2011, 11-07 Permit App: 11003527 MH„,. Va11ey
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B -3
Spokane Valley, WA 99206
Tel: (509) 688 -0036
Fax: (509) 688 -0037
permitcenterCaspokanevalley.orq
(Staff Use Only) 7
PERMIT NUMBER: e l am— 3 SL
-1
PERMIT FEE: !
MANUFACTURED HOME PERMIT APPLICATION
El OTHER
SITE ADDRESS: �a . 'Aft. SATLCA
ASSESSORS PARCEL NO.: 6.5—t
LEGAL DESCRIPTION:
BUILDING OWNER NAME: tMN ANA-vs:.
NAME: Oa t -' Q ,34tCV.
ADDRESS: q Vil W . 4.0 2c.
CITY:
PHONE:
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FAX:
STATE:
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CONTACT NAME: Q 34-S►+•^
PHONE: CioTh .1 \4- g-153 FAX:
CONTRACTOR NAME: t r. 3�-L-
MAILING ADDRESS: Q- b. 51 -Z-\
CELL:
CELL:
ZIP: 3V1 Oq
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IVY 114- 91S-)
CITY:
PHONE:
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STATE:
FAX:
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CELL:
ZIP: CIS 7,115
5-05- 1-7 - 3l.t�L
CONTRACTOR LICENSE No.: bATr�C�r n�S Q b EXPIRES: ‘\. \'-1- CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
-et,
MANUFACTURED HOME WIDTH: 7d
MANUFACTURED HOME LENGTH: Tai'
YEAR OF MANUFACTURED HOME: 2010 wuv 4o +s'114L
PIT SET:
MANUFACTURER: 5 r 6,,.t
PREVIOUS ADDRESS:
PROPOSED USE:
SEPTIC /EWER: J
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is /will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit o approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to t tted and subsequently approved before this application can be processed.
Signature
Method of pay'ment: ❑ Cash
Bankcard #:
Authorized Signature:
❑ Check
Date: /1 -7 -J I
❑ Visa ❑ Mastercard
EXP: VIN #:
Effective October 28, 2007 Page 1 of 1
P: \Community Development \02 Administration \03 Forms - Official Versions \Permit Center \Manufactured Home Permit App 10.28.07.doc
Proj et. Number: 11003527 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 11/7/2011 Page 1 of 2
Project Information:
Permit Use: PIT SET 28x56 FAS ON PRIVATE LOT Contact: CMH HOMES INC
Address: 5000 CLAYTON RD
C - S - Z: MARYSVILLE, TN 37806
Setbacks: Front Left: Right: Rear: Phone: (509) 891 -9996
Group Name:
Site Information: Project Name: 2010 SKYLINE 28x56 PIT SET FAS
Plat Key: Name: Range
District: East
Parcel Number: 55182.5405
SiteAddress: 1224 N ARC ST
Location:: CSV
Block: Lot:
Owner: Name: CMH HOMES INC
Address: 5000 CLAYTON RD
MARYSVILLE, TN 37806
Zoning: R -4 SF Res Urban District
Water District: 134 CONSOLIDATED ID #19
Area: 9,721 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Review
Landuse /Zoning/HE Conditions
Permits:
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Released By:
Originally Released: 11/7/2011 By: MBonduran
Manufactured Home
Contractor: BARNES ENTERPRISES INC Firm: BARNES ENTERPRISES INC
Address: PO BOX 141617 Phone: (509) 921 -9068
SPOKANE WA 99214
Item Description
SETTING PERMIT
Units Unit Desc
2 # SECTIONS
Fee Amount
$100.00
Permit Total Fees: $100.00
Operator: MBB Printed By: MBB Print Date: 11/7/2011
Project Number: 11003527 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 11/7/2011 Page 2 of 2
PRIOR TO C of 0 PAVING MUST BE COMPLETED
A 6 -FOOT HIGH SIGHT - OBSCURING FENCE MUST BE INSTALLED AROUND PERIMETER
OF VALLEY COACH ESTATES SUBDIVISION PRIOR TO ANY BUILDING PERMITS -MH
THE FENCE HAS BEEN INSTALLED. BUILDING PERMITS FOR VALLEY COACH ESTATES
ARE OKAY -MH
Payment Summary: 4. .- .
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $100.00 $100.00 $0.00 $100.00
$100.00 $100.00 $0.00 $100.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and /or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: MBB Printed By: MBB
Print Date: 11/7/2011
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