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1998, 06-08 Permit App: 98004965 MH PROJECT NUMBER= 98004965 APPLICATION DATE= 06/08/98 PAGE= 01 PROJECT NUMBER= 98004965 APPLICATION DATE= 06/08/98 PAGE= 01 ****** THIS IS NOT A PERMIT ****** PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT SITE STREET= 18812 E VALLEYWAY AVE PARCEL#= 55173.2708 ADDRESS= GREENACRES WA 99016 PERMIT USE= SINGLE WIDE MOBILE HOME PLAT#= 002442 PLAT 'NAME= SOUTHERN'S MOBILE PARK ADD BLOCK= LOT= ZONE= UR-7 DIST#= G AREA= 00000000 F/A= F WIDTH= DEPTH= R/W= # OF BLDGS= 1 # DWELLINGS= 1 WATER DIST = OWNER= HENDRICKSON, DAVID & CLAUDIA PHONE= 509 893 9545 STREET= 15407 E 12TH AVE ADDRESS= VERADALE WA 99037 CONTACT NAME= DAVID BOYCE PHONE NUMBER= 509 535 8881 BUILDING SETBACKS : FRONT= 4 LEFT= 5 RIGHT= 5 REAR= 5 ****************************** REVIEW INFORMATION ***************************** DEPARTMENT REVIEW REQUIREMENT r f! BUILDING L & I ALTERATION PERMIT �' /C' COMMENTS : ****************************** MOBILE HOME PERMIT ***************************** CONTRACTOR= UNKNOWN PHONE= STREET= UNKNOWN ADDRESS= UNKNOWN WA UNKNOWN YR/MAKE= 1995 BROADMORE MODEL= SERIAL#= WIDTH= 14 LENGTH= 56 HEIGHT= 10 ITEM DESCRIPTION QUANTITY FEE AMOUNT INSPECTION FEE 1 50. 00 COUNTY SURCHARGE Y 11 . 00 STATE SURCHARGE Y 4 . 50 PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING MANUFACTURED HM 65.50 . 00 65 . 50 65.50 . 00 65 .50 PROJECT NUMBER= 98004965 APPLICATION DATE= 06/08/98 PAGE= 02 ******************************************************************************* PROJECT NOTE: TOPIC = CONDITIONS DEPT = BUILDING * ******************************************************************************* ALL CONDITIONS OF LABOR & INDUSTRIES ALTERATION PERMIT MUST BE MET PRIOR TO OCCUPANCY OF MOBILE HOME. PROCESSED BY: CAROL FRAZIER PRINTED BY: CAROL FRAZIER ******************************** THANK YOU ************************************ Department of Labor&IndustriesALTERATION PERMIT Factory Assembled Structures Section ,;BC'i....4:e., Do not complete shaded areas iri •qii'l i'Permit#.:::...•:.: : :.",....:::,..::-,:',.:.,:::.?,,,.:.:,:::.::::::..:.:::::::,-.-.,,,,,r.-.:::-.q:.?..i.iiii.::...„) INSTRUCTIONS: •,:i:......,:,::,,,,, , i' il::i.:.i::!::!..:11.ii,,ili.,iii...::, 1. Complete all spaces,including the signature box(marked with an X). •::,Invoice#..:.::<'.......,..:::::.::.. ::. :••"•.......••...7 5 T •:,......'.:.:-. ...i.::::in:ii...!iiii-..,. 2. Draw a map on reverse side of WHITE copy only. '....••:,..v...-,•:..•::::::::::::::::::::,,....:::::::::::::::,:::.::::::.:,.............:,...........-2.- .,................,,,,................„..-...................................................... . . ,..• ....v.v.........,,,,,,,,,...............,,,............,:,::,:::::::::::...................,.....:, 3. Forward completed permit and fees to the nearest L&I office. See list on reverse. ..c-i"....,""....:-................::::::::::........,-...........„.-...............--... -.Insignia#, 4. Contact and schedule the inspection with the same L&I office within 15 days. ..i:::. :•::,U::....:.::: ::.P....::::::::::.n.:::...,':','..*h..:::::.:•::::.*'.*:.,:,:.**::::::::::::':::::... ., Owner last stamp , first name Day time phone . . . Date . i 0. 