1995, 08-04 Permit App 95005985 Relocate MHPROJECT F"MBER= 95005985 APPLICATION DATE= 08/04/95 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 6300 E 1ST AVE 4132A PARCEL#= 35242.6096M
ADDRESS= SPOKANE WA 99212
PEP T USE= RELOCATE SINGLE MOBILE HOME
PLAT#= MH0069 PLAT NAME= VALLEY BREEZE TRAILER PARK
FLOCK= LOT= ZONE= UR-7 DIST#= E
AREA= F/A= F WIDTH= DEPTH= R/W=
# OF ELDGS= # DWELLINGS= 1 WATER DIST =
OW'TER= MC CALL. MARK
STREET= 6300 E 1ST AVE #132A
ADDRESS= SPOKANE WA 99212
PHONE= 509 928 7071
CONTACT rTME= MARK MC CALL PHONE NUMBER= 509 921 7971
BUILDT- l'BACKS: FRONT= 4 LEFT= 5
RIGHT= 5 REAR= 5
******-4****************** ****************** REVIEW INFORMATION ****************************
DEPART=T REVIEW REQUIREMENT
LABOR & STRUCTUAL ALTERATION
COMP'.77
*****" "'• " ***************** MOBILE HOME PERMIT *****************************
DR= OWNER PHONE=
YR/P"..".'.'' ' 75 PORT ROYAL MODEL=
SF.T: - WIDTH= 14 LENGTH= 70 HEIGHT= 10
ITEM DESCRIPTION
QUANTITY FEE AMOUNT
"PECTION FEE 1 50.00
': E SURCHARGE Y 4.50
C:JUNTY SURCHARGE Y 9.00
PDD-- TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
'RED HM 63.50 .00 63.50
63.50
PROCESSED BY: JOHN LARSON
P"T : JOHN LARSON
.00 63.50
******4-.:...4.****************** THANK YOU ************************************
Departure* of Labor &Industries
Factory gssembled Structures Section Ifl
INSTRUCTIONS: ND
1. Complete all spaces, including the sig t r
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fee to he nearest L&I office. See hst on reverse.
4. Contact and schedule the Inspection with the same L&I office within 15 days.
Owner last name
Address
2
first name
-7- y
Day time phone
(5-1)
ER.ON PERMIT
,„4,
not coimplete shaded areas
42•!yr.eit:',:i]:.:•E'i:!4:. 0
Dare, 7„,
Ciry
State ZfP
Installer/Com-actor/Dealer
Address
Phone
( )
City
1Contraaoesnewm-amonnember
ZIP+4
Check the appropriate boxes in section A and section B.
A B D Alteration Inspection (check appropriate boxes below) $75.00
Co ercial Coach
Air Conditioning/Heat Pump
Electrical npp, _ PAID
Electrical Appliancg I MFAIT OE LABOR & INDUSTRIES
Fire Safety
Gas Furnace RUG 04 7995
Gas Piping
Plumbing R.11-. ic, le 0
SP()Kp iiir
Structural
1
Wood/Pellet Stove — —
Plan Review
RV Inspection
Reinspection 'Uncial P.emut:: .: ::..,
114e. • :
Technical Inspection
[:I Mobile Horne
Scxiat
DRecreational Vehicle or 11:3 Park Trailer
Serlaffta.:::
• .• • •
Mode.. plan.Aptiretal,No:
$70.00
$70.00
$50.00
$50.00/hr
Signature of applicantor authorized representative
Make check payable to: Dept. of Labor & Industries
KX
SPeefile
:,,,,,: •
•aftdregu1at1onsViolations
hinst.lie:•cerrecte4:nn:
Is teflon requested within 10 days •for recreational vehkles and 20 days for moblie hoznes and
e°it""'not apply to technlS xnspections) it 15 u&awfal to offer for sale,
rent,commercial coach orrecreational„.„ • , orleascanf ribiacOmplying.mo • home,
•:']•.• • ,:••• ,•• ::."
• •:H•1'..?.:]' 77: .":
:. • : : • '
FEES DUE $
, :v.:: • .• ,
'Hy
' •-t:t .":": ::]1E :
:: • Dato Area office kspector )(Total
. pages)
F622-012-000 alteration p
•
• •
c..-White-OIYMPla nni 6-94 Green -Contractor Canary Inspector Pinlc-Purchaser Goldenrod -Purchaser