1986, 10-24 Permit 00013833 MHSIGNATURE OF APPLICATION �
OWNER ORAGENT DATE
JOB ADDRESS
05 COURTLAND A�
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J7 E 12TH AV
CITY: `" Z~�
WA ,9216
APPLICANT:
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MOBILE HOME
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PROJECT#
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$181.58
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MOBILE HOME PERMIT
MOBILE HOMES
Make Serial 0
Number I W i d t 0 Length 50 Height 10
Number 2 Wid�e� h �0 Lngh 50 Height 10
Mzsc Desc . SURCHARGE
PLANS CXA.:
TOTAL FEE
Misc Fee 1.50
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DEPARTMENTAL REVIEW
Approved
Cond.
Approval
Hold
Environmental Health Application #
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W. 1101 College
Room 200
/�
Planning/Zoning
N. 721 Jefferson
Engineers
N. 811 Jefferson
Utilities
N. 811 Jefferson
Plan Review/Fire Prevention
N.811 Jefferson
Other (SEPA/Critical Material/etc.)
Fast Track/Special Inspection Information
Protect Representative
Phone
Address
1 certify that I have examined this application and state that the information contained in it and submitted
by me or my agent to compile said application is true and correct.
Signature
Date I e514.