1999, 07-02 Permit App: 99005932 MHProject Number: 99005932 Inv: I
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/2/99 Page 1 of 2
Project Information:
Permit Use: MANUFACTURED HOME REPLACEMENT Contact:
Setbacks: Front NA Left: 20 Right: 16 Rear:
Site Information:
Plat Key: 002379 Name:
10
.:.,. :+
SIESTA MOBILE PARK 1ST ADD ,
Address:
C - S - Z
Phone:
GREER, BILL M & PAM
1225 S DISHMAN RD
SPOKANE, WA 99206-3114
(509) 893-0584
District: F
Parcel Number: 45203.0803
SitcAddress: 1225 S DISHMAN RD
Spokane, WA USA 99206
Location:: SPO
Zoning: UR -7
Water District'
Area: 6,750 Sy Ft
Nbr of Bldgs: 2
Review Information: .:....... :.. ..
Urban Residential -7
Width: 0
Nbr of Dwellings: 1
Owner: Name: GREER, BILL M & PAM
Address: 1225 S DISHMAN RD
SPOKANE, WA 99206-3114
Hold: 0
Depth: 0 Right Of Way (ft): 0
Department Review
B4'JLtNG Site Plan Review
2e,n/y
Comments:
lD
1
HEALTHDISTRICT Septic System Review
Comments:
B4+ffi1#1186- °"7Spe 1littCt'i� ar
Comments:
IS 01 . id �. .
#4100)(
foicers41 t( ✓c V
d �n�ceA1�cvJ
Contractor: OWNER
Address: 0
000000, 00 000000
Item Description
STATE SURCHARGE
INSPECTION FEE
COUNTY SURCHARGE
Manufactured Home
Units
1
2
1
Finn: OWNER
Phone: (000) 000-0000
Unit Desc
Y OR BLANK
SECTIONS
Y OR BLANK
Permit Total Fees:
Fee Amount
$4.50
$100.00
$22 00
$126.50
Project Number: 99005932 Inv: 1
Application
THIS ISNOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 7/2/99
Payment Summary.
Operator: JDL Printed By: JDL Print Date: 7/2/99
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $126.50 $126.50 $0.00 $126.50
$126.50 $126.50
$0.00 $126.50
Page 2 of 2
JUL-16-1999 14:30
4r�
THIS ISfNOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: MANUFACTURED SOME REPLACEMENT
Setbacks: Front NA Left: 20 Right: 16 Rear: 5
Site Information:
Plat Key , "002379. Name: SIESTA MOBILE PARK 1ST ADD l District 1?
P. 01
Contact GREER, BILL M & PAM
Address: ' 1225 S DISHMAN RD
C - S - Z SPOKANE, WA . 992063114.:
Phone: (509) 89341584' ,
Parcel Number;,45203.0803
SiteAddress: 1225 S DISHMAN RD
- Spokane, WA USA 99206
Location:: SPO
• Zoning::UR 7 . • Urban Residential -7
W4c!.Oistrict
• Area 6,750 Sq Ft • Width: 0
Nbr of Bldgs: 2 . Nbr of Dwellings: 1
?new Infortriatiori:
Department'
Comments'
i'
, Hp,ALTHDISTRICT
Comments:
R�
Site Plan Review
Owaer. Name: GREER, BILL M & PAM -
Addtess: 1225 S DISHMAN RD .
SPOKANE; WA 992063114.
Com=1as:
I
Penitits: :
Maaufadured home
Firm: '• OWNER
C9n4r2tnr., :OWNER .
-000000-00 000000
jam Deacd2tion
STATE, SURCHARGE
INSPECTION FEE
COUNTY SURCHARGE
• Phone: (000}000- O00
UnitsUnit Hese
1 Y OR BLANK
2 • SECTIONS ' • ;
•i • YORBLANK''
• Permit Total Fees:
• JUL-16-1999 14:31 4 •
• ,
idn-SiteSewage Systems'(Chafiter •h4O-L vv eta-)
Request For Waiver From StatiRegulations
P. 03
re'37eze-
COMPLETED BY APPLICANT
Name: (1)
Address: .112..55-17:14.10.M.W Rol
5 pokAs1C MIA. en 7.04,
Telephone: (564) » 433-0.513
1
Signature: A. nen 2/aft--
.•••1=••••
Local Health Deparmrent / District (2)
SPOKANE REGIONAL HEALTH DISTRICT
Property Identification: (3) 4/57e3 030?•, . 57ech infirrye park_
.0 I
IsEcncont. I
COMPLETED BY APPLICANT
WAC Number: (4)
246-272- 0942/
(i )
Subsection:
wAyR;riteirns4
cf.P.J.AioN
g- »Cn1•
Waiver Sosgett: (k, Lite
e 6*te 1-49A3e renk
Justification (Mitigation measures to be provided): (7): • " - • • - •
70 Sat AA44 To o ft dots& 14:.;16 foal A ••>9.61 /aA 41 ra
!YTS AIR W Aland Age R.Ecto get)
Ico' Seer amass( hi rivet Abettaritto • ' • ' •
SECTION
commas° ay HEALTH orrman Tholv1/43;
•or ew Crit ria (8)
•
. - La,
Comments / Conditions: (10i
Mitigation Measures (in addition to Mose proposed); (9)
•
Type otWaiver: (ID Dans A Daus B
Neighbor Notification: (12) ReqUifte YCS
ISECTION IV, 1
..:"•ir••• • ' • ,
C"-ReqUest DOH ityler beton granules? Yes
Na.., I "laded:are sintements
•opirrly fikd?
