP+4
Serial Number(s)
HUD Number(s)
Place fee amount in proper box
Mechanical
Heat Pump
Air Conditioning
Furnace Installation (gas or electric)
Gas Piping
ood Stove ----
Pellet Stove ---- Serial No.
Gas Room Heater
Gas Decorative Appliance
Range: changing from electric to gas
Gas Water Heater replacement
Water Heater: changing from electric to gas
Plumbing
Fire sprinkler system (also requires a plan review)
Each added fixture
Replacement of water piping system
Structural
Inspection as part of a mechanical installation
(cut truss/floor joist, sheet rocking)
Reroofs (may require a plan review)
Changes to home when additions bear loads on home per
the design of a professional (also requires a plan review)
Other structural changes (may require a plan review)
Fire Safety
Serial No.
Place fee amount in proper box
Electrical
Heat pump
Air Conditioner
Furnace Installation (gas or electric)
ood Stove (if applicable)
Pellet Stove (if applicable)
Gas Room Heater
Gas Decorative Appliance (if applicable)
Range: changing from gas to electric
Electric Water Heater replacement
Electric Water Heater replacing Gas Water Heater
Each added or modified circuit
Hot Tub or Spa (power from home electrical panel)
Replace main electrical panel
Low Voltage Fire/Intrusion Alarm
Fire Safety
Miscellaneous
JPlan review
Reinspection - - -
Insignia
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Original Permi
No.
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, 1 will call when ready.
Make check payable to: Dept. of Labor & Industries
FEES DUE $
(Signature of applicant or authorized representative
LX
LiRequest approved or,
It Violations must be corrected and re
a, may result in penalties per, chapter
Continuation Form".
F622-036-000 mfgd/mobile home alteration permit 7-02 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
Aink
SPOKANT Couxry
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: I i 3 03 C_t ���� �� V - #3
> Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: ry) ()() i yty ►'Yl a l/ L[ C-0 G7 2 red hQwt e-g n/'Vk l ertVCI /CST /O a r7 ()
❑ Building Permit
❑ Change in Use
❑ Grading
O Manufactured Home Permit
❑ Relocation
❑ Sign
❑ Tenant (New/Change)
❑ Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
-
Setbacks
Front Rear:
1,11: Right:
School District
Fire District
"Zoning
OWNER/APPLICANT INFORMATION
Indicate who thou/ die contacted re2ardinp this bro
Owner.
a.n (/00101
Phone:
I ,,
Applicant: Phone: 4,3 / rj'C/ /��
plc) Fax: 3a7 - / 2 s
Mailing Address:
Mailing Address:
I)303E_ -3--4crsw
City, State, Zip
City, State, Zip
Sao Irowil, Ira gq aC ;
❑ Contractor
Phone
Fax
❑ Architect/Engineer Phone
Fax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROTECT INFORMATION
Building Information
Building height to peak
# of stories
Main floor sq. ft.
Unfinished basement sq. ft.
Dimensions
Total habitable space
2nd floor sq. ft.
Finished basement sq. ft.
Occupancy group
Construction type
Garage sq. ft.
Deck sq. ft.
Cost of project
I-Ieat source (electric, gas, etc.)
Manufactured Home
Sign
Width:
Length: 66
(/[J
What is the square footage of the sign
face?
How high is the sign?
/rear: /U1_ C7fJ1O
Make:
Make:
roan
# of signs
Area of existing signs
Relocation
Fire Safety
Previous address
Fire Sprinkler
Tent
Paint booth Fire Alarm
Fireworks display
_ _
Proposed use
Value
Special Inspections Required?
Non -Residential Energy Code Compliance?
Firm Name
Phone
Plans Examiner
Phone
inspectors:
Address
inspector
Phone
0 Concrete
0 Welding
0 Bolting
0 Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? 0 Yes 0 No
Ifyer, identify 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?
Ifyes, identiO on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes 0 No
Will the site be served by a septic system? 0 Yes 0 No
Is any part of the property within a 100 yr flood plain?
Ifyes, ident f on site plan
0 Maybe 0 Don't know 0 Yes 0 No
Are or will there be wells located on the property?
Ifyes, identijt on the site plan 0 Yes 0 No
Are there any wetlands, streams or ponds within 200 feet of the property?
If yes, identibt on site plan 0 Yes 0 No
Is there evidence of fill or excavation on the property?
0 Yes 0 No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
(,G%) 0 Yes 0 No
Are critical or hazardous materials used or stored on site?
0 Yes 0 No
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
0 Yes 0 No
Is public sewer available to the site? 0 Yes 0 No
Is the property inside the ASA? 0 Yes 0 No
0 Yes 0 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?
0 Yes 0 No
Date Received:
Staff Representative:
METHOD OF PAYMENT
VISA
❑ CASI-I ❑ CHECK D 0 • 0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DIME
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SUBTOTAL,
TOTAL FEE
MINIMUM PERMIT FEE IS $35.0i0 PLEASE
' MAKE CHECKS PAYABLE TO SPOKANE
COUNTY PERMIT CENTER