2002, 04-24 Permit App 02002914 Place MHProject Number: 02002914 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Date: 4/24/2002 Page 1 of 2
Permit Use: PLACEMENT OF DOUBLEWIDE Contact: PANHANDLE MOBILE HOME SERVICE
MANUFACTURED HOME Address: BOX 130
C - S - Z: ATHOL, ID 83801
Setbacks: Front 30 Left: 22 Right: 10 Rear: 60 Phone: (208) 683-6124
Group Name:
Site Information: Project Name:
Plat Key: 002480 Name: SPRAGUE STREET ADD District: H
Parcel Number: 35232.2103
Block: Lot:
SiteAddress: 4410 E 2ND AVE
SPOKANE, WA USA 00000
Location:: SPO
Zoning: UR 3.5
Water District:
Urban Residential 3.5
Owner: Name: MOORE, LUCY
Address: 12504 N RITCHEY LN
SPOKANE, WA 99224-8958
Hold: ❑
Area: 13,500 Sq Ft Width: 100 Depth: 130 Right Of Way (ft): 60
Nbr of Bldgs: 2 Nbr of Dwellings: 1
........................
Review
Site Plan Review
Plan Review
it Septic System Review
Released By:
0 .
Sto rmw ate r_ Control (k vs-4 F
cl B
/� ( (/// S' �� I.Rcicase}.1- �--'_`_'� �l�z
`LET , 44,7 - fYcJ 74'417
(.1 no tk-3 501,01212-) TL.,155 z1 i D27L,i. i PL J-1r
Operator: DMD
Printed By: DMD
Print Date:
4/24/2002
Project Number: 0200291-1 Inv:
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: PANHANDLE MOBILE HOME
Address: PO BOX 486
SPIRIT LAKE, WA 83869
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Permit Type
Manufactured Home
Disclaimer:
Manufactured Home
Date: 4/24/2002 Page 2 of 2
Firm: PANHANDLE MOBILE HOME SE
Phone: (208) 263-6360
Units Unit Desc
9., SECTIONS
1 Y OR BLANK
Permit Total Fees:
Fee Amount
$50.00
$11.0
1 00 "t..)
1 22
Fee Amount Invoice Amount Amount Paid Amount Owing
$61.00 $61.00 $0.00 $61.
$61.00
$61.00 $0.00
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: DMD Printed By: DMD
Print Date: 4/24/2002.
3P0 R
Project Number: 02002914 A lA0�1
PP1Ca
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information: .
Permit Use: PLACEMENT OF DOUBLEWIDE. __ Contact: PANHANDL"`MOBILE HOME SERVICE
MANUFACTURED HOME Address BOX 130
C - S - Z: ATHOL, ID 83801
Phone: (208) 683-6124
Setbacks: Front 30 Left: 22 Right: 10 Rear: 60
Site Information:
Plat Key: 002480 Name: SPRAGUE STREET ADD:_ ,� `; _ .. District's H
Parcel Number: 35232.2103 Block: Lot:..
SiteAddress: 4410 E 2ND AVE Owner: Name: MOORE, LUCY
SPOKANE, WA USA 00000 Address: 12504 N RITCHEY LN
Location:: SPO SPOKANE, WA 99224-8958
Zoning:. UR 3.5 Urban Residential 3.5
Water District
Group Name:
Project Name:
Hold: D
-Area: 13,500 Sq Ft Width: 100 Depth: 130 Right Of Way (ft): 60
Nbr of Bldgs: 2 Nbr of Dwellings: 1
Date: 4/24/2002 Page 1 of 2
Review Information:. :.:r:x� ,r�:<.:<.:...;:<.>Y..::::,.; ...:,V.,::.{., :T Y:n;v«,.r<..: <.:>::.<;.:ri.>:.,.,.>::.. f.;:,;;;•n>.�:ry::c.;>.;�:o->;:.;:.dc:^:,:'•.0...........:.........."."s..4.n:..Y...Yi.....:... n........+.:e....a.. �„Yr.i:L:•k','•:::.>.> .
Review
Site Plan Review
Plan Review
* Septic System Review
7
Stormwater_Control £& ! / �/ S .0
-Gr-- t/. LLt I D Gar;
eleased By;
/SOT .ice A/oDiv
t1 ru Clc�v 50i,t)t . ( Zo t ssdb d�c 1�1c A&tr
1 5(1
Operator: DMD Printed By: DMD
Print Date: 4/24/2002
03/18/02 10:37 r8500 324 3803 SP0 REGIONAL REA
On -Site Sewage Systems (Chapter 246-272 WA()
Request For Waiver From State Regulations
I' SECtIOYi.
- commtieO3v APftICAWt 5-1 - C57/4 Y
Name: (I) LI,tLIY MOC�2E.
