1986, 07-28 Permit: 00012346 MH� �
SIGNATURE OOWNER OR AGENT D2110 < Sir F
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JOB ADDRESS
./ODCES �D
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ADDRESS:
NODCES Rf.)
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LAKE WA 99019
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PAMELA J
CONTRACTOR.
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PLATS:
0D254500
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PLAT NAME:
MISSION IV
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26 SINGLE WIDE MH REPLACEMENT
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1502 N HODCES RO
APPLICATION
DATE
PROJECT#
O0l3678
07/28/86
MOBILE HOME
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$51.50
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COUNTER APP:
PLANS EXAM:
DATE:
MOBILE HOME PERMIT
MOBILE HOMES
Make Serial #
Number 1 Width 14 Length 56 Height 10
Misc Desc / BLDG SC
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D7�7O~/6
TOTAL FEE
Fee
Misc Fee
$51.50
50.00
1.50
4O7. U5 *5 1.5 U�u
•
DEPARTMENTAL REVIEW
1 certify that 1 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
Approved
ACond.
pproval
Hold
Environmental Health Application `,
l\ $
W. 1101 College
Room 200
(.•! (1
1
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
I
Plan Review/Fire Prevention
N. 811 Jefferson
Other (SEPA/CrltIcal Material/etc.)
Fast Track/Special Inspection Information
Project Representative
Phone
Address
1 certify that 1 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
;
(7,11 cla
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