2000, 04-03 Permit App 00002278 MHProject Number: 00002278 Inv: I
Appiication
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: SINGLE WIDE MOBILE HOME
Setbacks: Front 4 Left: 5 Right: 5 Rear: 5
Site Information:
Date: 04/03/2000 Page 1 of 1
Contact: ACARRIER, TAWNEY
Address: 11012 E 31ST AVE
C - S - Z: SPOKANE, WA 99206
Phone: (509) 927-1966
Group Name:
Project Name:
Plat Key: 005186 Name: CENTRAL MHP District: D
Parcel Number: 35231.6036
Block: Lot:
SiteAddress: 421 S HOWE RD
SPOKANE, WA USA 00000
Location:: SPO
Zoning: UNKN Unknown
Water District:
Area: .00 Acres Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Department Review
BUILDING Special Reviews
Hold Reasons:
Permit Conditions:
Permits:
Owner: Name: CARRIER, LANE
Address: 5304 W SKAGIT AVE
KENNEWICK, WA 99336
Hold: ❑
Depth: 0 Right Of Way (ft): 0
By: - JC1,_(„ q5
Manufactured Home
Contractor: OWNER Firm: OWNER
Address: 0
000000, 00 000000
Item Description
INSPECTION FEE
COUNTY SURCHARGE
Payment Summary:
Operator: CKF
Permit Type
Manufactured Horne
Notes:
I/O
Phone: (000) 000-0000
Units Unit Desc Fee Amount
1 SECTIONS $50.00
1 Y OR BLANK $11.00
Printed By: CKF
Permit Total Fees: $61.00
Print Date: 04/03/2000
Fee Amount Invoice Amount
$61.00 $61.00
$61.00 $61.00
Amount Paid
$0.00
$0.00
Amount Owing
$61.00
$61.00
LicparTment or Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. 7 ':7•":•`-',
TERATION PERMIT
Do not complete shaded areas
( Perinit
1. Complete all spaces, including the signature box (marked with an X).
2. Draw a map on reverse side of WHITE 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.
Invoice
- • •
Owner
last nprie., c.3
first name
.,'•
Day time phone
)
Date
/ :_, •
Address
\j,„;
Installer/Contractor/Dealer
=.1 'tf)i ".• i'
Address -
City
.:1 .
Phone
'••••" ) -
City
.(.
State ZIP'
Contractor's registration number
I: r
State ZIP+4
Check the appropriate boxes in section A and section B.
A
[DI Commercial Coach
{:3 Mobile Home
SetialNo,
ZiRecreational Vehicle or [J Park Trailer
ei
MU
B [:11 Alteration Inspection (check appropriate boxes below) $
Air Conditioning/Heat Pump
Electrical
Electrical Appliances
ire Safety
Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove - -
Plan Review
RV Inspection
Reinspection
Technical Inspection
Seria1146.,
Original
Note: This permit expires one year after date of purchase. (Non-refundable)
fignature of applicant or authorized representative Make check payable to: Dept. of Labor & Indus es
1
FEES DUE $
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ALTERATION PERMIT
• " CALL 324-2568 FOR INSPECTION
• ••. PLS GIVE PERMIT NUMBER
........
• ......... • • • - ...... • • • • • • • • • • .... .
Included are forms required which must be completed and fees submitted before reinspection.
CDate. • Area office
F622-012-000 alteration permit
1 0 -
Inspector
White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser