1997, 04-17 Permit App: 97002320 MHw
61,
PROJECT NUMBER= 97002320 APPLIC T°4
PROJECT NUMBER= 97002320 APPLICATION
******
THIS IS NOT A'TERMIT
DATE= 04/17/97
DATE= 04/17/97
******
PAGE= 01
PAGE= 01
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 17410 E 5TH AVE PARCEL#= 55192.1803
ADDRESS= GREENACRES WA 99016
PERMIT USE= DOUBLE WIDE MOBILE HOME
PLAT#= 000078 PLAT NAME= APPLE VALLEY ESTATES 2ND ADD.
BLOCK= 3 LOT= 3 ZONE= UR -7 DIST#= G
AREA= 00000000 F/A= F WIDTH= 72 DEPTH= 131 R/W= 50
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST = CONSOLIDATED IRRG #1
OWNER= THELEN, ALLAN & DIANA PHONE= 509 924 9365
STREET= 17410 E 5TH AVE
ADDRESS= GREENACRES WA 99016
CONTACT NAME= ALLAN THELEN PHONE NUMBER= 509 924 9365
BUILDING SETBACKS: FRONT= 30 LEFT= 43 RIGHT= 5 REAR= 49
******************************
REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING L & I ALTERATION PERMIT 4P� /,,L-739f9r tn.,'
COMMENTS':
BUILDING SETBACK REVIEW REQUIRED
APPROVAL: C. FRAZIER DATE: 04/17/97 r
OSc — ` �G-n
f�%%
HEALTHDIST INCREASE IN LOT COVERAGE 7
ert COMMENTS: 38-ot0-0b ' frn..z4. Per–LA0e.,.SSl� r`w v'r-
if®Z o
****************************** MOBILE HOME PERMIT
*****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 1969 PARKLANE MODEL=
SERIAL#= WIDTH= 24 LENGTH= 52 HEIGHT= 10
ITEM DESCRIPTION
INSPECTION FEE
STATE SURCHARGE
COUNTY SURCHARGE
PERMIT TYPE
QUANTITY FEE AMOUNT
2 100.00
Y 4.50
Y 22.00
FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 97002320 APPLICATION
PERMIT TYPE FEE AMOUNT
AMOUNT PAID
DATE= 04/17/97 PAGE= 02
AMOUNT OWING
MANUFACTURED HM 126.50 .00 126.50
126.50
.00 126.50
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* PROJECT NOTE: TOPIC = CONDITIONS DEPT = BUILDING *
*******************************************************************************
ALL REQUIREMENTS 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 & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete all spaces, includi:: � F VT E
2. Draw a map on reverse side f py
3. Forward completed permit and fee to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.
ALTERATION PERMIT
Do not complete shaded areas
Owner .- / lastpame
first name
Day time phone
1 )
Date
i
Address .. _ City
Installer/Contractor/Dealer
Phone
( )
State ZIP
, -
Contractors registration number
Address
City
State ZIP+4
Check the appropriate boxes In section A and section B. FEES
A r—h$ ❑ Alteration Inspection (check appropriate boxes below) $75,00
LI Commercial Coach
Y❑ Mobile Home
Recreational Vehicle or ❑ Park Trailer
Air Conditioning/Heat Pump Kin
Electrical DERARTMFNT OF LABOR & INDUSTRIES
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — —
Plan Review
RV Inspection
Reinspection
Technical Inspection
APR 2 3 1997
-
f5:-l:!UIV
SPOKANE, WA
$70.00
$70.00
$50.00
$50.00/hr
Make check payable to: Dept. of Labor & Industries
CSignature of applicant or authorized representative
X
FEES DUE $
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�y Request apps»ve$ ot Ut 'Requestdetiled becausasif specifieytotationsGliashington rtiles:nd regulations,
smust;ire:_t`oYtected,andaetaspecf ou r•e•ejues{ed within IO}days forrbcieationat:vettcles and 20 ags'for,mobile;h•ottie's and':
com)nefciaZtoaChes ottb nottce of yiolatlun date (Thisdoes'n'ot apply 9o't�ialnical:inspectlotts) It IsvniawfLt to offerforsa1e
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in' l iuoblle,hbtge,``commetdal e6a0t,oraectOdotialiy.thOq `'..>; r •`
4.n.cludt4:1Bra
nIPletedian3,fee5" sltlfiYirtted before ftil$pection.
F622-012-000 alteration permi 4-96
White -Olympia
Total pages
Green -Contractor Canary -Inspector Pink -Purchaser Goldenrod -Purchaser