2001, 08-30 Permit App 01007388 Family RoomProject Number: 01007388 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 8/30/01 Page 1 of 2
Project Information:
Permit Use: MOBILE HOME ADDITION - FAMILY ROOM Contact: DEABEL, MAVIN
Address: 7210 E 5TH AVE
C - S - Z: SPOKANE WA 99212
Setbacks: Front 40 Left: 30 Right: Rear: Phone: (509) 921-5765
Group Name:
Site Information: Project Name:
Plat Key: 003063 Name: 2ND EMPIRE HEIGHTS ADD District: D
Parcel Number: 35241.3519
Block: Lot:
SiteAddress: 7210 E 5TH AVE
SPOKANE, WA USA 99212
Location:: SPO
Zoning: UR-7
Water District:
Urban Residential-7
Owner: Name: DEABEL, MAVIN
Address: 7210 E 5TH AVE
SPOKANE WA 99212
Hold: ❑
Area: 0 Sq Ft Width: 75 Depth: 125 Right Of Way (ft): 60
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Department
BUILDING
Hold Reasons:
Permit Conditions:
BUILDING
Hold Reasons:
Permit Conditions:
Review
Site Plan Review
Plan Review
BUILDING Special Reviews
Hold Reasons:
ermit Co , di ons:
H THDIS CT Septiie System Review
Hold Reasons:
Permit Conditions:
Permits:
Released By --
Released By:
Project Number: 01007388 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Date: 8/30/01 Page 2 of 2
Contractor: OWNER Firm: OWNER
Address: 0 Phone: (000) 000-0000
000000, 00 000000
Building Characteristics
Const Category: Addition Group: R-3 Type: VN
Nbr Of Dwellings: Occupant Load: Building Height: Stories: 1
Bldg W x D: 12 x 36 Building Sq Ft: 432 Sprinklers: 0
Req Parking: Handicap Parking: Critical Materials: ❑
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
RES ADD R-3 VN 432 $26,784.00 432 $26,784.00
Totals: 432 $26,784.00 432 $26,784.00
Item Description Units Unit Desc Fee Amount
RESIDENTIAL VALUATION 1 Y OR BLANK $370.00
STATE SURCHARGE 1 Y OR BLANK $4.50
RESIDENTIAL SURCHARGE 1 Y OR BLANK $81.40
Contractor: OWNER
Address: 0
000000, 00 000000
Permit Total Fees:
Mechanical Permit
Firm: OWNER
$455.90
Phone: (000) 000-0000
Item Description Units Unit Desc
WOOD/PELLET STOVE/INSERT 1 NUMBER OF
MINIMUM FEE ADJUSTMENT 1 Select
Payment Summary:
Operator: JAS
Permit Type
Building Permit
Mechanical Permit
Notes:
Permit Total Fees:
Printed By: JAS Print Date:
Fee Amount
$455.90
$35.00
Invoice Amount
$455.90
$35.00
Fee Amount
$25.00
$10.00
Amount Paid
$0.00
$0.00
$35.00
8/30/01
Amount Owing
$455.90
$35.00
$490.90 $490.90 $0.00 $490.90
I , I
SPoxw CougrY
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:
7a / 0 s-t/1
Assessor's Tax Parcel Number(s):
Legal Description:
Project Description: /�� / X 3 (� if rid 1 f4-.J
Building Permit
❑ Change in Use
❑ Grading
O Manufactured Home Permit
0 Relocation
❑ Sign
O Tenant (New/Change)
O Other
Department Use Only
Water District/Purveyor.
Sewer District/Purveyor
Road width
Setbacks
Front
Left
Rear:
Right ..
School District
Fire District
Zoning A
'�v
1�
OWNER/APPLICANT INFORMATION
Q Indic -ale who should be contacted re ardinP this Aro'ea
XOJwner.
Mil il 0 / 'V / C4 �l e.
