1996, 05-15 Permit App: 96003437 MHPROJECT NUMBER= 96003437 APFLICATCON
DATE= 05/15/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 504 S MCKINNON AVE 1 PARCEL#= 35231.1308
ADDRESS=Y WA 99003
� Z3 25 cl 3
PERMIT USE= RELOCATE SINGLE WIDE MANUFACTURED HOME
PLAT#= 000326 PLAT NAME= CAROLINE REPLAT,BLOCK 4
BLOCK= 4 LOT= 9 ZONE= UR -3.5 DIST#= D
AREA= 00000000 F/A= F WIDTH= 60 DEPTH= 122 R/W= 40
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= DICKENS, FRANK B
STREET= 8905 S WINDMILL RD
ADDRESS= SPOKANE WA 99223
PHONE= 509 448 9153
CONTACT NAME= FRANK DICKENS PHONE NUMBER= 509 448 9153
BUILDING SETBACKS: FRONT= 35 LEFT= 14 RIGHT= 5 REAR= 30
******************************
DEPARTMENT
REVIEW INFORWWW 'jt4M 'L*WW1W1r185tOr**
the following in relation to a manufactured home:
REVIEW REQUIREMEI7T t
Y2EEL
BUILDING REVIEW COORDINATOR - J SHATTO L&Ipermit#
COMMENTS:
Date
Reviewer
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
ENGINEER APPROACH/ DRAINAGE/ FLOOD
COMMENTS:
SiSEZ
1/(0 -Riff 3/7 'CA(e5tr
UTILITIES W/IN PRIORITY SEWER AREA �'LSu.✓L`��+� 5i5. `,
CCN,JisCr -ro 8)asio,v; sistrestey St 2. /94 ra /Ss eelstria-
5
Se-to-CR * - 5 5 5 </
************************ ***** MOBILE HOMEPERMIT *****************************
COMMENTS:
CONTRACTOR= OWNER PHONE=
YR/MAKE= 1993 MARLETTE MODEL=
SERIAL#= WIDTH= 14 LENGTH= 66 HEIGHT= 00
PROJECT NUMBER= 96003437 APPLICATION' DATE= 05/15/96 PAGE= 02
ITEM DESCRIPTION
QUANTITY FEE AMOUNT
i
INSPECTION FEE 1 50.00
STATE SURCHARGE Y 4.50
COUNTY SURCHARGE Y 11.00
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 65.50 .00 65.50
65.50
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
.00 65.50
56 ,ot
******************************** THANK YOU ************************************
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APPLICATION INFORMATION
(2S S p
1Nhais the SZ-'SITe ddress?
feif it o,, s � 5. "
PI
tNL/ /arptio
number?
-3 /.136Y
b
nR!�S/�tax
as'rt rc.'T!(JC' "operty�eed �1 / O ex 4, 7AL l�z /V/— ?E_, par
R . antes/ /7) 'Vo/Lcoree "l.J" o, »l /s . 7e .3% �.�w
RR—or OCCUPANT
OWNER
Prior* / j,
j�
�C.//, e 1 S
�!^L�rr(KB
Mailing address
I"9os' S La'? Ai i1/
City, state Zip
S70o41_0(c eGli fl-Z22s
Who should we contact regard. this project?
Phone
What work is being
1-46f�l/e>to
done
under this ermit?
.to, man
c
uyeQ.�24.rat" i47;en€1576i/-e
LoneInspec
or dist
Property size
Hight of way width
Water district
Building
Building height
# of stories
Contractor
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor license #
Main floor area
Unfinished basement area
Mailing address
2nd floor area
Finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Manufactured Home- ...:::.::. .°.
Sign:,.;:, :.,.
Width:��
Length: /
What is the square footage of
the sign face?
How high is the sign?
Year:Make:
93
Pia..6^/1/e
Installer
Mie&xel Roar/ c
Contractor
We State Contractor license # n,p� ilA0i/5+�Og,40
/y C� �/[ !TU
We State Contractor license #
Meiling address
Alt
Meiling
Meiling address
Relocation-:- .. :.';. :,
_.:
Fire :
Safet - .. . . .
