1996, 01-02 Permit App 96000006 Relocate MHPROJECT NUMBER= 96000006 APPLICATION DATE= 01/02/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 7328 E 1ST AVE PARCEL#= 35241.0404
ADDRESS= SPOKANE WA 99212
PERMIT USE= SINGLE WIDE MANUFACTURED HOME RELOCATION
PLAT#= 000000 PLAT NAME= UNKNOWN
BLOCK= LOT= ZONE= UR-7 DIST#= D
AREA= F/A= F WIDTH= DEPTH= R/W= 60
# OF BLDGS= # DWELLINGS= 1 WATER DIST =
OWNER= WELLS, CORY &bEVERLEY
STREET= 205 S PARK RD #94
ADDRESS= SPOKANE WA 99212
PHONE= 509 928 2236
CONTACT NAME= CORY WELLS PHONE NUMBER= 509 928 2236
BUILDING SETBACKS: FRONT= 25 LEFT= 40 RIGHT= 12 REAR= 60
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING L & I PERMIT
COMMENTS:
BUILDING
SETBACK REVIEW REQUIRED -E-0 "'TTA C (--WO
COMMENTS:
HEALTHDIST NEW OR ADDITIONAL WASTE WATER
COMMENTS:
/-0
r?, / 7 '
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER
PHONE=
YR/MAKE= 70/FLEETWOOD MODEL=
SERIAL#= WIDTH= 14 LENGTH= 54 HEIGHT= 10
ITEM DESCRIPTION
INSPECTION FEE
STATE SURCHARGE
COUNTY SURCHARGE
PERMIT TYPE
QUANTITY FEE AMOUNT
1 50.00
Y 4.50
Y 11.00
FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 96000006 APPLICATION DATE= 01/02/96 PAGE= 02
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 65.50 .00 65.50
65.50
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: BURRIS, ROBIN
.00 65.50
******************************** THANK YOU ************************************
Department of Labor & Industries r
Factory Assembled Stntctures Section p e e
INSTRUCTIONS: , ® A
1. Complete all spaces, including the signature box (marked with an X)
2. Draw a map on reverse side of WHITE opy only.
3. Forward completed permit and fee to the nearest L&I office. See lis on reverse.
4. Contact and schedule the inspection with the same L&I office within 15 days.
Owner last name
first name
Address
(7
Day time phone
( -,: ) ,
City
(Penn
nvotcc
ERATION PERMIT
Do not complete shaded areas
6224
State ZIP
Installer/Contractor/Dealer
Phone
(
Contractor's registration number
Address
City
State ZIP+4
Check the appropriate boxes in section A and section II
A
Li Commercial Coach
j. Mobile Home
Seri
HUD
Recreational Vehicle or Park Trailer
Serial No.
Model No. or Plan Approval No.
FEES
B Alteration Inspection (check appropriate boxes below) $75.00
Air Conditioning/Heat Pump
Electrical PAID
Electrical Applian ARTMENT OF LABOR & INDUSTRIES
Fire Safety
Gas Fumace
Gas Piping J AN 2 - 1996
Plumbing
Structural REGION 6
Wood/Pellet Stove — —
sertal�-rpOKANEWA
Plan Review
RV Inspection
Reinspection
Technical Inspection
OngtnalPermn
$70.00
$70.00
$50.00
$50.00/hr
( Signature of applicant or authorized represehtative
X t t.
Make check payable to: Dept. of Labor & Industries,
FEES DUE $
De. artment use only
, Request approved ` or ❑ .Request denied because of specific violations of Washington rules and regulations. Violations
must be corrected andreinspection 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 orrecreational vehicle.
'❑ Included are forms required which must be completed and fees submitted before reinspection.
( Date Area office Inspector )(Total pages
F622-012-000 alteration permi 4-95
White -Olympia Green -Contractor Canary -Inspector Pink -Purchaser Goldenrod -Purchaser
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FINAL AS -BUILT INSTALLATION
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10
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