1999, 01-25 Permit App: 99000525 MHProject Number: 99000525 Inv: 1
'Application
Date: 1/25/99 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SINGLE WIDE MOBILE HOME
Site Information:
Setbacks: Front 63 Left: 20 Right: 44 P—ar: 30
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Contact: ANDERSON, FLOYD & BETT
Address: 4303 N .ELLEN
C - S - Z SPOKANE, WA 99216
Phonc: (406) 826-5501
Plat Key: 002677 Name: TRENTWOOD ORCHARDS District: H
Parcel Number: 45022.4403
SiteAddress: 4303 N ELLEN RD Owner: i,—me: ANDERSON, FLOYD & .BETTY
SPOKANE, WA 99216 Ad:; css: 4303 N ELLEN
Location:: SPO SPOKANE, WA 99216
Zoning: UR 3.5
Water District:
Urban Residential 3.5
Hold: ❑
Area: 15,000 Sq Ft Width: 0 Dept);: 0 Right Of Way (ft): 40
Nbr of Bldgs: 2 Nbr of Dwellings: 1
Department Review
BUILDING Site Plan Review
Comments:
BUILDING
Comments:
Plan Review
HEALTHDISTRICT Septic System Revie
Comments:
BUILDING
Comments:
Permits:
Special Reviews
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L, L 'u -t&
Sewage system designed
for ._ bedrooms only. Ok
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Contractor: OWNER
Address: 0
000000, 00 000000
Manufactured Il i ne
Ua • v� rk1
Firm: i.='WNER
Phone: (000) 000-0000
Item Description Units Unit Desc Fee Amount
STATE SURCHARGE 1 Y OR BLAN.i ; $4.50
INSPECTION FEE 1 SECTIONS $50.00
COUNTY SURCHARGE 1 Y OR BLANK $11.00
Permit Total Fees: $65.50
Project Number: 99000525 Inv: 1
Application
Date: 1/25/99 Page 2 of2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Payment Summary:
Operator: CKF Printed By: CKF Print Date: 1/25/99
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home • $65.50 $65.50 $0.00 $65.50
$65.50 $65.50 $0.00 $65.50
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
�?Z 6e/6
ALTERATION ALTERATION PERMIT
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.
Owner last name
Address
first name
Day time phone
( )
Do not complete shaded areas
%.Permit #.
Invoice :#
Date
City
State ZIP
Instal ler/Contractor/Dealer
Phone
( )
Contractor's registration number
Address
City
State ZIP+4
Check the appropriate boxes in section A and section B.
A
DCommercial Coach 1 Li
Li Mobile Horne
Serial No.
;IIUD'No::
DRecreational Vehicle or Park Trailer
Serial No
Model No orYlan Approval No.:`'
Alteration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
[ Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — —
Plan Review
RV Inspection
Reinspection
Technical Inspection
FEES
s �;a � B1999
Serial
Original Perrnit:
Note: This permit expires one year after date of purchase. (Non-refundable)
(-Signature of applicant or authorized representative
Make check payable to: Dept.
of Labor & Industries
FEES DUE E
Department use only ; ; >
Request approved or :; Request denied because of speciIic violations of Washington rules and regulatiops Violations•must
be corrected and reinspection requested witl in l0 days forrecreatronal vehicles and:20 days;for mobile homes and commercial coaches;.'
of tfe`notice of violation date. (This does: not apply to technt�al;inspections) If is unlawful to offer'';fair sale, rent,"or'lease'any
niln=com I in mobile home; ctimmercia1 c each iii recreuti�ina1 vehicle
lncludcd are forms r.cyiiircd which must tic.Cottijiletcd and fccs submitted ticforc rc inspection:
(l)ate
Area office..
F622-012-000 alteration permit 7-98
Total pages
White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
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