1991, 05-23 Permit App: 91002851 MHSPOKANE COUNTY DEPARTMENT OF BUILDINGS
1AVENUE
SPO�ANE, WASHINGTON 99260
/ certify that I have examined this permit/app I icat ion, state that the information contained in it and submitted by me or my agent to compile said permit/app I ication is true
and correct, and au5orize Spokane Cwnty to proceed 64 pwwsing. In addition, I have mad and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance ofthis permit/application and any subsequent inspection approvals or CertHicates & Occupancy sha"ot beconstrued to
give authority to violate orcancel the provisions of anystate or local law regulating construction, oras a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER= 0002851 APPLICATION DATE= 05/23/91 PAGE= Oi
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIJ
- - - - W ----------
SITE STREET= 18610 E DALTON AVE PARCEL*= 06554-0609
ADDRESS= LIBERTY LAKE WA 99019
PERMIT USE= REPLACE EXISTING / WITH DOUBLE WIDE MOBILE HOME
PLATO= 060646 PLAT NAME= DONWOOD EAST
BLOCK= 5 LOT= 9 ZONE= UR -7 DIST*= G
AREA= OOOiOOOO F/A= F WIDTH= 117 DEPTH= 85 R/W=
0 OF BLDG%= 4 DWELLINGS= WATER DIST =
OWNER= / ILA PHONE= 509 926 3538
STREET= 1800 E DALTON AVE �
ADDRESS= LIBERTY LAKE WA 99019 .
CONTACT NAME= ILA AV N PHONE^�Y~ NUMBER=
BUILDING %ETBACK%: FRONT= TOT -LEFT= E���-�IGHT= EAR=
REVIEW INFORMATION **************************
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DEPARTMENT' REVIEW COMMENTS APPROVAL COMMENTS
---------- ------------------------------ ------------------------------
.6-0/�-�"�
BUILDING SETBACK REVIE�� REQUIRED ----�----�=`--~~--�~-------
BUILDING SETBACK REVIEW REQUIRED ��^�����-------
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HEALTHDIST NEW OR ADDITIONAL WASTE WATER
W°
MOBILE
****************************** MOBILE HOME PERMIT
CONTRACTOR= OWNER
\
PHONE:-..-
HONE=YR/MAKE=
`
YR/MAKE=1991
ODEL=
%ERIALO=
WIDTH=
`
28 LENGTH= 56 HEIGHT=
10
ITEM DESCRIPTION
-------------------------
4: -
QUANTITY FEE
AMOUNT
INSPECTION FEE
-------- ------------
2
100.00
STATE %URCHARG[^
�
Y
4 5O
COUNTY SURCHARGE
Y
i6.00
PERMIT TYPE FEE
---------------
AMOUNT AMOUNT PAID AMOUNT
OWING
-------------
MOBILE HOME PMT
------------
00.50
-------------
.00
i20.50
-------------
------------
120.50
-------------
.0O
i2O.5O
PROCESSED BY: JOHN LAR%ON
,
PRINTED BY: JOHN LAR%ON
�
******************************** THANK YOU *********************************
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. I J
MAY—�3—°91 16:09 ID:HEALTH SPO TEL NO:94582243
DEPT OF $U I LD I NGS TEL ND: 509-4564703
#010 P01
#614 001 . M
SPOKANE COUNTY DF.PAiRTMENT 08: B{UIL01 btu S
W,1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 09280
(509)456.3675
I certify that I have examines this perrnit/appllcation, stato that the informatiOn oOntefned in it and eubmllted by moot myspent to oorhppr10 6810 permit/w�apIloattlon is true
and correct, end authorize Spokane Oounty to procood with promsfrns, In addition, I have read and understand the tNSQECTION REWIREtJIENTS/NO710E.
provlelons Inc:utled herein and agree to comply with some. All provisions of Iswu and ordlnenaeo governing this typo of worts will be Complied with whether apeclfled
haroln or not, I undo ratand that the ieouence of thla parmlVapplicalionand any owb equont Inspection approvals or Certificates of Occupancy Shell hot be oonstrued to
gWe authority to violate or cancel the provisiona of itny state or looal law toguiattn® construction, or so a warranty of conformance with the provisions ofeny eta to or local
fiws. regulating construolion.
S1GNATURF-OP APPLICATION
OWNraR OR AGENT — - DATE
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Ctf.i1'I...X3�;�JIti ,�I:.xX't(ryl:iC;,,• I::rCti�i',;:: L,.f:l"r', trT,:a P:k(idV=
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Spokane County
DEPARTMENT'OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER:
STREET ADDRESS:.
CITY/STATE/ZIP:
r-.
SUBDIVISION:
rR
BLOCK:_ LOT: �_ ZONE: �,,� ,2 DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
# OF BUILDINGS: # OF DWELLINGS:
OWNER:-.
MAILING ADDRESS:��j���
CITY/STATE/ZIP;
CONTACT:
WATER DISTRICT:
PHONE: — —
PHONE: cp
SETBACKS: — FRONT: LEFT: RIGHT: REAR:
PERMIT USE: e°f �X�j"�� 7
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE:
PHONE: — —
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTii X DEPTH) SQ. FT.
REQUIRED PARKING: n HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
JUL-12—'91 13:14 ID:HEALTH SPO ' TEL NO:94582243
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IF YOU CANNOT INSTALL THIS SYSTFM ACCORDING
10 THIS APPROVED PLAN, YOU MUST CALL THE OFFICE
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