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2002, 03-08 Permit App 02001453 Relocate MHAitIlk SPOMNE COUNTY PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 Project Description: TYPE OF APPLICATION O Building Permit 0 Change in Use O Grading 0 Manufactured Home Permit O Relocation O Sign D Tenant (New/Change) O Other SPECIFIC SITE INFORMATION Street Address: y6-- 6,5-- t 4 o--,--, / . Assessor's Tax Parcel Number(s): / C '/ J !� % c�0'- J Legal Description: Department Use Only Water District/Purveyor: Sewer District/Purveyor Road width Setbacks Front: Lett: Rear: Right: School District: Fire District: Zoning OWNER/APPLICANT INFORMATION El Indicate who should be contacted regarding this project Owner: 7C/cr`- f JL2e Phone: g 2 7 oc 2 77 t,- rip ax�: 5_ F ❑ Applicant: Phone: Fax: / Mailing Address: a (25 ,9, c,(7 cgs- Mailing Address: ce Ci tat, Zip Ciry, State, Zip ❑ Contractor Phone Fax ❑ Architect/Engineer Phone Fax Mailing address Mailing address Ciry, 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 2'd floor sq. ft. Finished basement sq. ft. Occupancy group Construction type Garage sq. ft. Deck sq. ft. Cost of project Heat source (electric, gas, etc.) Manufactured Home Width: Length: What is the square footage of the sign face? How high is the sign? Year: Make: # of signs Area of existing signs Relocation Fire Safety PreviousFire address / , G /Gib, �cr!f. 12,V Paint booth Sprinkler Tent 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 ❑ Concrete 0 Welding 0 Bolting 0 Reinforcement Address RMATION Are there structures on the property?I Yes ❑ No If yes, ident fy on site plan What is the current property size? j (square feet or acres) Z c ! ; `° . Is any part of the property within 250 feet of a shoreline? If yes, identify on site plan 0 Yes C' No What is the current use of this property? Is your property in a designated wildlife habitat area? 0 Don't know 0 Yes jr No Will the site be served by a septic system?.. Yes 0 No Is any part of the property within a 100 yr flood plain? If yes, identify on site plan 0 Maybe 0 Don't know 0 Yes 4rf No Are or will there be wells located on the property? If yes, identify on the site plan 0 Yes' No Are there any wetlands, streams or ponds within 200 feet of the property? If yes, identify on site plan 0 Yes No Is there evidence of fill or excavation on the property?, 0 Yes 1:jj No Are there slopes greater than 30% on the property? (30 ft rise in 100 ft) ( / %) 0 Yes J'No Are critical or hazardous materials used or stored on te? _ 0 Yes No RTMENT USE ONLY Is the property in a designated Stormwater Control Area? ❑ Yes 0 No Is public sewer available to the site? ❑ Yes 0 No Is the property inside the ASA? 0 Yes ❑Yes 0 No ❑No Is public water available to the site? ❑- "Yes 0 No Is the property inside the PSSA? ❑ Yes 0 No Is the property located within 1000 feet of a Natural Resource Area? ❑Yes ❑No 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: BANKCARD NUMBER: AUTHORIZED SIGNATURE: SUBTOTAL TOTAL FEE MINIMUM PERMIT FEE IS $35.00 PLEASE MAKE CHECKS PAYABLE TO SPOKANE COUNTY PERMIT CENTER Project Number: 02001 453 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: ..........................................................:... Date: 3/8/2002 Page 1 of 2 Permit Use: RELOCATION OF SINGLE WIDE Contact: TEEPLES, AUDI MANUFACTURED HOME Address: 8523 E BROADWAY AVE C - S - Z: SPOKANE, WA 