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1996, 09-16 Permit: 96007744 Relocate MHPROJECT NUMBER= 96007744 .APPI.II;ATIOlr DATE= 09/16/96 PAGE= 01 ****** THIS IS NOT A PERMIT ****** PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT SITE STREET= 4220 S HATHERLY CIR PARCEL#`= 45334.0302&0303 ADDRESS= SPOKANE WA 99206 PERMIT USE= RELOCATE SINGLE WIDE MOBILE HOME PLATO= 001146 PLAT NAME= HATHERLY'S SUB BLOCK= 3 LOT= 2030 ZONE= UR -7 DISTO= F AREA= F/A= A WIDTH= 100 DEPTH= 130 R/W= 40 # OF BLDGS= 1 O DWELLINGS= 1 WATER DIST = CHESTER OWNER= CROCKER, PEARL STREET= 14816 E 12TH AVE ADDRESS= VERADALE WA 99037 PHONE= 509 922 4644 CONTACT NAME= PEARL CROKER PHONE NUMBER= 509 922 4644 BUILDING SETBACKS: FRONT= 25 LEFT= 42 RIGHT= 25 REAR= 20 ****************************** REVIEW INFORMATION ***************************** DEPARTMENT REVIEW REQUIREMENT BUILDING SETBACK REVIEW REQUIRED COMMENTS: PRO CH/ DRAINAGE/ FLOOD HEALTHDIST NEW OR ADDITIONAL WASTE WATER COMMENTS: LABOR & IN STRUCTUAL ALTERATION COMMENTS: ****************************** MOBILE HOME PERMIT ***************************** CONTRACTOR= OWNER PHONE= YR/MAKE= 1992 MODEL= SERIALO= WIDTH= 14 LENGTH= 60 HEIGHT= 10 PROJECT NUMBER= 96007744 ITEM DESCRIPTION • APPLICATIbN DATE= 09/16/96 PAGE= 02 QUANTITY FEE AMOUNT INSPECTION FEE 1 50.00 STATE SURCHARGE Y 4.50 COUNTY SURCHARGE Y 11.00 PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING MANUFACTURED HM 65.50 .00 65.50 PROCESSED BY: JOHN LARSON PRINTED BY: JOHN LARSON 65.50 .00 65.50 330 •SO ******************************** THANK YOU*****************************+r****,r* Department of Labor & Industries Factory Assembled Structures Section INSTRUCTIONS: NON- 1.FL) 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 fee 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 first name Day time phone ( ) ATION PERMIT Do not complete shaded areas Address City tate ZIP Installer/Contractor/Dealer Phone ) Contractor's registration number Address City State ZIP+4 Check the appropriate boxes in section A and section B. A CICommercial Coach j Mobile Home 441014. Recreational Vehicle or ❑ Park Trailer Serial No. Model No. or Plan Approval No. FEES B ❑ Alteration Inspection (check appropriate boxes below) $75,00 Air Conditioning/Heat Pump PAI Electrical �EpgRTMENT OF LABOR & INDUSTRIES Electrical Appliance Fire Safety Gas Furnace Gas Piping Plumbing Structural Serials �%�i��,ID! Wood/Pellet Stove — — Plan Review RV Inspection Reinspection Technical Inspection SEP 18 1996 AE :;ION 6 Original Pemut No. $70.00 $70.00 $50.00 $50.00/hr C._Signature of applicant or authorized representative X artment use only Request approved or Li Request denied because of specific violatlonsof 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. Make check payable to: Dept. of.Labor & Industries FEES DUE $ Included are forms ............................................ which must be completed and fees submitted before reinspecti Date Area office Inspector )(Total pages F622-012-000 alteration permit 4-96 White -Olympia Green -Contractor Canary -Inspector Pink -Purchaser Goldenrod -Purchaser r !t ij _ s • 'A8 a3M31A3H :S1N3WW00 :0INNtll.4' iNOHI ©9 mum avou 4, —.4'17 :3NOZ ��✓ 6'� ocoe°4 :SS3Haad i r 14tYM-e-, (€04- ID 7 ,C .