1988, 10-05 Permit App 88003079 MHSPOKANE COUNTY DEPARTMENT OF BUILDING AND SAFETY
W. 1303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509) 456-3675
I certify that I have examined this permit and state that the information contained in it and submitted by me or my agentto compile said permit istrue and correct. In
addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE provisions included herein and agreeto comply with same. All provisions of laws
and ordinances governing this type of work will be complied with whether specified herein or not. I understand that the issuance of this permit and anysubsequent
inspection approvals or Certificates of Occupancy shall not be construed to give authority to violate or cancel the provisions of any state or local law regulating
construction, or as a warranty of conformance with the provisions of any state or local laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
PROJECT NUMBER= 88003079 DATE= 10/05/88 PAGE= 01
APPLICATION
3f3f***)fif*******###7f#•}E)E#9fih•********f APPLICATION 1F##*k#****aEae****.#*ka(x•ri Fitt**•>Exa{#
SITE STREET= 19138 E CANE CIR PARCEL 17553-2529
ADDRESS= GPEENACRES WA 99016
PERMIT USE= REPLACEMENT OF SINGLE WIDE MOBILE HOME
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PLAT;r= 001407 PLAT NAME= LABERRY MOBILE PARK ADD
BLOCK= 6 LOT= 29 ZONE= RMH DIST0=
AREA= 00000000 F/A= F WIDTH= 115 DEPTH= 68 R/W=
t OF BLDGS= 1 0 DWELLINGS= 1
OWNER= WILLMS, MARK
STREET= 19138 E CANE CIR
ADDRESS= GREENACRES WA 99056
PHONE= 509 922 3092
CONTACT NAME= MARK WILLMS PHONE NUMBER= 509 922 3092
BUILDING SETBACKS: FRONT= EXIS LEFT= EXIS RIGHT= EXIS REAR= EXIS
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DATE
DEPARTMENT NAME REVIEW COMMENTS IN/OUT INITIALS
ENVIRONMENTAL HEALTH NEW OR ADDITIONAL WASTE WATER 881005 DMS
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MOBILE HOME PERMITx..n.......*3*3tt.tt..tt.at•.tt..x*aeac
CONTRACTOR= OWNER PHONE::=
YR/MAKE= 1979 MODEL= UNKN
SERIAL:= WIDTH= 14 LENGTH= 70 HEIGHT= 10
PROCESSED BY: SILVA, DAVID
PRINTED BY: SILVA, DAVID
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INFORMATION WORKSIEET
PARCEL NUMBER:
STREET ADDRESS: J 113 caw? e,
CITY/STATE/ZIP:
SUBDIVISION: LA 4-Vn
BLOCK:_ LOT: ZONE: I'� �� DISTRICT:
LOT AREA: F/A: WIDTH:: DEPTH: b d R/W:
# OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER :_G �(� (p PHONE:
MAILING ADDRESS:
CITY/STATE/ZIP: (f>` ci g o Z l�2
CONTACT:
PHONE: -
SETBACKS: - FRONT: LEFT: RIGHT: REAR:
PERMIT USE:
zxxxxxxxxxxzxxxzxxzxzxxxxxxxxxxxxx.xxxxxxxxxxxxxxzxxz*xxx*xxz*xxxxxxxzxxxxxzxzx
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:
MAILING ADDRESS:
ARCHITECT/ENGINEER:
MAILING ADDRESS:
PHONE:
1Q.
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT.:
REQUIRED PARKING: # HANDICAP: SEWER (Y/N): HYDRANT:
SPOKANr= COUNTY HEALTH DEPARTMENT
E. 0. PLOEGER, M. D. , M. P. H. , Health Officer
Division of Sanitation -
N. 810 Jefferson Street
✓�% Spokane, Washington 99201 DATE.
PERMIT NO.17 U // �4 N9 A 04229
-
APPLICATION FOR PERMIT TO INSTALL
—1- _-" Addres
Address of Proposed Sin
Type of Use--ea>a basNumber of Bedroo/m-;s-Water Supply. cl"-, .Cng).Septic tank capacity_aLength of disposal fields p
(1) Show relative location of: proposed heusa, se a
disposal field, well, garage and other on b ildia
(2) Make note of any heavy slope or swat Area or any
other important topographic details. -//
-Installer
'Final Inspection Dafe
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Remarks:- -
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