Local Health Department r District (2)
Address: yN 10 E. smE&»JD zr,
'3Po#&AnE wR x 3n_
onc:VII) `jgia -L.
Tcivil
*nature: 074840.--)
,41,.Ey
Peoperty identification: (3) 9wo f 2r,/d '
#34 3�. ec/O3
SECTION E,
C Mn.;r'ED oY APPLICANT
WAC Number: (4)
W C Requircm nt: (S)
/,'i v I e e„tt-. - i 4r f
Waiver Sought: (6) f
Gu�1sa�L >or; / E'. �, /n
/�f�j�!`� %
"J_C°(
f
ea✓-r/e/[r`.J..-/ ...'
frt./1 firer A/Et-v., QJC
2d6-272-
free1 /J -
L)
trv-iii--eu/✓ 2 hi* vA- /i
Subsection: /_Li -
Juus/tifiiccation (Mitigation meassuures provided):r��(7) ti ,f
(��
�too�b-e
...may-. t��-,
A Ir1 r ml'a./R�r{F.T C]Y ((%s✓.IYf I%Ir✓•"
txr1 `� f G��CtI y.
aer ,.[may ; ^- /1— girt- .:it./ -
7 is
SECTION'lu.
I COMTLETEDHY trEALI'M omar, cJ Jj%51 Deis P .4V .iO&p/C't°5 oA1
SV7C4i/02. •. spice✓S
Review =ritsr_5a $) , ,
Sa -/ cw n 54tioq. to Jtus pi
h
hS
y
ci4Q ce,,,,Asz t iG Sze -et 4? efeer
Comments/Condltlons:(I6f )1�t10 jP
,iv
Type ni Waiver: (I I) Mina A Odes B �1Class C- Request OOH review(.rjptz grmnin;?Yes_ No.X_. 1
Neighbor Notification: (12) Required7 Yes No !/needed are agreements, easemcMA, etc, property hated? Yes_„ No^
ISECTION' IV•
COvitiTED 3Y HEALTH OFFICER
Tills flegtiest For tSaiver'From State Regulations has been reviewed acording to the ptovisions or Chapter 246.272 WAC On -Site Scwaae Systems.
Thefeilcw erachaapplied, and the mitigation measume prrtfwsed and/or required, have been evaluated for their ability in provide public health
prole dion m lea./ cgeel to *tw prodded by this chapter wAC. -'
/ 'Approved t Granted - Subject to all comments, conditions and requirements Noted in Section 11 and I11
' Li Denied /n
ei/ one: // 2--+
Local Health Orfccr (13) 7-e'--"-~' (`
Mop t fiefrfrilj
NaLA513wIt-
Legal Description:
Street Address: 10 E
cjf�t��h�
Assessor's Tax Parcel Number(s): 3- • 3 2
AMR
SPOT COUNTY
PROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
3 pa c3c
C2:5
Project Description:
l Building Permit
0 Relocation
O Change in Use
O Sign
O Grading
' Manufactured Horne Permit
O Tenant (New/Change)
0 Other
Department Use Only,
Water District/Purveyor.
School District
Sewer District/Purveyor
Fire District:
OWNER/APPLICANT INFORMATION
Setbacks
Erotic' .
I.e
ROC.
—
.QlOxner: Phone:
�/y�
1 Lt,G t ! 4.6 r•' (r Fax:
•••—••�••—•,4,J,..,•.......co
.c..,CU,Lung nnrpryea
❑ Applicant:
PP
Phont-
Fa.:
hiatling: css:
1,2 60 q /1% /2 . '-"e% dt Let.., e.
Mailing Address:
(an-, State, Zip
5/, a k-G.., e. Wc.. r 9 9 zzy
Cin, State. Zip .
up Contractor Phone(lli &/
� / /
Pr £e... ei4,I / �' rJ/tl r/e. !'OA,C Fax
O
(0�3 �0z`f
0 Architect/EngineerPhone
Fax
Mailing address
i 0 s & /30
Afarling address
City, State Zip
A,idio( .�� 81 8 01
City, State Zip
WA State Contractor license #
13,.9 4J H' R /17 P o 41 N J< 8
Contact name:
- .-..,.......a as ma VAS-MI.111V111
Building Information
Building height to peak
# of stories
Main floor sq. ii_
Unfinished basement sq. ft-
1)imetui.7ns
Total habitable space
?nu floor: fr.
W-
Finished basement sq. ft.
Occupancy group
(,tnlatn,ction type
Garage sq. ft.
Deck sq. ft.
Cost of project
}teat source (electric, gas, etc.)
Is the property in a designated Stormwater Control Area?
