1986, 10-10 Permit: 00013545 MHSIGNATURE OF APPLICATION
OWNERORAGENT DATE
JOB ADDRESS
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PLANS EXAM:
MOBILE HOME PERMIT
MOBILE HOMES
Make Serial #
Number 1 Width 14 Length 70 Height 10
Misc Desc SURCHARGE
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DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date
Cond.
Approvveedd Approval
Hold
Environmental Health
W. 1101 College
Room 200
Application # 3�
(Approved-*
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Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Pian Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special inspection Information
Project Representative
Phone
Address
I certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date