Y
Previous address
Fire Sprinkler Tent
_
Paint booth _ Fire Alarm _ Fireworks display
VALUE
Contractor
Contractor
WA State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
Fuel Storage: Tanks .
Swimming Pool .
(Circle one) Above -ground Underground
Size / gallons
Private
Contents of tank(s)
Size / gallons
Public/semi-private
Contractor
Contractor
Wa State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
coto
0.
m
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
nALTERATION PERMIT
Do not complete shaded areas
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.
cm"" 56584
Invoice #
Insignia
Owner last name first name
Day time phone
( ) •
Date
Address
r / ,
City
State ZIP
Installer/Contractor/Dealer
Phone
( ') i
Contractor's registration number
Address City
State ZIP+4
Check the appropriate boxes in section A and section B.
A
Li Commercial Coach
Serial No.
Li Mobile Horne
Serial No.
THUD No.
Recreational Vehicle or Li Park Trailer
Serial No.
Model No. or Plan Approval No.
FEES
B ❑ Alteration Inspection (check appropriate boxes below) $75,00
Air Conditioning/Heat Pump
Electrical PAID
Electrical AppliancA EPARTMENT OF LABOR & INDUSTRIES
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet
Plan Review
RV Inspection
Reinspection Origt`�al] a mit
No.
Technical Inspection .
MAY 17 1996
REGION 6
Serial SPOKANE, WA
$70.00
$70.00
$50.00
$50.00/hr
(-Signature of applicant or authorized representative
Make check payable to: Dept. of Labor & Industries
FEES DUE $
De artmcnt use only
Request approved or ❑ Request denied because of specific violations of Washington rules and regulations. Violations
must be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and
commercial coaches of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale,
rent, or lease any non -complying mobile home, commercial coach or recreational vehicle.
Included are forms required which must be completed and fees submitted before reinspection.
F622-012-000 alteration permit 4-95
White -Olympia Green -Contractor
Canary -Inspector Pink -Purchaser Goldenrod -Purchaser
,2ALE/DEVELOPMENT/DIVISION SEGREGATION
This application is to be completed in its entirety before processing.
-.l
APPLICANT
Nome ! rGaii`</ �ig
Address fres
Cif y4 1aCa,,e.-C
State cf� Zip �J� ZZ
ore
<,
OWNER (IF NOTAPPLICANT)
Nome
Address
City
ee ,Za /7
Stole
Zip
APPLICANT IS:
Owner n Purchoser
Lessee Other *
Parcel Number(s)-
TAXPAYER(S)
Name, ;etTk 2 0/deca/2S
Address 571-af`e
City
Stole -414/r_ 5-t4/O Zip
Name
AT duVetcr hSH��ON tans
CP • of sPO �: y Assessor ut "cfri.ttv that
flatql-IPSLE
County State Washington, i
foregoing In to g°i not its on fit
FA" foregoing
original th
Name Date
Address
City
State Zip
Add sheets if more taxpayers
•
0
correct ce
in erg°
�r
PLEASE READ BEFORE SIGNING: Division of land for the purposes of sale or lease must be divided in
occordonce with applicable state and local laws governing such divisions. (Contact your locol city or county
planning department for futher Information) Complete This form and return together with supporting
document s (if ony) to the Spokane County Assessors Office al West 1116 Broadway, Spokane WA 99260.
Telephone: 456-3698
"This segregation application is for the sole lease or transfer of property into more than one owner-
3h1p,bycontroc�eof !conveyance or for finoncing orrangments': ( Please sign below.)
76
Apel cents Si3noture (owner orogen!) ( Dote)
3.523/,730?�
,r3O rrd
Tax Status:
(Year)
NOTES:
ir
//�,,�Lr' ��
ray
L? -L
PLANNING DEPARTMENT REVIEi
r�
I I proved Date:
a e d
(Of
Ial)
Date received: (0////g'/fc'
Checked by:
Field Book number
Approved by:
Pv
(Signature)