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
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Z
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it COURT 11
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