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2003, 09-11 Permit App BLD-03-02444 MHPROJECT APPLICATION WORK SHEET SPOKANE COUNTY BUILDING AND PLANNING DEPARTMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 ((. 3 SPECIFIC SITE INFORMATION Street Address: Pinecroft MHP# I I b 11920 E. Mansfield Spokane, WA Assessor's Tax Parcel Number(s): Legal Description: Project Description: S' e ( E- '-1/4-1 ? N ems@ 1-1- HP O Building Permit 0 Change in Use 0 Grading n Manufactured Home Permit 0 Relocation 0 Sign 0 Tenant (New/Change) O Other Department Use Only Water District/Purveyor Sewer District/Purveyor Road width Setbadrs Front Rear: Left Right: School District fire District Zoning OWNER/APPLICANT INFORMATION Xff; Owner.Prare: Douglas Saty wrwv uc (509) 891-2581 Fax: unnoceru , spa umy LJA y/U�t2i © Applicant Phone Fax: Mailing Address: _ E. 14111 Desmet City Mailing Addres State, Zip Spokane, WA 99216 City. State, Zip S-Gentractor PhDAe f� I_ a `� f Fax 1 J 1 0 Architect/En liner phone Fax 4144M111.302 City, a C.Y Mailing address zip v.., ,,,.. L....)ri. i 9-7(7,City. State Zip WA Ste or license # t/ti662(Le Contact name: 8uikiing height to r PROJECT INFORMATION Building Information Dimensions / xS`11 Oixupancy group Cost of project Revised 07/25/03 # of stories Main floor sg. ft Unfinished basement sq. ft. Total ha'0( , Co; iIr /-poi---( rd floor sq. ft. Garage sq- ft Heat sour electric, a ec,) . �—�C�1�r 7 k 6A4P1-1.2-c-ci/L� Finished basement sq. ft Deck sq. ft. Manufactured Home Sign With: 14ft_ Length 5 �r What is the square footage of the sign face? How high is the sign? Year: Make: f # of signs Area of existing signs Relocation Fire Safety Previous address 39 F ''TT c p _ (/ „ Y ,�� / , , (1 (�iC.JC� fQQ�� \/a- k . \/ CJ Fire Sprinkler — Tent Paint booth _ Fire Alarm — Fireworks display — Proposed use1 �, �. Value 95 ©U A•.� Special Inspections Required? Non -Residential Energy Code Compliance? Finn Name Phone Plana Examiner Phone Inspectors: Address --- Inspector f Phone0 Concrete 0 Welding 0 Bolting 0 Reinforcement Address Are there structures on the property? O Yes CJ No f3^�, r on site plan What is the current propsizeY(-,m b i(��< +Z- ' J fcct or acres) /' / f � f�T� �}— Is any part of the property within 250 feet of a sh _Eyes, identify on site plan 0 Yes a No What is the cauent use of this property? /71h ( t C "`-C 6:34)re-I-K Is your property in a riPcignated wildlife habitat area? _� 0 Don't know 0 Yes !Q No Will the site be served by a septic system? 0 Yes -�No Is any part of the property within a 100 yr flood plain? fyer, on site plan 0 Maybe 0 Don't know 0 Yes $�No Are or will there be wells located on the property? Ifs identib aRthe rite ' 0 Yes �J'No Are there any wetlands, streams or ponds within 200 feet of the property? If9a*, idnit y on site plan 0 Yes �No Is there evidence of fill or excavation on the property? 0 Yes -EF1clo Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( / %) 0 Yes ergo Are critical or hazardous materials used or stored on site? O Yes erNo Is the property in a designated Stotmwater Control Area? 0Yes 0No Is public sewer available to the site? 0 Yes 0 No Is the property inside the ASA? 0 Yes 0Yes 0 No 0No 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 0 Yes 0 No Natural a Resource Atr:a& Date Received: Staff Representative METHOD OF PAYMENT ❑CASH ❑CHECK ❑X `7 ❑ FARED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: Revised 07/25/03 EXPIRES: SUBTOTAL TOTAL FEE MAKE CHECKS PAYABLE TO SPOKANE COUNTY PERB.4T CERISE Department of Labor & Industries Factory Assembled Structures Section INSTRUCTIONS: 1. Complete all spaces, Including the signature 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 tiro name Dayume phone (••••''- • '5 - Do not complete shaded areas Address City I Date / , • State ZIP • Installer/Contractor/Dealer Phone ( Address City !Contractor's registration number State ZIP+4 Serial Number(s) HUD Number(s) Place fee -=111111MIN\ 11 LI amount In proper box Mechanical Heat Pump Air Conditioning Furnace Installation (gas or electric) Gas Piping Wood Stove ---- Pellet Stove ---- 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 Setiallsio. • SoriaiNo, Place fee amount in proper box Electrical Heat pump - : Air Conditioner Furnace Installation (gas or electric);-, Wood Stove (if applicAle),_ Pellet Stove (if applicabIe),' 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 Original Permit No. Insignia , Other' "^ Miscellaneous Plan review Reinspection - - - - Note: This permit expires one year after date of purchase. (Non-refundable) bjWork is completed at this time. An inspection is requested. Work is NOT completed at this time, I will call when-reagy. Make check payable to: Dept. of Labor & Industries t Signaturee o pplicciht or auth59 - , FEES DUE $ t tative 0 1— o_ cr) e'45 Z W — 2 C4 < 0z u_ CD < 0,1 W (r) (f) _1 < W < 0 a. Request approvedRequest denied because t-r specific yiicla tionsrtir VVa, shillgtoint,rtillesvdainidurr:tgouclaoiniolpnisy• Sted witilin 20 days 14ticsns mustust be corrected •and nspection:rtqueIRCW. All i f. volati()ns noted are shosin on an theja.Otrce v,i()Intiou e.. perm t chapter 43.2 . Uterati()11: 11.c“r3 fOrIlIS 1 Oquired 1cn nitast-be completed and fees submitted before reinspection. r Dale Area offiet, Insilector ITotal pages w ED 1— uJ a_ 0 1— _J F622-036-000 mfgd/mobile home alteration permit 11-02 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser