Loading...
2003, 07-10 Permit App BD-03-776 MHSpolia„" ne 4,00Valley PERMIT APPLICATION WORK SHEET SPDXA NE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 Phone: (509)688-0036 Fax: (509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: 17 3 IS E 1 A, 'L ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: M ; 1 e. Pu L BUILDING PERMIT ® CHANGE IN USE D GRADING � RELOCATION ® SIGN TENANT aANUFACTURED HOME OTHER OWN EiR 1 '" PPIICANT INFOR ATOOg ® OWNER: C k CLf I t •2- S f'D n © APPLICANT: PHONE: a, Off' -- � 3 '7 y FAX PHONE: FAX: ADDRESS: I'1 31 & E , '41 1' P git- ADDRESS: CITY,STATE, ZIP CITY, STATE, ZIP ARCHITECT: CONTRACTOR: �w++-k es Fiernh'e5s e)c C0..s+ PHONE: 5-0 33-d'Oc24 FAX;-OK")33-Poo PHONE: FAX: ADDRESS: 1 • 0• 60S 1080 La-., Lako w A- (DRESS: d� CITY, STATE, ZIP CITY,STA7E, ZIP R N 14 WA ST CONTRACTOR LICENSE # TA M G S N Cf9 c N Itµ CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT:, 6 20D • 00 30% SLOPES ON PROPERTY: BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: BUILDING DIMENSIONS: CONSTRUCTION TYPE: NUMBER OF STORIES: STRUCTURES ON PROPERTY: NUMBER of BEDROOMS: 3 CRITICAL AREAS: FLANKING SETBACK: - CURRENT PROPERTY SIZE: FRONT SETBACK: Lk 3 I C-e, PNofk RENT PROPERTY USE: REAR SETBACK: CURRENT SEPTIC USE: LEFT SETBACK: CURRENT WELL USE: RIGHT SETBACK: IMPERVIOUS SURFACE AREA: MAIN FLOOR SQ FT: 2ND FLOOR SQ FT: UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: COVERED DECK: DECK: MANUFACTURED ECM u 1. •.,_ ��-� WIDTH: TZ b LENGTH: 5 2 YEAR: I ct 49 5— PIT SET: MANUFACTURER: (r C r c, ULA/ SO FT OF SIGN: HEIGHT OF SIGN: OF SIGNS: AREA OF EXIST SIGN: TYPE OF SIGN: RELOCATION PREVIOUS ADDRESS: PROPOSED USE: FIRE SAFETY FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: FIREWORKS DISPLAY: BLASTING: DATE/TIME: WA STATE NON -RESOD ENTO A ? ENERGY CODE PLANS EXAMINER: ?HONE: FAX: ADDRESS: CITY, STATE, ZIP INSPECTOR: PHONE: ADDRESS: FAX: SPECIAL L INSPECTIONS CITY, STATE, ZIP © BOLTING FIRM NAME: INSPECTOR(S): CONCRETE REINFORCEMENT PHONE: ® WELDING FAX: SUP DI N'G STAFF USE ONLY IS PUBLIC SEWER AVAILABLE: YES NO IF YES: ® COUNTY ® CITY 0 IS PUBLIC WATER AVAILABLE: YES NO IF YES, WHICH WATER DIST/IRR: IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO IS THE PROPERTY LOCATED WITHIN ASA: ° YES ® NO PSSA: YES NO DATE: STAFF: 8(318111W- 1 del✓ETI-10D OF PA YMENT • CASH CHECK BAN/(CARD #,• EXPIRES: VINE# AUTHOR/ZED SIGNATURE: vrsA *'AXED PERMIT APPUCA p NS ILL ONLY BE ACCEPTED WTH nnAOR BANKCrR D Quality Custom Homes HENNESSEY CONSTRUCTION P.O. Box 1080, Loon Lake, WA 99148 509.233-8004.991-0538 . (cell) State Certified pads & foundations for mobiles JAMESHCO99KH LIC, BONDED, INS. Excavation Site Prep 401a, illlout 61 (-142g S6i T ?' l 0 4- 7 07/08/2003 08:40 5093241567 SRHD EHS PAGE 01 SPOKANE • REGIONAL H LTH DISTRICT Fax To: Few Plane: Envirohmental Health 1101 West College Avenue, Room 402 Spokane, WA 99201 Phone 509-324-1560 FAX 509-324-3603 or 324-1567 From: Phone Date: "mit Re: Pages Including cover. ❑ Urgent ❑ For Review ❑ Please Comment ❑Please Reply ❑ Please Recycle Comments:�/ / n--eJP %�G run- igfr This facsimile may contain privileged and confidential Information Intended only for use by the Individual or entity named above. If the reader of this message Is not the Intended redplent, or the employee or agent responsible to deliver this Information to the recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is ate* prohibited. If you have received this communication in error, please call the sender's telephone number listed above. JUL 05 2003 09:40 5093241567 PRGE.01 07/08/2003 08:40 5093241587 SRHD EHS PAGE 02 SPOKANE COUNTY HEALTH DISTRICT E. O. PLOEGER, M. D., M.P.H., HEALTH OFFICER N. 819 Jefferson Street Spokane, Washington 99201 PERMIT NO. - Vol 774" DATE t9A`7�% No. A 14118 APPLICATION FOR PERMIT TO INSTALL OR RECONSTRUCT SEWAGE DISPOSAL FACILITIES Name ,-r-od 4.].-GCIiGdaY�KL Address Ria.1 :6• rG101MiS,-Phone No Address of Proposed Site / t — .• yc�. Type at Use Z( 94 Is basement for building planned, Number of Bedrooms obi Building Capacity Water Supply C / 1) Septic tank capacity 7SO Length of disposal field /.$1:5 (1) Show nlellva loomlon ol: Proposad house. septle tent. dlapoael Held. well. prep and other out buildings. (2) Mahe note of any heavy slope or ampy moo or any other Impatient topotraohlo dololl . Installer: Final Inspection Remarks- -frhe tonoreic Camp Capacity Other (City, Well, Spring). Dryw611 gals. Style I of tank • Absorption Pits d Cllr .d Leach Bed • — N t jei ire / / r �7 . �mol, /r c?Piffle Otir I c/t For Spokane County Health District ea JUL 05 2003 08:40 :.%r%..:C4:i3iGirme Mio;,i 508324156? PRGE.02 SRHD EHS PAGE 03 07/08/2003 08:40 5093241567 n Subdivision/Bloc wLot. 3 FINAL F S- ;4 3( LATION �� Address/legal Description: y{(� 4 . ` Afe ,4//,t, (c'/ C Appfcation # -1 357 NORTH t Remarks: n N fi 'Signatur 3 Y . 3 J 0%.11,I� T COMMON OF THE Oa- PETF - - _ SITE SEnA� �` ' TO BECONETe .E AS AN EXACT LOCATION OF THE SYSTEM. Septic Tank Size els. Drainfield:3j' q�o- e-- ft. Leachbed: sq. ft. Double Plumbing ❑Yes p6lo H -- - - S093241567 PRGE.03 JUL 0S 2003 08:40