1986, 12-08 Permit: 00014440 MHSIGNATUREOF �
OWNER OR AGENT AZ-aCz/--le-ef-r/
JOB ADDRESS
11405 F VALLEYWAY A�
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APPLICANT:
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1/405 E VALLEYWAY AC.
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APPLICATION
DATE
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00014440
MOBILE HOME $101.50
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MOBILE HOME PERMIT
MOBILE HOMES
Make Serial #
Number 1 Width 14 Length 52 Height 10 •
Number 2 Width 14 Length 52 Height 10
Misc Desc SURCHARGE
TOTAL FEE
Fee
$101,50
100.08
Misc Fee 1.50
Int CMW GE C O M M E N T S Insp Ref
-- -- - --- - ------------------------ - * Type Date
*REPLACEMENT OF M BIL H ME FRONT LO SETBACK IG 55 FEET CE 12/08/86
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12-08-86
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DEPARTMENTAL REVIEW
I certify that I have examined this application and state that the information contained In it and submitted
by me or my agent to compile said applicaion is true and correct.
Signature
Date
Apprp% d
�-
Cond.
A' proval
Hold
, Environmental Health Application #
/3J7
/'r
,a j
I
_2/
At
W. 1101 College
Room 200
j/2--_
f-1 )
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N. 811 Jefferson
Other(SEPA/Crfical Materiel/etc.)
Fast Trac&I$peclal Inspection Information
Project Representative
_
Phone
Address
I certify that I have examined this application and state that the information contained In it and submitted
by me or my agent to compile said applicaion is true and correct.
Signature
Date