1983, 04-08 Permit 83A-2749 MHPLAN NUMBER
AFFLIt►A I RAN/ rtIKIVII I
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
YGXMII NVMtltH
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APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS Pinecroft Mobile Dome Park #129
1• E.11920 Mansfield Spokane, Wa. 99206
LOT
2.
OWNER
BLOCK
SUBDIVISION
'PARCEL NO.
pC*(,r I ; — 640- I
3Henry Done & Gordon Meyer
MAILING ADDRESS
n 0 Box 8528 -- San Marino
CONTRACTOR
4 Northwest Mobile Horses
ADDRESS
DESIGNER
5. ADDRESS
PHONE
Ca.
LICENSE EXPIRES
PHONE
zIp1108
PHONE
PHONE
LEGAL DESCRIPTION:
Actual Set Backs in Feet to: r_(t y 01,1/4)4
North l South East
Size of Parcel
New Const. Valuation
West
Zone Classification
Sprinklered
❑Yes ❑No ❑Req'd.
Residential
Commercial ❑
Remode ed Valuation
Bldg. Floor Area
CHANGE OF USE FROM
6.
ZIP
TO
TYPE "NEW D ALT. 0 AD'N. ❑ RPL. ❑ MVE.
7. OF 0 BLD. ❑ PLMB. 0 MECH. )] M.H. 0 POOL
WORK
0 OTHER
Main Floor
Upper Floors
Garage/Storage
Greenhouse
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
No. Baths
No. Floors
No. Fin. Rooms
No. Dwellings
Certlfi. of Exempt.
or Variance
Required Yes❑ No
i
Received Yes No❑
Number
8.
9.
DESCRIBE WORK
Set a 1966
VALUATION
SOURCE
UTILLIITIES
Fleetwood 10X50 SN#S5393
GAS l ELECTRIC
WATER
PUBLIC
PRIVATE 0
SEWAGy
SEPTIC
SEWER ❑
Shorelines/Flood Hazard Plans Required ❑
Veen NotApplic. ❑ Received ❑
Ownership
Public ❑ Private
I hereby certify that I have read and examined this appl'cation 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 law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
SIGNATURE OF
OWNER OR AGENT DATE
APPLICATION
SPECIAL APPROVALS SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
PRELIM. FINAL DATE
Env. Health
Planning
Ire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
9f.?
a-hA
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
50.00
TOTAL $ �.
Fil F (APY
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
DATE loSUEDU 8 -8
PERMIT NO 4,9 z >k 5 D O O TOTAL