99212 Setbacks: Front 100 Left: 6 Right: 6 Rear: 25 Phone: (509) 927-8277 Group Name: Site Information: Project Name: ....................................... Plat Key: 001288 Name: HUTCHINSON'S ADD District: F Parcel Number: 45181.1525 Block: Lot: SiteAddress: 8605 E BROADWAY AVE SPOKANE, WA 99212 Location:: SPO Zoning: UR 3.5 Water District: Owner: Name: TEEPLES, AUDI Address: 8523 E BROADWAY AVE SPOKANE, WA 99212 Hold: ❑ Area: 0 Sq Ft Width: 62 Depth: 311 Right Of Way (ft): 40 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information: ::................................. Review Site Plan Review SDLAIQ Plan Review Released By. /7. 70 Special Reviews Released By. Septic System Review Private Well Review l414riL 14, Operator: RMB Printed By: RMB Print Date: 3/8/2002 Project Number: 02001453 Inv: 1 Permits: Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: OWNER Item Description INSPECTION FEE COUNTY SURCHARGE Permit Type Manufactured Horne Manufactured Home Firm: OWNER Phone: Units Unit Desc 1 SECTIONS 1 Y OR BLANK Fee Amount $50.00 $11.00 Permit Total Fees: $61.00 Fee Amount Invoice Amount $61.00 $61.00 Amount Paid $0.00 Amount Owing $61.00 $61.00 $61.00 $0.00 $61.00 Date: 3/8/2002 Page 2 of 2 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: RMB Printed By: RMB Print Date: 3/8/2002 Project Number: 00008898 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: PLACEMENT OF SINGLEWIDE MOBILE HOME Contact: TEEPLES, AUDI Address: 8523 E BROADWAY AVE i 2D C - S - Z: SPOKANE, WA 99212 Setbacks: Front 440' Left: 12 Right: — Rear: 100 Phone: (509) 927-8277 Group Name: Site Information: Project Name: Plat Key: 001288 Name: HUTCHINSON'S ADD Parcel Number: 45181.1525 Block: Lot: SiteAddress: 8605 E BROADWAY AVE SPOKANE, WA 99212 Location:: SPO Zoning: UR 3.5 Water District: Date: 10/02/2000 Page 1 of 2 District: E Owner: Name: TEEPLES, AUDI Address: 8523 E BROADWAY AVE SPOKANE, WA 99212 Hold: ❑ Area: 0 Sq Ft Width: 62 Depth: 311 Right Of Way (ft): 40 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information: Department BUILDING Hold Reasons: Permit Conditions: BUILDING Hold Reasons: Permit Conditions: HEALTHDISTRICT Hold Reasons: Permit Conditions: BUILDING IIoM RGAJVnJ Permit Conditions: Permits: Review Site Plan Review Plan Review Septic System Review Special Reviews Released By: t l7 / 6)-- 2-- 2 cra-13 Released By: ��s�q /qo(,/_ Project Number: 00008898 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 10/02/2000 Page 2 of 2 Manufactured Home Contractor: OWNER Firm: OWNER Address: 0 Phone: (000) 000-0000 000000, 00 000000 Item Description INSPECTION FEE COUNTY SURCHARGE Payment Summary: Operator: DMD Permit Type Manufactured Home Notes: Units Unit Desc 1 SECTIONS 1 Y OR BLANK Printed By: DMD Fee Amount $61.00 $61.00 Permit Total Fees: Fee Amount $50.00 $11.00 $61.00 Print Date: 10/02/2000 Invoice Amount $61.00 $61.00 Amount Paid $0.00 $0.00 Amount Owing $61.00 $61.00 peop©se \ob� l `o ` 1 This site is being submitted for the purpose of obtaining a bu'i!jir g permit and is a tiue and correct representation of the proposal. All known property Tines/dimensions, curb lines. structures and easements have been identified. Also indicated are wetlands, bodies of ter, steep slop er critical areas. Signed: .:u-YiL-Uu� Date: 3 - 0 ,2_ ADDRESS ZONE ROAD WIDTHFLANKING FRONTS-- COMME REVIEWED u,rida1-;c1 Vr a` f e /QJ,r G C , g..