Phone: 72 ( 5-76,5~
Fax:
El Applicant
Phone:
Fax:
vf�
Mailing Address:
r 7aUO -st-/
Mailing Address:
City, State, Zip
jig ,f l'{., ,(%
P"),/ a
City, State, Zip
❑ Contractor
Phone
Fax
❑ Architect/Engineer
Phone
I ax
Mailing address
Mailing address
City, State Zip
City, State Zip
WA State Contractor license #
Contact name:
PROTECT INFORMATION
• Building Information
Building Ijeight to peak
# of stories
Main floor sq.ft.
Unfinished basement sq. ft.
Dimensions
iA'3A
TotalJ
habitable space
/1.34 3,c
2'a 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
Sign
Width: L
//
Length:
7 iJ
What is the square footage of the sign
face?
How high is the sign?
Year do
Make:
# of signs
Area of existing signs
Relocation `
Fire Safety
Previous address
Paint booth
Fire Sprinkler
'1'cnt
Fire Alarm
Fireworks display
_
Proposed use
value
Special Inspections Required?
• NonResidential Energy.Code Compliance?
Firm Name
Phone
Plans Examiner
Phone
Inspectors:
Address
Inspector
Phone
O Concrete
O Welding
O Bolting
O Reinforcement
Address
ADDITIONAL SITE INFORMATION
Are there structures on the property? Jg Yes 0 No
Ifyes, 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, ident on site plan O Yes No
What is the current u of s property?r1
/`-P 6 i o'4j4/N t4--t I t / kr_
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes Al No
Will the site be served by a septic system? Yes 0 N6 9
Is any part of the property within a 100 yr flood plain?
Ifyes, identifj on site plan
0 Maybe 0 Don't know 0 Yes IV No
Q
Are or will there be wells located on the property?
Ifyes, identify on the site plan 0 Yes Itr No
Are there any wetlands, streams or ponds within 200 feet of the property?
Ifyes, identify on site plan 0 Yes -1$ No
Is there evidence of fill or excavation on the property? ,�(
0 Yes ,9' No
Are there slopes greater than 30% on the property? (30 ft rise in 100 ft)
( / %) 0 Yes No
Are critical or hazardous materials used or stored on site?
0 Yes arNo
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area?
O Yes
/ No
Is public sewer available to the site? 0 Yes
No
Is the property inside the ASA?
es
Yes
0 No
0 No
Is public water available to the site? ](Yes
0 No
Is the property inside the PSSA?
es
0 No
Is the prqpery located within 1000 feet of a Natural Resource Area?
OYes No
-de
METHOD OF PAYMENT
Staff Rre
VISA '�'�'�-
❑ CASI I ❑ CHECK 0 0 Y`s
0
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE:
EXPIRES:
BANKC:\RD NUMBER:
AUTHORIZED S]GNATURE:
SUB1O'l'AL,
TOTAL FEE
MINIMUM PERMIT FEE IS$3S00PLEASE
MAKE CHECKS PAYABLE TO SPOKANE
. COUNTY PERM]T CENTER
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 WH1Tecopy 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&1 office within 15 days.
Owner last name
Address
first name
Day time phone
City-.......
ALTERATION PERMI
Do not complete shaded areas
r Permit
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 ❑ Commercial Coach B
Serial No.
jMobile Home
Serial No.
HUD No.
Recreational Vehicle or ❑ Park Trailer
Serial No.
Model No. or Plan Approval No.
A teration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
Gas Fumace
Gas Piping
Plumbing
Stmctural -
_ Wood/9ellet Stove — _
Plan Review
RV Inspection
Reinspection
Technical Inspection
Serial No..:
Ongmal Permit
No,
Note: This permit expires one year after date of purchase. (Non-refundable)
(Signature of applicant or authorized representative 1 Make check payable to: Dept. of Labor & Indusstries
FEES DUE $ <,
Department use only
Request approved or ❑ Request deniedbecause of specific violations of Washington rules and regulations. Violations must
be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent, or tease any
non -complying mobile home, commercial coach or recreational vehicle. -.
CALL 324-2640 FOR AN INSPECTION
PLEASE LEAVE NAME &
ALTERATION PERMIT NUMBER
LiIncluded are forms required which must be completed and fees submitted before reinspection. I'
F622-012-000 alteration permit 8-99 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
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