2002, 05-09 Permit App: 02003536 MHProject Number: 02003536 Inv t
•Application.
THIS IS NOTA PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/9/2002 Page I of 2
Project Information:
Permit Use. PLACEMENT OF SINCLEWIDE Contact' PICKLE, LOREN
MANUFACTURED HOME SINCE 1999 Address: PO BOX 754
C - S - Z: MEAD, WA 99021
Setbacks: Front 52 Left. 31) Right 60 Rear 25 Phone: (509) 326-8562
Site Information:
Plat Ker 000325 Name. CAROLINE ADD.
Group Name-
Project
ameProject Name.
District: F
Parcel Number: 35231.1422
Block: Lot•
SitcAddress: 610 S MCKINNON AVE
SPOKANE, WA 99212
Location:: CH
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Area: .1111 Acres Width 0
Nbr of Bldgs: 1 Nbr of Dwellings. 1
Review /nThr,natwn:
Review
Site Plan Review
Plan Review
Owner: Name PICKLE, LOREN
Address. PO BOX 754
MEAD, WA 991121
Hold' ❑
Depth: 0 Right Of Way (fl): 0
Release
Released %)
'Special Inspections
ma..e,U&&30
Septic System Review
Rcicasecl, Bv:
Operator. DMD Printed By: DMD
Print Date: 5/9/2002
Project Number 02003536 Inv: t . Application Date: 5/9/20112
THIS, IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Permits:
Contractor: OWNER
Manufactured Horne
Page 2 of 2
Firnr OWNER
Phone.
Item Description Units Unit Desc Fee Amount
INSPECTION FEE 1 SECTIONS 550.00
COUNTY SURCHARGE 1 Y OR BLANK $11.00
Notes:
Payment Summary
Permit Type
Manufactured Home
Permit Total Fees: $61 00
Fcc Amount Invoice Amount Amount Paid Amount Owing
$61.00 $61 00 50.00 561.00
561.00 561 00
50 00 561 00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the infornurtion
contained within to he true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will he
complied with. Subsequent issuance of a permit shall not he contrued to be a permit for, or an approval of, any violation of any of the
provisions of the code or of any other. state or local laws or ordinances.
Signature:
Operator. DMD Printed By. DMD
Print Date 5/9/2002
Project Number 02003536 Inv•7
Application.
THIS IS NOTA PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use- PLACEMENT OF SINGLEWIDE
MANUFACTURED HOME SINCE 1999
Date: 5/9/2002 Page 1 of 2
Setbacks Front 52 Left: 31) Right: 60 Rear: 25
•
Site Information:
Plat Key: 11011325 Name: CAROLINE ADD. District.
Contact: PICKLE, LOREN
Address: PO BOX 754
C - S - Z MEAD, WA 99021
Phone: (51)9) 326-8562
Group Name:
Project Name:
Parcel Number 35231.1422
Block: Lot:
SiteAddress 611) S MCKINNON AVE Owner: Naive. PICKLE, LOREN
SPOKANE, WA 99212 Address: PO BOX 754
Location- CH MEAD, WA 99021
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Hold: ❑
Area. .1111 Acres Width: 0 Depth: 0 Right Of Way (ft): I)
Nbr of Bldgs- 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Plan Review
'Special Inspections
Released
rite. _ . eair.
— 1 ,'eleased:y
p- sfriz
Approach / Drainage
4.q2_,0011:_2•30
Septic Sem Review
Released By:
Operator DMD
Printed By: DMD Print Date' 5/9/2002
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
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 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.
Owner last name
, .
first name
ALTERATION PERMIT
Do not complete shaded areas
ir Permit # • •
•
454'4
Invoice ti
As -
Day time phone
• •. •
Date
_ .•
Address City State ZIP
Installer/Contractor/Dealer
r Address
Phone
)
City
Contractor's registration number
State Z1P+4
Check the appropriate boxes in section A and section B.
A
• Commercial Coach
U Mobile Home
Serial No.": ei !Z4;"1"1" -g..•
'HUD No.'.
• Recreational Vehicle or Park Trailer
*4) N.& „-•
rt.
Model No: or PlanApproval No."- •
B DI A teration Inspection (check appropriate boxes below)
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
Fire Safety
Gas Fumace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — —
, d Plan Review
RV Inspection
Reinspection
Technical Inspection
FEFS
Origmal Permit
Note: This permit expires one year after date of purchase. (Non-refundable)
Make check payable to: Dept. of Labor & Industries
FEES DUE $ L71
Signature of applicant or authonzed representative
X
• Departmenttotergy;', .z, •-• „r:
Request approved or '.tItegue-sediniedteilinie"Of, sPeeillivielations of Washington rulesandregulatiims:.„Violations must
be corrected and rcInspectionreqnested within AO days forrecreatiOna3vehieles and 20 ds for mobile homes and Commercial coaches
of the notice of violation'date..(This doeSitiot-aPply..tolteChoyalinspections),:, It is unlawful to Offer for sale, rent, or lease any
non-eomplying3noblle hothe Comnieitiartich oileereationitl Cohicle.t.")?, f.t,1",""t"! "‘" ' • , • "•••••
....... ... ' . • . „ ..... ... .
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.
..... .. •-•," ".„7- "t"o".i"."- <
' in•r: ..... i CALL 324-2640 FOR INSPECTION
z.,('-ic;;"2..:2•yr`•;"-r-Cez-Sltil,i PLEASE LEAVE NAME &
. 1 ALTERATION PERMIT NUMBER
............. ..... . ... ..
........ .. ... . : . I .
........ V. ..... •
• ,
• „
spOKAINIE-
... z<r„ z • - .. . . : . • • • [. : ... ' "," " yr::: • -• re:g00?"'"
, .
•
. • .
Included are forms required which must be cernpleted and fees Subrititted before reinspec
F622-012-000 alteration permit 7-01
White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser
This site plan is being suhmitted for thepurpose of
obtaining a building permit and is a true and correct
representation of the proposal. All known property
lines/dimensions, curb fines. structures and easemen
have been identified Also indicated are wetlands,
bodies of water, steep slop other critical areas.
Signed:-- -
Ft Erd\,n� ct
I'
,; X10 I
Ii.
ADDRESS Le (0
ZONE
!NG
WIDTH ROAD WID`'f2�
FRONT °-
�
COMMENTS
REVIEWED E
c I / 11 b1 4P.