1995, 06-26 Permit App: 95004633 MHPROJECT NUMBER= 95004633 .-APPIyjCATION
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
DATE= 06/26/95 PAGE= 01
SITE STREET= 16924 E MEADOWBROOK LN #20 PARCEL#= 45241.9126
ADDRESS= GREENACRES WA 99016
PERMIT USE= INSTALL DOUBLE WIDE MOBILE
PLAT#= MH0107
BLOCK=
AREA= 00000000
# OF BLDGS= 1
PLAT NAME= MEADOWBROOK VILLAGE
LOT= 20 ZONE= UR -7 DIST#=
F/A= F WIDTH= 53 DEPTH=
DWELLINGS= 1 WATER DIST =
OWNER= SKIPWORTH, DON
STREET= 309 N RAYMOND RD
ADDRESS= SPOKANE WA 99206
CONTACT NAME= DON SKIPWORTH
BUILDING SETBACKS: FRONT= 4 LEFT= 5
F
76 R/W= 30
PHONE= 509 926 4954
PHONE NUMBER= 509 926 4954
RIGHT= 5 REAR= 5
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 1995 MODULINE MODEL=
SERIAL#= WIDTH= 27 LENGTH= 44 HEIGHT= 10
ITEM DESCRIPTION
INSPECTION FEE
STATE SURCHARGE
COUNTY SURCHARGE
PERMIT TYPE FEE AMOUNT
MANUFACTURED HM
122.50
122.50
PROCESSED BY: JOHN LARSON
PRINTED BY: JOHN LARSON
QUANTITY FEE AMOUNT
2
Y
Y
100.00
4.50
18.00
AMOUNT PAID AMOUNT OWING
.00 122.50
.00 122.50
******************************** THANK YOU**********,t*********************,t***
AI5PLICATION •INFORMATION
11Nhat is the JOB SITE address?
ASSESSOR'S tax parcel number?
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Legal description as it appears on the property deed
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OWNER or OCCUPANT
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Mailing address
Phone
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Who should we contact regarding this project?
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City, state
/l
ll Phone
Zip
What work is being done under this permit?
Contractor
Building height
# of stories
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Mailing address
2nd floor area
Architect/Engineer
Garage area
Unfinished basement area
Finished basement area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Manufactured Home
Sign
Width:
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Length:
What is the square footage of
the sign face?
How high is the sign?
Year:
Make:
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Installer
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address
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Mailing address
Relocation
Fire Safety;
Previous address
Fire Sprinkler _
Paint booth Fire Alarm
Tent
Fireworks display _
VALUE
Contractor
Contractor
WA State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
CL
m
Fuel Storage Tanks
Swimming Pool
(Circle one) Above -ground Underground
Contents of tank(s)
Size / gallons
Size / gallons
Private
Public/semi-private
Contractor
Contractor
Wa State Contractor license*
WA State Contractor license #
Mailing address
Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.