1985, 10-29 Permit: 00008380 MH`L -00D
SIGNATURE OF �
OWNER Op AGENT s%Ii✓tl
'189'166E: BLOOM CR
UMPHENOIIR, JAMES
1 891'6 E BLOOM CR
fl
CREENACRES TWA v99016
UMPHENOLJR, JAMES
UMPHENOUR, JAMES
189'16 E. BLOOM CR
CITU: ZIP:
CRI.ENACRES TWA . 99016
LIC BNa.:
509--924•-3019
A Ncn)ENYINEEP:
CITY. 9T: Zlv:
175532412
C6N.Y9T
INevE<TOP.
00062700
LOT & OLOCN
012 006
FINAL
LABERRY MOB1LE PARK ADD
ZONES.
ZONE
RMI -I
0"00
so -do
so -do
000
006
26 DOUBLE WIDE MOBILE HOME
49:
'18916 E.•BLOOM CR
t--14412 ) 4 DATE
APPLICATION
Ea s
0009199
DATIP
0/29/85
00008380
MOBILE HOME
$10'1.50
PAID AY;
$101.50
CA
CG
COY
TEN
PLANS CPA
DAT
MOBILE HOME PERMIT
MOBILE HOMES
Make Serial t
NuMber 1 Width 12 Length 60 Height 10
NuMber 2 Width• 12 Length 60 Height 10
Misc Desc ; SURCHARGE:
TOTAL FEE
Fee 10010.00
$$1 .50
Misc Fee • 1.50
OFFICE COPY
10;.29-85 6148= *1111506
(THIS IS NOTA PERMIT)
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
COMPLETE IN INK
(Please return this original and your building plans to the Department of Building and Safety)
.,.---- -11--. 1.-...r, 1-.1-r.,i. 1 ""1-1.1 n'w�
Prolect Number
Owner's Name LAST FIRST MI
h -h henou.r Sfres / ('a.-/%rine_
Project Address Street Name & Number)
£'a.s f /2 9/41 . morn (7/rct/e 4
Zip
re enrere _s kv/9 990/6
Applicant
ijnwAenou r , LT es £,
Address
r., JY 9/6 B/eom dirC%.
City '
GreenoerES'
State
WA?
Zip
99D/6
I Phone
(509) 9a'/ -3O/9
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
( 1
Lender
Address
City
State
Zip
Phone
Describe Work
COO e1—g- 0.)iDE12`1K00)
Res.
Comm.
Subdivision/ Plat Name/Short Plat Number
LA &RR.v Ho &,LE PAreK .
Assessor Parcel Number
'7553--ta l2'-
Lot
I2
Block
6
Plat Number
Pertinent File Numbers
Zone
RI -rte
Comp. Plan
Census Tract
Number of Dwelling Units
i
Number of Buildings
1
Lot Size (Sq. Ft./Acre)
/!Qt
Depth
Frontage
Front Setback
Left Setback
Right Setback
Rear Setback
R/W Width
Additional Information
BUILDING INFORMATION
Square Footage
Number of Bedrooms
Building Technician
Cf/k'u1
Date
/025-S5
Group
Type
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 /8-,95-26"
Approved
Cond.
Approval
Hold
Environmental Health Application p
p
'11 .■.e0,4
Is - i
W. 1101 College
Room 200
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Planning/Zoning
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 '
Protect 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 /8-,95-26"