2001, 05-15 Permit App: 01003576 MHProject Number: 01003576 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/15/01 Page 1 of 2
Project Information:
Permit Use: RELOCATE DOUBLE WIDE MANUFACTURED
HOME (REPLACEMENT)
Setbacks: Front 25 Left: Right: 5 Rear:
Site Information:
Plat Key: 000323 Name: CARNHOPE ADD
Parcel Number: 35232.4410
SiteAddress: 4524 E 7TH AVE
SPOKANE, WA 99212
Location:: SPO
Zoning: UR -3.5
Water District:
Contact: SIMON, RON
Address: 708 S THOR
C - S - Z: SPOKANE WA 99202
Phone: (509) 534-4414
Group Name:
Project Name:
Block: 15 Lot: 1
Urban Residential 3.5
Owner: Name: SIMON, RON
Address: 708 S THOR
SPOKANE WA 99202
Hold: O
District: D
Area: 0 Sq Ft Width: 50 Depth: 135 Right Of Way (ft): 60
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information: membsommonamimmaar
Department Review
BUILDING Site Plan Review
Hold Reasons:
Permit Conditions:
BUILDING Plan Review
Hold Reasons:
Permit Conditions:
Released
Released B .i—/L I
�1
HEALTHDISTRICT Septic System Review
Hold Reasons:
Permit Conditions:
BUILDING Special Reviews /`•
Hold Reasons:
Permit Conditions:
Permits:
Released BY/LZ�2
Released
Project Number: 01003576 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/15/01 Page 2 of 2
Manufactured Home
Contractor: OWNER Firm: OWNER
Address: 0 Phone: (000) 000-0000
000000, 00 000000
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Units Unit Desc Fee Amount
2 SECTIONS $100.00
1 Y OR BLANK $22.00
Permit Total Fees: $122.00
Payment Summary:::
Operator: JAS Printed By: JAS
Permit Type Fee Amount Invoice Amount
Manufactured Home $122.00 $122.00
$122.00
Print Date: 5/15/01
$122.00
Amount Paid
$0.00
$0.00
Amount Owing
$122.00
$122.00
Notes:;
L & I SAFETY INSPECTION MUST BE CONDUCTED AND
CORRECTIONS MADE, IF ANY, PRIOR TO OCCUPANCY
g
o -13//
/Vg.a/74t
A»»
use 7/
J r K 7 7--
�rgaff fr,
404 za ze
ztifye� _/
K w al
Owner
j o
Phone:
Fax: 53Y yyi y
❑ Applicant:
wets
Phone:
izx _
Mailin Dr
'!jT
�� O/
Mailing Address:
Ciry, Sutq Zip
Q2Q
q y
77- y �Y
Ciry, State, Zip
❑ Co nctor
Phone
Fax
0 Archittn/Enginecr
Phone
Fix
Mailing address
Mailing address
Ciry, State Zip
City, State Zip
WA Sntc Comractor Iicensc d
Conus name:
Width:
Length:
hat is she :quare footage of die sign How high is she sign?
Year:
Make:
1 of signs
Area of existing signs
0 Concrete 0 Welding 0 Bolting 0 Reinforcement
ADDITIONAL SITE INFORMATION
Are There strunures on the property? 0 Yes O No
I%yes, idem ry on site plan
What is the current property size?
(square fees or acres)
Is any part of she property within 250 fees of a shoreline?
Ilya, identify on site plan 0 Yes 0 No
What is the current use of this property?
Is your property in a designated wildlife habitat area?
0 Don't know 0 Yes O No
Will the site be served by a septic system? 0 Yes O No
Is any pan of the property within a 100 yr flood plain?
Ilya, idenrh on site plan
0 Maybe 0 Don't know O Yes 0 No
Are or will there be wells located on the property?
Ilya, identi on the site plan 0 Yes O No
Are there any wetlands, screams or ponds within 200 feet of the
property?
If yo, identify on site plan 0 Yes 0 No
Is theft evidence of fill or excavation on she property?
0 Yes 0 No
,
Are there slopes greaser than 30% on the property? (10 ft rise in 100 h)
%) O Yes O No
Are critical or hazardous materials used or stored on site?
O Yes O No
DEPARTMENT USE ONLY
IHie Rect.
METHOD OF PAYMENT
❑ CASH 0 CHECK 9
Suff Rep
DKKCG.E
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
DATE. EXPIRES:
BANKCARD NUMBER.
9 UTHORIZED SIGNATURE:
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete allspaces, including the signature box (marked with an X.
2. Draw a map on reverse side of W BYTE copy only.
3. Forward completed permit and fees 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
%Permit 8 -
9527
Imignu #+
Owner last name
....-._. s .._'--.........
Address
} 5./
first name Dayt phone I Date
City State ZIP
J
Waller/Contractor/Dealer`
Address
Check the appropriate boxes in section A and section B.
A
Commercial Coach
Sena) No,
`4 Mobile Home
Serial No. 4
HUD No.
Recreational Vehicle or Ld Park Trailer
Serial No.
Model No. or Plan Approval No.
APhone Contractors registration number
( )
City State ZIPt4
FEES
B ❑ A teration Inspection (check appropriate boxes below) $
Air Conditioning/Beat Pump PAIL)
Electrical DEPARTMENT OF LABOR & INDUSTRIES
Electrical Appliances
Fire Safety
Gas Furnace
Gas Piping
Plumbing REGION 6
Structural serkeZ KANE, WA
dWood/Pellet Stove - -
Plan Review
MAY 1 5 2001
RV Inspection
Reinspection
Technical Inspection
Ungual Permit
No.
Note: This permit expires one year after date of purchase.- (Non-refundable)
/signature of applicant or authorized represenatioe Make check payable to: Dept. of Labor_$, Industries
/ FEES DUE $
'Departmaut use only- r—y v , y• •'
. CIRequest approved or 'Reques( denied because ofpeci
Uspecific Wolationi of Washington rules and regulstions. Violations must
be corrected and relnspeedon requested within 10 drys for recreational vehiekaand 20 days for' mobile homes and commercial roaches
of the notice of violation date. (This does not apply to technical inspection). It is unlawful (o offer for sale, rent, or lease any
non -complying mobile home, commercial coach or recreational vehicle. .
Date
•
CALL 324-2640 FOR AN INSPECTION
PLEASE LEAVE NAME &
ALTERATION PERMIT NUMBER
Included are fortes required which must be completed and fees submitted before reidspc
Area office x Ins
F622-012 alteration permit 8-99
White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser