1999, 12-27 Permit App 99012121 MHProject Number: 99012121 Inv: 1
Application
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:
Plat Key: MH004 Name: PINECROFT MOBILE HOME PA
Parcel Number: 45094.6138M
SiteAddress: 11920 E MANSFIELD AVE #
SPOKANE, WA 99206
Location:: SPO
Zoning: RHM
Water District:
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 0
Date: 12/27/19 Page 1 of 1
Contact: YEAGER, MADELENE
Address: 11920 E MANSFIELD AVE #0
C - S - Z SPOKANE, WA 99206
Phone: (509) 000-0000
District: F
Owner: Name: YEAGER, MADELENE
Address: 11920 E MANSFIELD AVE #044
SPOKANE, WA 99206
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review Information:
Department
BUILDING
BUILDING
Comments:
Comments:
Review
Plan Review
Hold: ❑
Ol d c-Vlt -
Special Inspections Ak' -FQSe
Permits: ct04ar a; .,w1:$'g ^ 4..
Contractor: OWNER
Address: 0
000000, 00 000000
Item Description
STATE SURCHARGE
INSPECTION FEE
COUNTY SURCHARGE
Payment Summary:
Operator: CKF
Permit Type
Manufactured Home
Notes:
Manufactured Home
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 Y OR BLANK
1 SECTIONS
1 Y OR BLANK
Printed By: CKF
Permit Total Fees:
Fee Amount
$4.50
$50.00
$11.00
$65.50
Print Date: 12/27/1999
Fee Amount Invoice Amount Amount Paid Amount Owing
$65.50 $65.50
$65.50
$65.50
$0.00 $65.50
$0.00
$65.50
il.
THE STATE OF WASHINON
DEPARTMENT OF LABOR AND INDUSTRIES
ALTERATIONISI SHOWN BELOW HAVE BEEN APPROVED AS HAVING BEEN IN
C MPLIANCE'WITH RULES AND REGULATIONS FOR MANUFACTURED MOBILE
• MES IN EFFECT AT THE TIME OF APPROVAL RCW 43.22.360.
.L
Address City State ZIP
g(2 ��x 96 ? /494'a 9- y I,EEl.‘ zet54/ 9%0,I
Installerntractor/Dealer Phone Contractor's registration number
h'
��f elhovez y ge s 609 -,2 5 -6 %,..-
Address City State �,
-to 9Vo �s� &f. 5- u.�/ 7 �',aakZIP+4 gwv� 9922�
Check the appropriate boxes in section A and section B. FEES
A Commercial Coach B j AIteration Inspection (check appropriate boxes below) $
Air Conditioning/Heat Pump
Electrical QS- ` m
Ul Mob' .�• e Electrical Appliances - C q V74 -) a
Fire Safety l Ct t V \ �(�
A - Gas Furnace v-6�
Gas Piping
Plumbing
Structural
Wood/Pellet Stove
Plan Review
RV Inspection
Reinspection
Technical Inspection
F622030.000
th an X).
t. See llst on reverse.
e within 15 days.
trs ame Day time phone
ALTERATION PERMIT
Do not complete shaded areas
Permit
114850
Invoice 0
Insignia li
Serial No.
Hurl No.
_J
5
Recreational Vehicle or ❑ Park Trailer
Serial No.
IMadel No. or Plan Approval No.
Serial No,
Ongtnal Permit
No.
Nnto• Thic normit orniroc nno uonrnftor 'Into of nrnrehnco (Nnn_rofurndnhlol
$
$
r autho�i1�seeres egta e
Make check payable to: Dept. of Labor & Industries
FEES DUE $
Department use only
Request approved or j Request denied because of specific violations of Washington rules and regulations. Violations 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 unlawful to offer for sale, rent, or lease any
non -complying mobile home, commercial coach or recreational vehicle.
Included are forms requ'red which must be completed and fees submitted before reinspection. Date Area office Inspector DCTota1 pages
F622-012-000 alteration permit 10-9a White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod -Purchaser