2001, 10-17 Permit App: 01009175 MH •
Project Number: 01009175 Inv: 1 Application Date: 10/17/01 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
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Permit Use: RELOCATE DOUBLE WIDE MOBILE HOME Contact: RENZ,DAVID W&LANA L
(REPLACEMENT) Address: 17411 E 4TH AVE
C-S-Z: GREENACRES WA 99016
Setbacks: Front 25 Left: Right: 6 Rear: 29 Phone: (509)927-8651
Group Name:
Site Information: Project Name:
Plat Key: 000077 Name: APPLE VALLEY ESTATES 1ST ADD. District: G
Parcel Number: 55192.1310 Block: Lot:
SiteAddress: 17411 E 4TH AVE Owner:Name: RENZ,DAVID W&LANA L
GREENACRES,WA USA 9901 Address: 17411 E 4TH AVE
Location::GRE GREENACRES WA 99016
Zoning: UR-7 Urban Residential-7
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: 'AWL-- .: ,r: � . a1 M* .*E4; "t ..a ; ,041g .. .. = 4, .1: ,,.h:
Review / )
Site Plan Review Released— t (,
Plan Review Released By
Special Reviews ( Released By:
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Septic System Review Released By: 4001ff tea 17 est
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Permits: 3,K4'44,_ ri -9VA, .. ,r4 44404440,::w14 . _ :: .:'4% 44x.. -A
Operator: JAS Printed By: JAS Print Date: 10/17/01
Project Number: 01009175 Inv: 1 Application, Date: 10/17/01 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
L&I SAFETY INSPECTION MUST BE CONDUCTED AND CORRECTIONS MADE,IF ANY,
PRIOR TO OCCUPANCY
Payment Summary: ;��� - .r � �....._.m ....� �. � 4r4480.1� t _. ‘w2.__.. 6 a..._... . �a
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
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subse u • •ssuance of • shall not be contrued to be a permit for,or an approval of,any violation of any of the
provisions of the co 8 or of ny other tate or I al laws or ordinances.
Signature:
Operator: JAS Printed By: JAS Print Date: 10/17/01
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This site plan is being submitted for thepurpose of SePTiIsI-0kmK.
obtaining a building permit and is a true and correct EA�sttNv
representation of the proposal.All known property
lines/dimensions,curb lines.structures and easements l
have been
identified,Also indica :• are wetlands, i\ 'a
bodies of wate- p slopes• othe ritical areas.
Signed: !,,.. / 12 7a 6. 0
Date'. 9%1 97u4,
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REVIEWED BY �iC5 -'-t- - ' \
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