1999, 03-03 Permit App 99001600 Relocate MHProject Number: 99001600 Inv: 1
Apnlicati
on
Date: 3/3/99 Page 1 of 1
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: RELOCATE SINGLE WIDE MANUFACTURED
HOME
Setbacks: Front 4 Left: 3 Right: 3 Rear: 3
Contact: PENCE, SHAWN L
Address: PO BOX 502
C - S - Z NEWPORT WA 99156
Phone: (509) 447-4649
Site Information:
wszwomukvsmowAye
Plat Key: MH004 Name: PINECROFT MOBILE HOME PA District:
Parcel Number: 45094.6067M
SiteAddress: 11920 E MANSFIELD AVE # Owner: Name: PENCE, SHAWN L
SPOKANE, WA 99206 73 Address: PO BOX 502
Location:: SPO NEWPORT WA 99156
Zoning: UR-7
Water District:
Urban Residential-7
Hold: 0
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 1
Review information: 0.2,w,,mm.,,cei,..,4:-.33,,w,,m=0,-0,-6,=3,333m00.003m-m5-w,-,,3m.WiM3K•1•W3Ma:M.-M53,' "MMWOMi'Ma-WWM:3:=Mi:MMi:KMK•MiMi,1:03
Department
BUILDING
Conunents:
BUILDING
Permits:
Comments:
Review
Site Plan Review
Special Reviews tx,--L;72-
••:•WitiS.:$::•:•*:C$M:i.SMS•I'S•Sftiff!k•WpCjp:$3C1$,LS•:.•:•,:t6•KiMp:•:(gSgSSSi•NO:(‹{S,X{S.X.X...Xpt...*2,,,,,,tii{.2$,,i ••• • • -• • po, • sy • • • • • • . •
Contractor: UNKNOWN
Address: UNKNOWN Phone: (000) 000-0000
UNKNOWN, WA UNKNOWN
Manufactured Home
Finn: UNKNOWN
Item Description Units Unit Desc Fee Amount
STATE SURCHARGE 1 Y OR BLANK $4.50
INSPECTION FEE 1 SECTIONS $50.00
COUNTY SURCHARGE 1 Y OR BLANK $11.00
Payment SumMarV.:
Operator: JAS
Pernik Type
Manufactured Home
Permit Total Fees: $65.50
Printed By: JAS Print Date:
Fee Amount Invoice Amount
$65.50 $65.50
Amount Paid
$0.00
3/3/99
Amount Owing
$65.50
$65.50 $65.50 $0.00 E' $65.50 \.
Notes: $MM;ziMMMI,V8,1&43.4X4VSAWMM.t.tts.'i43§zika,:3303:?•MV3M.3304:ki:.‘:
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
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.
Owner last name
Address
.l ) i X.
Installer/Contractor/Dealer
first name
ALTERATION PERMIT
Do not complete shaded areas
Day time phone
( `7) I ')_LF(14.=.;
City
Phone
( )
1:
Permit# : 1.177'i8
Date
961
State ZIP
Contractor's registration number
Address
City
State ZIP+4
Check the appropriate boxes in section A and section B.
FEES
A ❑ Commercial Coach B ❑ Alteration Inspection (check appropriate boxes below) $ ' •
DMobile Home
Serial No.
HUD No.
Recreational Vehicle or ❑ Park Trailer
Serial No
Model No: or Plan Approval No.
Air Conditioning/Heat Pump >A,
Electrical n; PAR-fM. JT OF LABOR & INDUSTR ES
Electrical Appliances`
Fire Safety
--Gas Furnace
Gas Piping
Plumbing
Structural
Wood/Pellet Stove — —
Plan Review
RV Inspection
Reinspection
Technical Inspection
IvIM 0 3 1999
REG:Oil 6
Serial 07OK4CJ, WA
Original Permit
No.
]Unln • Ti.ic nnrsnif nvssiroc nsro vanr nftor 'into of nurrbaco_ (Nnn-refundahle)
Signature of applicant or authorized representative
Make check payable to: Dept. of Labor & Industries
FEES DUE $ 1' •
Department use only
Request approved or . Request denied because of specific violations of Washington rules and regulations. Violations must
be corrected and reinspectlon 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.
NSPECTIONS
LUST GIVE PERMIT NUMBER
'ALK TO INSPECTOR 8-9:008- a.m.
24-2640 70
Included are forms requ'red which must be completed and fees submitted before reinspection.
Date ': Area office
Inspector
Total pages
F622-012-000 alteration permit
10•98 White -Olympia Canary -Inspector Green -Contractor Pink -Purchaser Goldenrod-Yurcnaser