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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"! "‘" ' • , • "••••• ....... ... ' . • . „ ..... ... . ...... ... • ••• • ' • • : :" .. . • .. ' ...... ; " • • t " • . ..... .. •-•," ".„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.