1 , , i \ A (17i,i,k it , .. i:;,:, . .,, ., ,•': ' '.; ( ) ' Address .,- City State ';ZIP1 ( ( • ) "7 ' ' . ' (... Installer/Contractor/Dealer .. , Phone - , -- , , , \. l'. t"'l..")''• 1." ' `..1(.,,' ,' 1 Contractor's. registration numberc, , ( ) / , / ) 1 ' . Address - City i- , State ZIP+4 .. . ( ) i • -. ) .".,• , ' ' "---., ) i' ; . ., , (.7 .... Check the appropriate boxes In section A and section B. / FEES A Li., Commercial Coach B 1:-.1 Alteration Inspection(check appropriate boxes below) $ Air Conditioning/Heat Pump phli n §:e.t:i41.,:i9•::',..::::::•.',.,.....•.... ..'''...:.::...:::-.:::.:: ......::::..',•,:,', Electrical OFPARTNIENT OF LABOR & INDUSTRIES Electrical Appliances [:I Mobile Home Fire Safety -IUN () 8 1998 Gas Furnace Gas Piping lu_s..,....,i4 o Plumbing liOKAE, WA Structural Park Trailer settitt,40 ...:.,..-.. mi:.:•:m. ,,v.:,:.....,:::.....:....:.:,m; Wood/Pellet Stove—— ::::.:•.:::::: ::',.:.::::::::: ....,::..::::::::i::::....:.:....,..:::..,..,::-:.:..:.,..:-:n:::::„............. [j Recreational Vehicle or Ull ''•••••••••:•:•••••••••' •••:::::,:•::•••::::::,•••:: -::-::••••- ......... ..: .. Plan Review $ Serial NO::::::::• : ::::•::::::::::::,.::::i::::nigiiiii.:;•ii:::.....:ii.im... RV Inspection .40:4!..:004:a: ::.......i...............:::.............g:: ., i'vlodet:Noo's•,.gfim::Atilovo.: itii:,iii:i..,:„1.....,:!..;...:....1:,.........: .: Reinspection N4:;::::::•:.v:ft.:: ::;:i::.mfg:..::::.nm::.=:,:Ei:.-..::: ,.....-...,....................,..........-...........................:.,........:.....:.:........., Technical Inspection $ 1Signature of applicant ok authorized representative ; .,,,,) Make check payable to: Dept.of Labor&Industries V . -... ....") i .‘,.. i ri, _I FEES DUE $ i '..d. f' • . . „ „ .. . ..._... ......„,::„.:.:..,:,,:::::,„;,,,......:„..,...,:,:::.:.:.„,,,.:..,,.............:„:.,,,..::,.„......:..,..,.... .......: . . ..,.. Department use tailvisoi:.:,:.::: .:•. ::, i.: ].:,]:::.:,:::::::,,1..':::-.::::::.:::::::'::::::-...:::.:::::a.:: :,:.:",:::::::::::..-,,,,,,....":..":,,:":::: ' " • ... Violations must 1,..1 Request approved.:::::::iie.............::::::::'::::L21.:::::')Iteiiiiii0 filinied::.bi4i0$6:0f::::$0etii...k.....liioiatinp::ot Washington.. regulationsrules...„.....n....n4:,.: .........)...... *i:: :....„...,...:,..,,..11,1,............„.......... ... be corrected and rei-41000.0ii**(100*i0**00.......**:....i104.104i.:10.0*400*vehl01...f.*iiij.........:-.,10,4...:. .,:':f01ffi..:,..okiki..1-#0t:40:-....CO.:........in iflett.„.....441toiches ,...:,01:.the,::notice of vio1014.....1,0 04::::::AT....Sai:::i:::00040:400lt...:10:lethigiOgi...*specti6iii)Oitit'.nnlaW.f.tittiaftiM.....!!ttir sale, or lease any .....................,...„„„.„..„„„„„„„„„„....„„„..„............ .............,.:.:.......:,,.. ......„..„. ...,... .... ..,... , •-•::'...tiiiii;k'nintilying rii(ibileltdiiii;lititittilietirOaCCOttChfifteOtenIiOnalvohoe:• .:.. ''.::'.' ....:::'.''' 1 ..:i.:':'.....''..... : ''''' .....''— ...''''''...:.':''''':ivi.:..1.:'.'. . - ..'1. 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'.:::....,. ':::::<:.• _ _ (Date Atea office ..!::: ,.. :.:,.Inspector...::: rotal pages . . ., ..........:.z...-...:-....,-„•:,.....,:::-......,:.:::,-.:....::::.:,.:.:.::.:,..,. F622-012-000 alteration permit 11-97 White-Olympia Green-Contractor Canary-hispector Pink-Purchaser Goldenrod-Purchaser f