2001, 10-01 Permit App: 01008549 MH Project Number: 01008549 Inv: 1 Application Date: 10/1/01 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project In formation:
Permit Use: RELOCATE DOUBLE WIDE MANUFACTURED Contact: BEEMAN,KAREN S
HOME Address: PO BOX 243
C-S-Z: OTIS ORCHARDS,WA 99027-0243
Setbacks:Front 30 Left: Right: 6 Rear: 38 Phone: (509)226-1457
Group Name:
Site Information Project Name:
Plat Key: 000077 Name: APPLE VALLEY ESTATES 1ST ADD. District: G
Parcel Number: 55192.1304 Block: 2 Lot: 4
SiteAddress: 17406 E 3RD AVE Owner:Name: BEEMAN,KAREN S
GREENACRES,WA USA 9901 Address: PO BOX 243
Location::GRE OTIS ORCHARDS,WA 99027-0243
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 8,400 Sq Ft Width: 70 Depth: 120 Right Of Way(ft): 50
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: ,.., ,,r xx :..:-.. r .. .....:..R,aM E n. a ... oaf M. ,:,..X. ,,
Department Review
BUILDING Site Plan Reviewr Ia••r e
C Release y
Hold Reasons:
Permit Conditions:
BUILDING Plan Review Released By:
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Hold Reasons:
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Permit Conditions:
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BUILDING Special Inspections /2_ ;:i: ReleasedLByt
Hold Reasons:
rmit C•n,i ions: J��
ill
THDI' /RI Air 'e ti System Re?iew �/
H P Y Rel / .
eased By: j/es J l
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Hold Reasons: ?iii;atis,e n � } , ��
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Permit Conditions: fir !",¢e.c f n.1
Permits: .k '-!S,PINs,_.< 7F..-%a &raS.0; a,. i .x a...,,,s. . ,,.' a.,. ,A 4 tea. _.,M.,. . . ;a a
Project Number: 01008549 Inv: 1 Application Date: 10/1/01 Page 2 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Manufactured Home
Contractor: OWNER Firm: OWNER
Address: 0 Phone: (000)000-0000
000000,00 000000
Item Description Units Unit Desc Fee Amount
INSPECTION FEE 2 SECTIONS $100.00
COUNTY SURCHARGE 1 Y OR BLANK $22.00
Permit Total Fees: $122.00
Payment Summary:
Operator: JAS Printed By: JAS Print Date: 10/1/01
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $122.00 $122.00 $0.00 $122.00
$122.00 $122.00 $0.00 $122.00
Notes: ,,1r0i Gil7'7d*_74 — .... W. 777,77717,,77-7-7377,7777
Department of Labor& Industries ^r�n,T`o ALTERATION PERMIT
Facto Assembled Structures Section
'y ''!! �� Do not complete shaded areas
INSTRUCTIONS: X44,...No (Permit#
1. Complete all spaces,including the signature box(marked with an X).. 9 3
Invoice#
2. Draw a map on reverse side of W1-IITE 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&l office within 15 days. Insignia#
\ 1
Owner last name first name Day time phone Date
:. ......... .:� .4.A.....-4"...,.,... t _a......._. _(:_`x_.41 = .' cr .l Lf /...-
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AddressCity State ZIP
Installer/Contractor/Dealer Phone Contractor's registration number
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Address CityState
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f c,cam, r ( r ,(!`� c-t-/ '"
Check t e appropriate boxes in section A and section B. FEES
_A ❑ Commercial Coach B ❑ Alteration Inspection(check appropriate boxes below) $
Serial No. Air Conditioning/Heat Pump
Electrical ,
Electrical Appliances - t r `
Mobile Home
Fire Safety _ F.
Serial No. Gas Furnace - ';
=
Gas Piping :'L•.._ I't.: I
HUD No. .
Plumbing
Structural
Recreational Vehicle or ❑ Park Trailer Wood/Pellet Stove — — Serial No.
Serial No. Plan Review $
RV Inspection $
Model No.or Plan Approval No. Reinspection Original Permit $
p No.
- Technical Inspection $
Note: This permit expires one year after date of purchase. (Non-refundable)
(-Signature of applicant or authorized representative Make check payable to: Dept.of Labor&Industries
Y 1
FEES DUE $ ,,- 1; , = , .
Department use only
Request approved or Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and reinspection requested within 10 days for recreational vehicles and 20 days for mobile homes and commercial coaches
of the notice of violation date. (This does not apply to technical inspections). It is unlawful to offer for sale, rent, or lease any
non-complying mobile home,commercial coach or recreational vehicle.
3a`-I _ar? 17
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Included are forms required which must be completed and fees submitted before reinspection.
(Date Area office Inspector 1Total
F622-0 I2-000 alteration permit 8-99 White-Olympia Canary-Inspector Green-Contractor Pink-Purchaser Goldenrn'
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COMMENTS ='�I ,► ` d ` I er°rit a�a�°�s x'7/4
REVIEWED �•
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