1997, 01-23 Permit App: 97000361 MH PROJECT NUMBER= 97000361 APPLICAT:ON DATE= 01/23/97 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 17509 E 6TH AVE PARCEL#= 55192.0327
ADDRESS= GREENACRES WA 99016
PERMIT USE= RELOCATE SINGLE WIDE MANUFACTURED HOME
PLAT#= 005842 PLAT NAME= SP-1073 —CAD /044
BLOCK= LOT= ZONE= UR-3.5 DIST#= G
AREA= 00019600 F/A= F WIDTH= 122 DEPTH= 160 R/W= 50
# OF BLDGS= 2 # DWELLINGS= 1 WATER DIST = CONSOLIDATED IRRG #1
OWNER= KLINGER, MICHAEL A PHONE= 509 927 4697
STREET= 21725 E WELLESLEY AVE #36
ADDRESS= OTIS ORCHARDS WA 99027
CONTACT NAME= MIKE KLINGER PHONE NUMBER= 509 927 4697
BUILDING SETBACKS: FRONT= 42 LEFT= 50 RIGHT= 20 REAR= 38+
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING L & I SAFETY PERMIT f 57 l
r7 ,,,z/4,
COMMENTS: (=j ')
BUILDING WATER DISTRICT VERIFICATION %'-d,t4 rte-7-7
COMMENTS: ] t `)"L
BUILDING SETBACK REVIEW REQUIRED
APPROVAL: J SHATTO DATE: 01/23/97
rai�x�//a /111 /7
ENGINEER 4PROACH/ DRAINAGE/ FLOOD 1--- 3---/7—P&A- 33
COMMENTS:
HEALTHDIST NEW OR ADDITIONAL WASTE WATER T'to/cL /23/g7 j
COMMENTS:
PLANNING UNPLATTED/SEGREGATED PROPERTY 767-7 61 434 4--
COMMENTS:
COMMENTS: /~ 3��
' r 1
PROJECT NUMBER= 97000361 APPLICATION ' DATE= 01/23/97 PAGE= 02
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 1991 NASHUA MODEL= CASTLEWOOD
SERIAL#= WIDTH= 14 LENGTH= 70 HEIGHT= 00
ITEM DESCRIPTION QUANTITY FEE AMOUNT
INSPECTION FEE 1 50.00
STATE SURCHARGE Y 4 . 50
COUNTY SURCHARGE Y 11. 00
IMPACT FEE= CV 750 750. 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 815.50 . 00 815.50
815.50 .00 815.50
"
********************************************************* *************
* PROJECT NOTE: TOPIC = CONDITIONS DEPT = BUI DING /5
*******************************************************************************
L & I SAFETY INSPECTION MUST BE CONDUCTED AND CORRECTIONS
MADE, IF ANY, PRIOR TO OCCUPANCY OF HOME.
*******************************************************************************
* PLAT NOTE: TOPIC = CONDITIONS DEPT = BUILDING
*******************************************************************************
VERIFY WATER & FIRE APRROVALS
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
******************************** THANK YOU ************************************
PROJECT NUMBER= 97000361 Pog.2L1CATION DATE= 01/23/97 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 17509 E 6TH AVE PARCEL#= 55192.0327
ADDRESS= GREENACRES WA 99016
PERMIT USE= RELOCATE SINGLE WIDE MANUFACTURED HOME
PLAT#= 005842 PLAT NAME= SP-1073 —WD 4714
BLOCK= LOT= ZONE= UR-3.5 DIST#= G
AREA= 00019600 F/A= F WIDTH= 122 DEPTH= 160 R/W= 50
# OF BLDGS= 2 # DWELLINGS= 1 WATER DIST = CONSOLIDATED IRRG #1
OWNER= KLINGER, MICHAEL A PHONE= 509 927 4697
STREET= 21725 E WELLESLEY AVE #36
ADDRESS= OTIS ORCHARDS WA 99027
CONTACT NAME= MIKE KLINGER PHONE NUMBER= 509 927 4697
BUILDING SETBACKS: FRONT= 42 LEFT= 50 RIGHT= 20 REAR= 38+
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT..
BUILDING L & I SAFETY PERMIT
COMMENTS:
BUILDING WATER DISTRICT VERIFICATION
COMMENTS:
BUILDING SETBACK REVIEW REQUIRED
APPROVAL: J SHATTO DATE: 01/23/97
ENGINEER APPROACH/ DRAINAGE/ FLOOD i-a3-417-P --33 arri4vvo
COMMENTS:
+ 1
HEALTHDIST NEW OR ADDITIONAL WASTE WATER 4't 3 ��
COMMENTS: - /70 7 PLANNING UNPLATTED/SEGREGATED PROPERTY - 0 ,-
! 6 4
COMMENTS:
I: ION PERMIT
gre' _ ALTERATION RAT
Department of Labor&Industries
Do not complete shaded areas
Factory Assembled Structures Section 9 °'° 1yenmr# i
INSTRUCTIONS: /
1. Complete all spaces,including the signature box(marked with an X). Invoice#
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fee to the nearest L&I office. See list on reverse. Insignia#
4. Contact and schedule the inspection with the same L&I office within 15 days.
I Date
Owner last name first nDay Y time phone Il
( .)
A
City.
State ZIP
Address
Phone I Contractor s registration number
Installer/Contractor/Dealer ( ) jl
City State ZIP+4
Address
FEES
Check the appropriate boxes In section A and section B.
A B Pump Alteration Inspection(check appropriate boxes below) $75.00
Commercial Coach i Air Conditioning/Heat F�SID
DEPARTMENT OF LABOR & INDUSTRIES
Sepal hi : :•::
;
Electrical trt
c
G_
:::;::;:;;..:::.:::.::.:::::...............
Electrical Appliances
LI Mobile Home ® Fire Safety
. JAN 2 41997
Serial No. II Gas Furnace
Gas Piping
sii_...w,j 4 6
tlUD No. __ I Plumbing SPOKANE, WA
. structural Serial No,
® Wood/Pellet Stove— —` I
Recreational Vehicle or 1-3ParkTrailer Plan Review $70.00
Serial No. RV Inspection No. $70.00
(Original Permit I $50.00
Model No.or Plan Approval No. Reinspection $50.00/hr
Technical Inspection
Signature of applicant or authorized representative
C
Make check payable to: Dept.of Labor&Industries
X
FEES DUE $
Department use only
1Request approved or ['I Request denied because of specific violations of Washington rules and regulations. Violations
I 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 unlaw ful to offer for sale,
rent,or lease any non-complying mobile home,commercial coach or recreational vehicle. _
1 Included are fonns required which must be completed and fees submitted before reinspcetion. CTotal pag
F622-012-000 alteration permit 4-96 White-Olympia
Area office ��
Inspector �White-Ol m is Green-Contractor Canary-Inspector Pink-PurchaserGoolldenrod-Pure
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