1995, 06-06 Permit App: 95004019 MHI11111 t
PROJECT NUMBER= 95004 APPL
I1
****** THIS,IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED'FOR COMMENCING WORK WITHOUT A PERMIT
DATE= 06/06/95 PAGE= 01
SITE STREET= 4224 S HATHERLY CIR
ADDRESS= SPOKANE WA 99206
PERMIT USE= DOUBLE WIDE MANUFACTURED HOME
PARCEL#= 45334.0301&OYO
a,Ag..e Graze -4W
PLAT#= 001146 PLAT NAME= HATHERLY'S SUB
BLOCK= 3 LOT= 1020 ZONE= UR -7 DIST#= E
AREA= F/A= A WIDTH= 100 DEPTH= 130 R/W= 40
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= CROCKER, PEARL
STREET= 14816 E 12TH AVE
ADDRESS= VERADALE WA 99037
PHONE= 509 922 4644
CONTACT NAME= PEARL CROCKER PHONE NUMBER= 509 922 4644
BUILDING SETBACKS: FRONT= 20 LEFT= 30 RIGHT= 50+ REAR= 16
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING L & I ALTERATION PERMIT
COMMENTS:
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
ENGINEER
COMMENTS:
HEALTHDIST
COMMENTS:
qui a#nck�Cir\IN
E -E= ye 5
APPROACH/ DRAINAGE/ FLOOD
NEW OR
2
ADDITIONAL WASTE WATER
HEALTHDIST PRIVATE WELL REVIEW
COMMENTS:
PLANNING
COMMENTS:
36
6 K.
UNPLATTED/SEGREGATED P PERTY4 v
e S --9S
liet7
PROJECT NUMBER= 95004019 APPLICATION
****************************** MOBILE HOME PERMIT
CONTRACTOR= OWNER
YR/MAKE= 1987 REDMOND MODEL=
SERIAL#=
ITEM DESCRIPTION
DATE= 06/06/95 PAGE= 02
*****************************
PHONE=
WIDTH= 28 LENGTH= 64 HEIGHT= 10
QUANTITY FEE AMOUNT
INSPECTION FEE 2 100.00
STATE SURCHARGE Y 4.50
COUNTY SURCHARGE Y 18.00
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 122.50 .00 122.50
122.50 .00 122.50
31e0.00
******************************************************** *******
* PROJECT NOTE: TOPIC = CONDITIONS DEPT = BUILDING
*******************************************************************************
LABOR & INDUSTRIES ALTERATION PERMIT REQUIREMENTS MUST BE
MET PRIOR TO OCCUPANCY OF MOBILE HOME.
PROCESSED BY: CAROL FRAZIER
PRINTED BY: CAROL FRAZIER
******************************** THANK YOU ************************************
JUL-10-1995 15:15
r. LEL
PROJECT NUMBER= 9500461T--~ APPz'~1' 3'ION' DATE= 06/06/95 PAGE= 01
THIS IS NOT A PERMIT
******
PENALTIES WILL BE ASSESSED.FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 4224 S HATHERLY CIR PARCEL#= 45334.0301&O-39'P�
ADDRESS= SPOKANE WA 99206
PERMIT USE= DOUBLE WIDE MANUFACTURED HOME
144M
PLAT#= 001146 PLAT NAME= HATHERLY'S SUB
BLOCK= 3 LOT= 1020 ZONE= UR -7 DIST#= E
AREA= F/A= A WIDTH= 100 DEPTH= 130 R/W= 40
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= CROCKER, PEARL
STREET= 14816 E 12TH AVE
ADDRESS= VERADALE WA 99037
PHONE= 509 922 4644
CONTACT NAME= PEARL CROCKER PHONE NUMBER= 509 922 4644
BUILDING SETBACKS: FRONT= 20 LEFT= 30 RIGHT= 50+ REAR= 16
t***************************** REVIEW INFORMATION *f************ter*t*****,t***,r*
DEPARTMENT REVIEW REQUIREMENT
BUILDING L 6 I ALTERATION PERMIT
COMMENTS:
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
COMMENTS:
HEALTHDIST
COMMENTS:
HEALTHDIST
COMMENTS:
A-E
APPROACH/ DRAINAGE/ FLOOD 7-.01/4' 36 ��`�7 ����!"/•Sr
41
NEW OR ADD
/� •� j - TE WATER
PRIVATE
,/4\-q(°4 /mac &JJ+�L.
PLANNING UNPLATTED GREGATED PERTY4"'454E44
zfe
6617 c
COMMENTS:
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
NDABt.tri'inD°-
not complete shaded areas
u 4 445
.....................
ERATION PERMIT
1. Complete all spaces, including the signature box (marked wit
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.
first n
Address / 4/r/6' .� ,ric
Installer/Con
Address
00)7./ 2 .e-7
La-
Day time phone
City
Pho,ie
City
stat ZIP
r ti q qS
lContractor's registration number
State ZIP+4
Check the appropriate boxes in section A and section B.
A
ljCommercial Coach
Ul Mobile Home
seine..
LIRecreational Vehicle or ❑ Park Trailer
Model Ntior Plan Appiriw Noi:
B
FEES
Alteration Inspection (check appropriatAtfxes below) $75.00
Air Conditioning/Heat Pump �0�iii
Electrical DEPARTMENT OF LABOR & INDUSTRIES
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — -
Plan Review
RV Inspection
Reinspection thrgurallfemuc
No.
Technical Inspection
JUL - 71995
REGluil 0
SPOKANE, WA
Seriai.Nas
$70.00
$70.00
$50.00
$50.00/hr
(Signature of applicant or authorized representative
X
D artment use only
Request approved; or rouRegnest denied bemuse of spectgg violations of Vashington rules anti regulations 'Vlolats
st be; corrected aind reinspection requested within 10 days forrecreational vehicles and 20<days for mobile homestonand is
commercial �coa; hes of!the'notice of vtolatk n date ('I.'hts does not appty to technical;lnspeetions) It Is unlawful to offer for;sate,
rent,.or lease any non complying mobile home, commerclat coach or recreational vehicle
Make check payable to: Dept. of Labor & Industries
FEES DUE $
l,J Included airs forms required :which must be completed and fees submitted before reinspection.
f Date Area office
F622-012-000 alteration permit 6-94
Inspectdr.
Total pages
White -Olympia Green -Contractor Canary -Inspector Pink -Purchaser Goldenrod -Purchaser
2
A
A
3
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