O Yes 0 No
Is the property inside the ASA? .
O Yes 0 No
O Ycs. 0No
Is the property inside the PSSA? 0 ,Yes 0 No
Date Received:
Manufactured Home
Sign
Width: �/
l t >
Length: i
S.&
�J!
What is the square footage of the sign
face?
How high is the sign?
Year.
Make:
# of signs
Area of existing signs
Relocation
Previous address
Proposed use
Fire Safety
Fire Sprinkler
Paint booth _ Fire Alarm
Tent
Fireworks display
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
Are there structures on the property? Ycs 0 No
1f yes, identffr on site plan
What is the current property size?
(square feet or acres) / UO 13 v
Is any part of the property within 250 feet of a shoreline?
If pu, idnd on site plan 0 Yes 12c No
X
What is the current use of this property?
Is your property in a designated wildlife habitat arca? J
0 Don't know 0 Yes 137 No
Will the site be served by a septic system? 0 Ycs 0 No
is any pan of the property within a 100 yr flood plain?
lips, idtirti on site plan �/
0 Maybe 0 Don't know 0 Yes Irk No
Arc or will there be wells located on the property?
f per, idurt ' on the site plat 0 Ycs . SNo
Arc there any wetlands, streams or ponds within 200 feet of the property?
lips, ident6r on site plan 0 Ycs rrNo
Is there evidence of fill or excavation on the property?
0 Ycs No
Arc there slopes greater than 30°$ on the property? (30 ft rise in 100 ft)
( — %) 0 Ycs ,No
Are critical or hazardous materials used or stored on site?
0 Yes -IEir1Io
DEPARTMENT USE ONLY
Is public sewer available to the site?
O Yes 0 No
Is public water available to the site? 0 Yes 0 No
Is the property located within 1000 feet of a Natural Resource Area?
0 Yes 0 No
Staff Representative:
METHOD OF PAYMENT
VISA
❑ c;1si l 64 CI ii :i: ❑MOM - ❑
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
EXPIRES:
B_\NKC.IRD NUMBER:
.A157I IORIZtit) SlGN_vJ Upj
SLIRT(Y 1.
TOTAL FEE
MJNJMUM PERMIT FEEDS S3.£00111--V.E
\tAKIE CI IIECKS PAYABLE -ro SPOK,i\E
COUNTY PERNtrr cI NIF.R
24
of'
"1;17
Se
ADORES
ZONE
— -ROAD-WIDTH .
FRONT
jV COMMENTS
• REVIEWED 6
V
14i0.7.1••• • •••••
• .....
en,
44.44 tr..4. (
441. CO it
rfer • 1! ;0446.4.
2- • 0
kq
/7
/2?)
I
clk.N.,e
• p- ....It .1 4. di
1.z.
•
• •••••.•*•
.This site iif6&Is being-kibrifitted for thepu pose of
obtaining a building permit and is a true an correct
a son of.th.e•proposaL-All *no operty
IrnjTdimesions
curb lines. structures and easements
have been identified. Alsc indicated are wetlands,
bodies &water, steep lop er Critical.areas.
z 4.1 . •
..A 1,/
• 3
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
I. 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 with the same L&I office within 15 days.
Owner last name
ALTERATION PERMIT
Do not complete shaded areas
%Permit# .b54612
Invoice
insignia:*
first name- Day time phone
Address
City
Date
State ZIP
Installer/Contractor/Dealer
Address
Phone
...................:_........:
City
Contractor's registration number
State ZIP+4
Check the appropriate boxes in section A and section B.
A
FEES
Commercial Coach B j A teration Inspection (check appropriate boxes below) $
11 Air Conditioning/HeatPurnp
Electrical
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — —
Plan Review
RV Inspection
-id,
Reinspection
Technical Inspection
Note: This permit expires one year after date of purchase. (Non-refundable)
!Signature of applicant or authorized representative , Make check payable to: Dept. of Labor & Industries
X 2
Mobile Home
Serial No.
HUD No.
Recreational Vehicle or ❑ Park Trailer
Seria1No.
Model No. or Plan ApprovalNo.:
serial No
Ongmal.Permu
No.
FEES DUE s
Department use only
jRequest approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and reinspection requested within 10 days for recreational vehiclesand 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). 11 is unlawful to offer for sale, rent, or lease any
non -complying mobile home, commercial coach or recreational vehicle:
Included are forms required which must be completed and fees submitted before reinspection.
Date
Arta office
....Inspector
z
O - CC
W
C.) to
W 2
cn D
z °Z5 z
- Wcc
O c
W z [[
W
• a.
Q -
(O Q
CO UJ
J Q W
_1
• J J
C�aQ
Total pages
F622-012-000 alteration permit 7-01
White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
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