1995, 11-15 Permit App: 95009596 MH PROJECT NUMBER= 95009596 APPLICATION DATE= 11/15/95 PAGE= 01
****** THIS IS NO't' A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 17105 E 4TH AVE PARCEL#= 55192. 1201
ADDRESS= GREENACRES WA 99016
PERMIT USE= DOUBLE WIDE MANUFACTURED HOME REPLACEMENT (NEW)
PLAT#= 000077 PLAT NAME= APPLE VALLEY ESTATES 1ST ADD.
BLOCK= 1 LOT= 1 ZONE= UR-7 DIST#= G
AREA= 00000000 F/A= F WIDTH= 125 DEPTH= 80 R/W= 50
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= HAMILTON , ARLENE PHONE= 509 924 1417
STREET= 17105 E 4TH AVE
ADDRESS= GREENACRES WA 99016
CONTACT NAME= ARLENE HAMILTON PHONE NUMBER= 509 924 1417
BUILDING SETBACKS: FRONT= 30 LEFT= 30 RIGHT= 5 REAR= 40
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REOi�TRRn_ ' (ofCn
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COMMENTS: )TT ` U
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HEALTHDIST INCREASE IN LOT COVERAGE d / ()4-4&'/7
COMMENTS: /1 /- l / / 13(2',/76)(7/1"1- ./1I e9X �/ 5!
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 95/LIBERTY MODEL=
SERIAL#= WIDTH= 28 LENGTH= 56 HEIGHT= 10
ITEM DESCRIPTION QUANTITY FEE AMOUNT
INSPECTION FEE 2 100. 00
STATE SURCHARGE Y 4 .50
COUNTY SURCHARGE Y 21. 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 125 .50 . 00 125 . 50
125 .50 . 00 125 .50
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: BURRIS, ROBIN
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PROJECT NUMBER= 95009596 APPLICATION' DATE= 11/15/95 PAGE= 02
******************************** THANK YOU ************************************
APPLICATION INFORMATIONs37
%Khat is the JOB SITE address? ASSESSOR'S tax parcel number?
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Legal description as it appears on the property deed
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OWNER or OCCUPANT Phone
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Mailing address City,state Zip
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Who should we contact regarding this project? Phone
What work is being done under this permit?
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Lone .Inspector district Property size Right of way width
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Water district
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Building Building height #of stories
Contractor Dimensions TOTAL SQUARE FOOTAGE
WA State Contractor license# Main floor area Unfinished basement area
Mailing address 2nd floor area Finished basement area
Architect/Engineer Garage area Size of decks,etc.
What is the heat source? What is the cost of your project?
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Manufactured HomeSign
Width: Length: What is the square footage of How high is the sign?
�S" 5�I the sign face?
Year: Make:
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Installer Contractor
We State Contractor license# Wa State Contractor license#
Mailing address Mailing address
Relocation Fire Safety
Previous address Fire Sprinkler _ Tent
Paint booth_ Fire Alarm _ Fireworks display _
VALUE
Contractor Contractor
WA State Contractor license# WA State Contractor license#
Mailing address Mailing address
Fuel Storage Tanks Swimming Pool
(Circle one) Above-ground Underground Size/gallons Private
Contents of tank(s) Size/gallons
Public/semi-private
Contractor Contractor
Wa State Contractor license* WA State Contractor license#
Mailing address Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in,its programs or activities.
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Mike Bascetta — Joe Bascetta
S. 812 DISHMAN RD. • SPOKANE, WASHINGTON 99206 • PHONE 924-5130
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• DRYWELLS
• LAND CLEARING
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• FILL & BLACK DIRT
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