1995, 12-20 Permit App: 95010506 Relocate MHPROJECT NUMBER= 95010506 APPLICATION DATE= 12/20/95 PAGE= 01
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****** THIS IS NOT -A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 8317 E VALLEYWAY AVE PARCEL#= 45184.0548PTN
ADDRESS= SPOKANE WA 99212
PERMIT USE= RELOCATE SINGLE WIDE MOBILE HOME ea_elat.g-rv-/ord...:)
PLAT#= 005701 PLAT NAME= SP -958-94
BLOCK= LOT= 2 ZONE= UR -3.5 DIST#= F
AREA= 00000000 F/A= F WIDTH= 102 DEPTH= 124 R/W= 30
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST = HUTCHINSON
OWNER= LUCAS, JOHN & MICHELLE
STREET= 8317 E VALLEYWAY AVE
ADDRESS= SPOKANE WA 99212
PHONE= 509 922 4462
CONTACT NAME= JOHN LUCAS PHONE NUMBER= 509 922 4462
BUILDING SETBACKS: FRONT= 25 LEFT= 20 RIGHT= 12 REAR= 50
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED
APPROVAL: J LARSON
ENGINEER APPROACH/ DRAINAGE/ FLOOD
APPROVAL: 95FNA107 S JENNEN
4-1
HEALTHDIS
COMMENTS:
NEW OR ADDITIONAL WAST WATER
DATE: 12/20/95
DATE: 12/20/95
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LABOR & IN STRUCTUAL ALTERATION
COMMENTS:
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****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 1984 MODULINE MODEL= GIBRALTER
SERIAL#= WIDTH= 14 LENGTH= 66 HEIGHT= 10
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PROJECT NUMBER= 95010506 APPLICATION DATE= 12/20/95 PAGE= 02
ITEM DESCRIPTION
QUANTITY FEE AMOUNT
IMPACT FEE= PARKS - MH Y 400.00
INSPECTION FEE 1 50.00
STATE SURCHARGE Y 4.50
COUNTY SURCHARGE Y 10.50
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 465.00
PROCESSED BY: JOHN LARSON
PRINTED BY: JOHN LARSON
.00 465.00
465.00 .00 x.00
45. ,0d
******************************** THANK YOU ************************************
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
NDABtvER rr
Do not ciomplete shaded reas PERMIT
56247
1. 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.
Invoice #
Insignia #
Owner
last name
Address
/
Installer/Contractor/Dealer
\
first name
Day time phone
)
Address
City
Date
-
Phone
State ' ZIP
Contractor's registration number
City
State ZIP+4
Check the appropriate boxes in section A and section B.
A
Li Commercial Coach
:: • .
lj Mobile Home
SeiialNe••••••• • ••
111-1D No -
CIRecreational Vehicle or I:1 Park Trailer
Seriid
Signature of
B CI Alteration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — _
Plan Review
RV Inspection
Reinspection
Technical Inspection
FEES
$75.00
Serial No.
$70.00
$70.00
$ 0.00
plicant or authorized repre,sentative
Make check payable to: Dept. of Labor & Industries
artm. ent use.
. •• •
Request a • pr ved or j Request denled because of specilic violatlons of Washington rules and regulatlons. Vi Ia ons
mus( be corre te. and reinspection requested within 10 days for recreational vehlcles and 20 days for mobile ho es nd
commercial,. •s of the notice of violation date. This does not apply to technlcal inspections). It is unlawful to offer 'r
rent,•Otle04e...„.i on -complying mobile home, commercial coach or recreational vehlcle. 1
_ _ _ „ „ _ • ..„ _ _ _ _ _ „ _
......
InCluded'areforiii.Vrequixtd•WhiChrtalttexompIe
Date
F622-012-000 alteration permit 4-95
White -Olympia Green -Contractor Canary -Inspector
APPLICATION INFORMATION
What is the JOB SITE address'?
3/'7 U4// yI/4y
Legal description ask appears on the property eed
ASSESSORS tax parcel number?
'5/5/ray O�17J / ?5V
OWNER or OCCUPANT
(:—//ru /(( c745-
Mailing
fl $
Mailing address
Phone
City, state
I 11. 6'U /r /F- # I/5
Zip
Who should we contact regarding this project?
712, /7,/ (c2/
Phone
What work is being done under this permit? j, c4 re wSf- c/ e
zYJc 7/L r' /76'.M E CU 1/ .1"-e, i3 , / YX GG /y ,6 D/.2 2 1 13A 5A'//%l Y5i
Contractor
WA State Contractor license #
Mailing address
Building height
Dimensions
# of stories
TOTAL SQUARE FOOTAGE
Main floor area
Unfinished basement area
Architect/Engineer
2nd floor area
Finished basement area
Garage area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Man
ufactured Home
Sign
Width:
Year:
Length:
What is the square footage of
the sign face?
How high is the sign?
Make:
Installer
Wa State Contractor license #
Contractor
Wa State Contractor license #
Mailing address
Mailing address
Relocation
Fire Safety
Previous address
Contractor
Fire Sprinkler
Tent
Paint booth _ Fire Alarm _ Fireworks display _
VALUE
WA State Contractor license #
Mailing address
Contractor
WA State Contractor license #
Mailing address
Fuel Storage Tanks
Swimming Pool
(Circle one) Above -ground
Undernd
Contents of tank(s)
Contractor
rou
Size / gallons
Size / gallons
Private
Wa State Contractor license #
Mailing address
Contractor
Public/semi-private
WA State Contractor license #
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.
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Site Plan•
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ROAD WIDTH: 'D
RONT=FLAN (ING:
COMMENTS:
REVIE N
INCLUDE THE FOLLOWING:
❑ All roadways, driveways & easments
❑ Distances from center of roads, right of ways,
private roads & property lines
0 All existing & proposed buildings
❑ Underground utilities
❑ North arrow
O Septic tanks & wells
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FINAL AS—BUILT INSTALLATION
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