COMPLETEDBY HEALTH OFFICER
1J't
This Request For Waiver From State Regulations has bccn reviewed according
The tview criteria applied. and the mitigation measures proposed And/or reqUire
protection at leastequal to that provided by This chapter
Approved / Granted - bject to all comments, condit
0 Denied
Local ileatilt Officer (13)
•
1
On•Site Sewage Synems.
provide public health
n Section 11 and 111.
:•• • ..i.
Date:
TOTRL P.03
Deparunent of Labor & Industries
Factory Assembled Structures Section �'3aiF� afl�
fir• Do not complete shaded areas
i- i Permit N 10 7 1 0 3
1. 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.
ALTERATION PERMIT
INSTRUCTIONS:
Invoice N
Insignia N
Owner last name first name Day time phone
4 r 1 /_ (--.:/
(. j ( (:'D -f _ ‘-: './
Address City
t%.'r 5.
1 Date
Installer/Contractor/Dealer
Phone
1r\700'1;?L. if,`.) 14.. rv1t, a ALE: Irjc_ (- z.?' •.;'930
Address City
State ZIP
Ct (c
Contractors registration number
State ZIP+4
7C() itc
Check the appropriate boxes in section A and section B.
A
DCommercial Coach B ❑
Serial No.
❑ Mobile Home
Serial No.
'rtl. 7-..:016,1 ti
HUD No.
Recreational Vehicle or ❑ Park Trailer
Serial No.
Model No. or Plan Approval No.
Alteration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical `;^ . l
Electrical IES
ire SafetTPf R� llt7 U� LNUPt &41:30.1.„
Gas -Furnace
Gas Piping UL 1 9 1999
Plumbing
Structural
Wood/Pcliet Stove—��U1�vb
t'` \,r�i A
Plan Review — — — — 5� �rt�'E,
RV Inspection
Reinspection
Technical Inspection
Original Permit
No.
Note: This permit expires one year after date of purchase. (Non-refundable)
$
r
"Signature of applicant or authorized representative
J
Make check payable to: Dept. of Labor*Ipdustries
FEES DUE $
Department use only
❑ Request 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 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 lease any
non -complying mobile home, commercial coach or recreational vehicle.
❑ Included arc form required which must be completed and fees submitted before reinspection.
Date Area office Inspector Total pages
F622-012.000 alteration permit 7-98 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
2
CENTRAL PRE—MIX. CONCRETE CO.
SPOKANE KENT CLACKAMAS
P. O. BOX 3366, T.A. P. O. BOX 510 P. O. BOX 68
SPOKANE, WASHINGTON 99220 KENT, WASHINGTON 98031 CLACKAMAS, OREGON 97015
1509! 535-2941 (206) 852-7874 (503) 655-5111
SUBJECT DATE_ /
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DOUBLE
TEE
SINGLE
TEE
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THERMOWALL
ill 11‘
COREWALL
HOLLOW
CORE SLAB
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PANELS
a8
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Member Prestressed Concrete Institute
r.
CENTRAL PRE-•
SPOKANE
P. 0. 80X 3366, T.A.
SPOKANE, WASHINGTON 99720
1509) 535-2941
SUBJECT
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TEE
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Fl IERMOW:VALL
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III
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PANELS
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(FIJ^FO
1319 DECK
77
I GIRDER
)
30 X
:IRDER
IX CONCRETE CO.
KENT CLACKAMAS
P. O. BOX 510 P. 0. BOX 63
KENT, WASHINGTON 98031 CLACKAMAS, OREGON
1206) 852.7874 1503) 655-5111
97015
GATE -
-t51 )01A
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,6-1)( 30
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ADDRESS: - 07-5
ZONE:
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ROAD WIDTH:
FRONT. FLANK' G
COMMENTS: 47
REJIEWED BY.
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