1991, 04-03 Permit: 91001557 MH SPOKANE COUNTY DEPARTMENT OF BUILDINGS
W. 1303 BROADWAV,AVENUE
SPOKANE,WASHINGTON 99260
(509)456-3675
I certify that I have examined this permit/application,state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same.All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not.I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction,or as a warranty of conformance with the provisions of any state or local
laws regulating construction.•,,.•--.
SIGNATURE OF APPLICATION
OWNER OR AGENT / .tee�" � �' �� ��� DATE
i,!v,.i;:( 91 0 }' ISEU i SPERMIT Dft•.-. .. .1 PAGE= 01
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" I 1 1::: STREET= ! r1 c 1' 4TH H AVE 1.:Ai.;•;..; .. 19552-1502
ADDRESS= :r i'•:s::.:.~!-t A r.:I't:1...... WA s 0 ...
PERMIT UEE= DOUBLE WIDE MOBILE HOME .... REPLACEMENT
PLAT !:= 000077 PLAT NAME= APPLE VALLEY ESTATES 1ST ADD .
.vLt.J t.:,,+.... LOT=.... 2 ZONE= UR—7... r %.•,•
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WATER DIET ....
OWNER—.... GROUT , FLORENCE !,i...::r ! r'"! 11::. 1 ...'??.. ... .� 1 ... .. - ..- STREET=. 315 :A FLORA i..•• i ii
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CONTACT NAME- J;.1••j'+i P i» ..I::.e::. ``-11, (��; ;`',!�' PHONE 1`•?1 �i;•
L.'?.1.!`!=_r SETBACKS : FRONT= 25 »L..L:.1''•i ... .. RIGHT= '
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STREET= UNKNOWN
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YR/MAKE= 19;;::' ;'11,1..:.1... :: ...1!....l::.!"•: 1 •
SERTALO= WIDTH= 24 LENGTH= 60
HEIGHT= 10
ITEM DEECRIPTION QUANTITY FEE AMOUNT
IMEPECHON FEE 2 100. 00
STf'-".-TE SURCHARGE 4. 50
COUNTY EURCHARGE 16 . 00
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PAYMENT ::i•fii.. lii::t.:l::..l.! •Sr PAYMENT
04/03/91 1772 120,50
i { DUE=. i { TOTALti
! PAID= 120.50
, f...!",!1.e. 1 IYPL ;..C:.1::. AMOUNT AMOUNT PAID AMOUNT OWING
•
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MOBILE ..... .E i::i:;'•. 120,50 120.50 .00
PROCESSED BY : jULTE SHATJ0
PRINTED BY : jULTE SHATTO
c: . . 9u.. :PA . . :..... ) ! k: 6 k iP ; 4Puk THANK you„ { {. : j. Pjj : Lw :9j : . { { j*:j1 ¢. n *: ytA
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SPECIAL CONDITION CHECKLIST
Project •
Address: — Project# ____ —_Use:
Dept: Date: Condition: Init: Appr:
(in) (out)
Dept.of Bldgs.
Special Insp.Final Report
_ Hydrant( )
Lock Box
Engineer's_ RID/CRP
Easements
_ Road Plans/Improvements
Bonds
Planning __ Bonds.
Utilities_ _ Double Plumbing
— — ULID
Other__
'"***********"""*`THIS SPACE FOR COMMERCIAL PLANS TRACKING,CERTIFICATE OF OCCUPANCY ONLY*"'*""'**'"''*"'***'**'**`*
Date received for C/O processing: ___ _ Plans pulled for final processing:
Temporary C/O issued: ____._ .Certificate of Occupancy issued:
Office file review by: __._______W_______ Date:
Filed insp finaled by:_ �__._ . Date:
Ninety days after C/O issuance:
Owner/contractor called regarding the return of plans: __ _____________ Date:
Plans returned: Received by:_ ._-. -_________._.-_-
No response from owner/contractor-plans destroyed:__