HomeMy WebLinkAbout20211 67th Ave Ne Spc A_05-6756_2025 '-JNSPECTION REPORT
¢1.1N G1'O Permit No.: 015- 67 56 Lot #: /
Q" Address: 2oLcr 6 7 7 �
Contractor:
Owner:
ING� Date: 2 10_ 0
XAPPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION ❑ CORRECTION REQUESTED
❑ Corrections listed below MUST BE MADE before work can be approved.
❑ Please contact inspector.
❑ Was not able to perform inspection.
❑ CALL 435-0674 FOR RE-INSPECTION - 24 hour notice required.
/ L L1 r_ r47°p lC tl�ry
Inspector: 1 — Date: 2/0-0&
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in 0 Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other:
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NSPECTION REPORT
N G?'0 Permit No.: 10f c 1)1a Lot #:
Address: zo i i 6'1 A yr
Z Contractor:
O Owner:
IN G`t
Date: / -i 8 —oL,
APPROVAL ❑ PARTIAL APPROVAL
❑ VIOLATION ❑ CORRECTION REQUESTED
❑ Corrections listed below MUST BE MADE before work can be approved.
❑ Please contact inspector.
❑ Was not able to perform inspection.
❑ CALL 435-0674 FOR RE-INSPECTION - 24 hour notice required.
Inspector: — Date: /-I f3-b t.
TYPE OF INSPECTION REQUESTED
❑ Under-floor ❑ Framing ❑ Gas Piping
❑ Footing ❑ Drywall, Nailing ❑ Consultation
❑ Foundation ❑ Shear Nailing ❑ Groundwork
❑ Mechanical ❑ Grid ❑ Struct. Slab
❑ Wood Stove ❑ Rough-in ❑ Final
❑ Masonry ❑ Drainage ❑ Insulation
❑ Other: 'i 1e 3�_Z"4c-,,j t,
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CITY C7F= t� f L I lVGTC7ht
COt4!:�3'T' FRUC-F I C)t4 t3EHM I 'T-
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Owner: BEJARANO, GREGORIO 20211 67TH AVE HE #1 ARLINGTON '2'2'3
Value of Work: Tax ID: 009600--095--0ol-eO-L Phone:
Describe Work: INSTALL MOBILE HOME ON EXITING LOT
Proposed Use: SFR
Legal Description: PLEASANT MOBILE HOME PARK #1
Job Address: 20211 67 TH AVE NE #11
C-ontractor's Name Type Address License*
ROBINSON MOBILE G.EN 9214 46TE PL NE ROB1Nh*961L)9
TOTALS
Fee LG �
Permit Fee SSQ►Q►, Odd
State fee $4. Sit
SIGNATURE:
TOTAL FEE. . . . . . . . . . . . . . . . . $504. 50 I HEREBY CERTIFY THAT I HAVE READ
ANC EXAMINED THIS APPLICATION AND
PAYMENTS. . . . . . . . . . . . . . . . . . $0. 00 K.:,. THE SAME TO BE TRUE AND COR-
'S OF LAWS AND
TOTAL DUE. . . . . . . . . . . . . . . . . S504. 50 :�':� ,'4NCLPRGOV�INil THIS TYPE OF
W 11 h WILL E ;P;- -., WITH WHETHER
UA'Y'E RECEIPT #
_ ) NG OFFICIAL -
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MAID JFACTURED /MOB ,)LE HOME
PERMIT APPLICATION
Department of Community Development
City of Arlington • 238 N Olympic Ave. •Arlington, WA 98223 • Phone (360) 403 3431 • FAX (360)403 3447
Location of Installation:
Client's Name GXenoglrg &P a► OEwo Phone Number:
Address: aQo2 l Fj�l� Jl�t � City: 1���'�, ram { State: U04 Zip Code:
Lot number: ��.P.�a � o 1)
When acting as the general contractor for installing Manufactured Homes/Mobile HortS�the following requirements must be met per
the Washington Administrative Codes.
RECEIVED
WAC 296-15OM-0630—Who may install a manufactured home?
1. A manufactured home may be installed by: NOV 15 2005
• Homeowner
• A certified installer COA PERMIT CENTER
• An individual who is supervised by an on-site certified installer; or
• A specialty trades person,for certain aspects of installation.
2. A certified installer must be a registered contractor or his or her employee, or an employee of a registered dealership.
Contractor's Name: g°B 1 t'5 pp u Phone#: t/o?S ? �Sa--:z
Address:
L& I Number: 60'0 City Business License#:
I hereby certify the above information is correct and that the construction on, and the occupancy and the use of the above described
property will be accordance with the laws, rules and regulations of the State of Washington. The applicant will be responsible for
providing a method of safely accessing roof for inspection.
Contractor's Signature Date
Installer's Name: /Jteo pit,e C 49 �WS y 0, Phone#:
Address: fw/% qb 7�� ONA41 s V,(Zle 0� Qt3110
L& I Number: ����� `, � City Business License#:
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FOR STAFF USE ONLY
05 - Z 2-D
Permit# Accepted By Amount Received Receipt# Date Received
WEB Form—70 Page 1 of 1 6/05 dwa
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