1986, 11-10 Permit: 00014074 Mobile home°
S|QNATAIE OF APPLICATION
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JOB ADDRESS
MOBILE
HOME PERMIT
M BILE HOMES
TOTAL FEE
$51 .50
Make
Serial #
JL
50.00
Nomber, 1 Width 14 Length
70 Height 18
Misc. Desc : BLDC SC
-
M i s c Fee
1.50
AD
WA
99021
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ICI
INC
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INSPECTOR:
PLATO:
ILOT
BLOCK
FINAL
PLAT NAME:
USE OF PERM&-
JOB ADDRESS:
MOBILE
HOME PERMIT
M BILE HOMES
TOTAL FEE
$51 .50
Make
Serial #
Fee
50.00
Nomber, 1 Width 14 Length
70 Height 18
Misc. Desc : BLDC SC
-
M i s c Fee
1.50
FEES: : :
PAID BY:
I CA
A�
ICI
INC
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MOBILE
HOME PERMIT
M BILE HOMES
TOTAL FEE
$51 .50
Make
Serial #
Fee
50.00
Nomber, 1 Width 14 Length
70 Height 18
Misc. Desc : BLDC SC
-
M i s c Fee
1.50
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OFFICE COPY
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(THIS IS !IOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF 1 HE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
SHADED AREAS ARE FOR DEPARTMENTAL USE
Project Number
LAST
RST
MI
FOwner'sName
reet Name &Number)
Al /
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Zip
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Applicant
Address
Ad
Cit
State
Zi p
Phone
V
Business Phone
Contractor /Agent
Address
City
State
Zip
Phone
Contact
License Number (Required)
Business Phone
Architect/ Engineer
Address
City
State
Zip
Phone
Contact
Business Phone
Lender
Address
_
City
State
Zip
Phone
- --
Describe Work
Res.
Comm.
��r
Subdivision/ Plat Name /Short
Plat Number
Assessor Parcel Number
Lot
Block
Plat Number
Pertinent File Numbers
Zone` }yI
Comp. Plan
Census Tract
Number of Dwelling Units
Number of Buildings
Lot Size (Sq. Ft, /Acre)
Depth
Frontage
9
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
Square Footage
Z
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Q
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Number of Bedrooms
Building Technician
Date
Group
Type
Show on Site Plan: Additional Information: i j
, .
Lot Dimensions Landscaping
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Existing Structures Drainage Plan I
Proposed Improvements Hydrants ' 1
t,
Structure Setbacks Topography I j
Easements Lighting { '�f
Septic System(s) Si na a I — ——_; —
Water Lines Shorelines ! I j ( j
Sewer Lines Highwater Mark Y
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Fences,Wells
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Driveway(s) j
Right of Way Width(s) �_.... �._ -_. _ .... —�
Names of I
' Fronting Street
Flanking Street - ,----- -- __ IF--
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Legal Description I I
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Date: j
Revisions: Attachments: ,
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DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date
Approved
Cond.
Approval
Hold
Environmental Health Application M
W. 1101 College
Room 200
j
1
--
Planning /Z 'Wing
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review /Fire Prevention
N. 811 Jefferson
Other (SEPA /Critical Material /etc.)
Fast Track /Special Inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date