1983, 08-08 Permit 83A-4861 Set MHLP11\ I\vivroc 1
APPLICATION/PERMIT
SPOKANE COUNTY — DEPARTMENT F BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. E. 1192,0 -Le I1d — Pin of - MH RL jacP fr.I1
rL
2 LOT. BLOCK SUBDIV IO
co;
WNER
3. Ri rharrl W_ Askcaw
MAILING ADDRESS
N. 4210 Avalon 1L• 3
CONTRACTOR
4, Northwest Mobile Homes
AD RESS
.•�I hoc. 3306
DESIGNER
5.
ADDRESS
PHONE
LICENSE EXPIRES
PHONE
ZIP
99216
PHONE
ZIP
C{ Q0
PHONE
PARCEL NO.
O - o
LEGAL DESCRIPTION:
Actual Set Backs in Feet to:
North 'South
Size of Parcel
Type C `r
Ocgu�ncY
New Coast. Valuation
7AJc ►
East West
Zoneesificati n
/L1
Residential
Commercial ❑
Spr'nklered
❑Yes ❑No ❑Req'd.
Remodeled Valuation
Total Bldg. Floor Area
ZIP
Main Floor
Upper Floors
Garage/Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ NEW ❑ ALT. ❑ AD' N. 0 RPL. ❑ MVE.
7. OF
WORK 0 BLD. ❑ PLMB, 0 MECH. KO M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certifi. of Exempt.
or Variance
8.
9.
DESCRIBE WORK
Spt a 12 X 60 Used Mobile Home
VALUATION SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
PUBLIC ❑
PRIVATE 0
SEWAGE
SEPTIC ❑
SEWER ❑
Shorelines/Flood Hazard
Yes ❑ Not Applic. ❑
Ownership
Public ❑ Private ❑
Required Yes❑ No❑
Received Yes❑ Nof-1
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel the provisions of any other state or local taw regulating construction or the performance
of construction. SEE REVS DE FO EIRE PECTIONS
SIGNATURE OF APPLICATION
OWNER OR AGENT ; DATE
SPECIAL APPROVALS
PRELIM. FINAL DATE
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Number
Plans Required ❑
Received 0
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
_LO.0-..00
TOTAL $ 10O.00
PERMIT NUMBER
07* *100,00
* 1 00,006
A *0.00
4860
06-06-83
-2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
06-06-83
DATE ISSUED
4861s' *100.0011-
PERMIT NO. TOTAL