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1999, 11-29 Permit App: 99011416 MHProject Number: 99011416 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: - Permit Use: PLACEMENT OF SINGLEWIDE MOBILE HOME Contact: HOLCOMB. JAMES & DAWN Address: 3682 W JUMP OFF JOE RD Setbacks: Front 40 Left: 33 Right: 20 Rear: 160 C - S - Z VALLEY, WA 99181-9630 Phone: (5091 937-8334 Date: 11/29/19 I'age 1 of 2 Site Information. C_ Plat Key: 000325 Name: CAROLINE ADD. District: D Parcel Number: 35231.1434 SiteAddress: 521 S MCKINNON RI) SPOKANE, WA USA 00000 Location.: SPO Zoning: UR -3.5 Water District: Area: 18,681 Sq Ft Urban Residential 3.5 Owner: Name HOLCOMB, JAMES & DAWNE Address: 3682 W JUMP OFF JOE RD VALLEY, WA 99181-9630 Hold: ❑ Width: 0 Depth- 0 Right Of Way (ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: - Department BUILDING Continents: BUILDING Continents BUILDING Continents: UTILITIES Comments: Review Site Plan Review Plan Review `9"2C7 . 9srt P Special Inspections L £L Sewer Review 99 —11¼?a// -3 5-97 Permits: , Contractor: OWNER Address: 0 000000, 00 000000 Item Description STATE SURCHARGE INSPECTION FEE COUNTY SURCHARGE Manufactured home Finn: OWNER Phone: (000) 000-0000 Units Unit Desc 1 Y OR BLANK 1 SECTIONS 1 YORBLANK Permit Total Fees: Fee Amount 54.50 550.00 $11.00 565.50 Project Number: 99011416 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Payment Sananarv: Date: 11/29/19 Page 2 of 2 Operator: DMD Printed By: DMD Print Date: 11/29/1999 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Manufactured Home $65.50 $65 50 $0.00 565.50 Notes: $65.50 $65.50 $0.00 $65.50 Labor & Industries ..ssembled Structures Section STRUCTIONS: i1',Complete all spaces, including the signature box (marked with an X). 2 Draw a map on reverse side of WIIITE copy only. J. Forward completed permit and fees 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. Onner 4 _ tV f �. i, J M .. first name Day hie phohe t/ Cv[.. :i .'s�'tl L <...^�C- DatQ / ...r. Address! = .2.36 --/41;44'4� .7 7 City. may, •�te ZIP f) r") / S. /44 C k> AM/6 . tk '2,) r /) .t% fjti 4 A:C2- t Installer/Contractor/Dealer 7. i+ ! Phone Contractor's registration number t`,1 -' .''t i. Z...2• -•.1C. .1 l t..0 C ", 171 ii_ .n.' , ... , .. JL ( ) S-%-`=+ „i -C•: ' E1 8:. Address .. .. ......... i, � rt ...__ State ... IPiq.. / `3 r-C� y Z Check the appropriate boxes in section A and section 13. (f . `,.: • . FEES • ALTERATION PERMIT. Do not complete shaded areas.ri:,i,..' ' 4' Permitil Invoice • • • Commercial Coach B ❑ A teration Inspection'(clieck appropriate, o1xe`s below) $• ''•' Air Conditioning/Heat Pum Y�� �9 • Mobile Home Serial NO./ 'HUD No. `y Recreational Vehicle'or- Park Trailer . Sepal No:: • Model No: br Pla?Approval No: P.,hi�.t� :.YiSiPeltA�..*�C r•t!P �.. P - , Electrical DEPARTMENT OF LABOR & INDUSTRIES 4. Electrical`Appliances • Fire Safety • Gas Fumace Gas Piping .' Pldmbing Structural Wood/Pellet Stole — — Plan Review RV Inspection Reinspection NOV. 2 92•1999 REGION 6 POKANE,.W Technical lnspection Ongmal Permit Note: This permit expires one year after date of purchase. (Non-refundable) -\ Make check payable to: Dept. of Labor & Industries. ...-. J FEES DUE $ 4.1 Signature of applicant or authorized representative . X ' LJ 1 ., epartment use onlYa,: .. .., ..--,,:. r• ,-.._;3-_w x:=a•r:-�,.:,,,.:.n: •Y:,as%iCt1) _ Request approved, or ❑: _Request denied because of.specifie violations of Washington, rules and regulationsArislatidns'musty -becorrectedand reinspection requested within 10 days for recreational vehicles and 20 days for, mobile. homes and'comm- Y'- . ercial coaches, ' of the notice_ of; violation, date. �:(This,does not apply, to technical, inspections). It:is unlawful,jto offervc•afor•, sale :rept;_or;lease-any-- ho ^,o..•".k•, ;_ non-coroplyiog mobile home,, S commercial conch or recreational vehicie:�`; '<�• ::; •: r �.= � .a w�; �: �.::+ ,;'r;+ .;rA rA:.;-:,�F;;.g:�Cca;Ft_: �•.';�-,+x,,., (J Included are forms, required' which must be completed and fees submitted before reinspection F622-012-000 alteration permit 8-99 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser 2 ADDRESS. ZONE. ROAD WIDTH: _FLANKING:�� FRONT: _ COMMENTS: REVIEWED BY 53;27 / inn ADDRESS 3 _1cMr' 1-( NIRTI-I HUNI CUMMENTS This site plan is being submitted for the purpose of obtaining a building permit and is a true and correct representation of the proposal All known props lines/dimensions, curb lines, structures and easement: have bee.) i , r � bodies of v ifieu. A'so indicated are wetlands, , steep mopes a iei 'cal r as. Date: Signed: _ Z This site plan is being submitted for the obtaining a building permit and is a true and correct representation of the Purpose of lines/dimensions, representation Proposal. All know have been identified. lines, structures d property Also indicated are wd etlands, Signed:bodies of w. r, steep slopes or other critics a en. Date: _ q? 5 21 MLACkftiton UR 3.5 40 4-Q FLANKING REVIEWED BY O,r Q1:4t, %�l l O!'ktx mr, er' V' SJR bun ottrin0 J'.t 5W> td. from the desk of .. . Z O V) E Z Q 2 o8 W c 2 it COURT 11 )\ 0 0 0 CNI r-s4ge, ro c; -5111 r,si„ r •