2006, 06-19 Permit App: 06002385 MHSpot ane
Valley
Community Development
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Permit Center q
11707 E Sprague Ave, Suit1\06 JUN 19 2006
Spokane Valley, WA 9920
(509)688-0036 FAX (509'48 00�37Q
www.spokanevallev.org \) NJ u D pC1
Manufactured Home
Permit Application
PERMIT NUMBER:
ERMIT FEE: t4 9
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SITE ADDRESS: I f OCR si5A3(3N, rC,t
ASSESSORS PARCEL NO: SS'r 3.Q 3 GAL DESCRIPTION: Lc 15, 61K 6, Lab -P-1- f1ob (f° PCU,
Building Owner: Elly ,Q of E tzcabetvx
Name: tjicav,n.,-as C3,....2C-- _Q-6'eta-
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Address:ia'ie.
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City:3v,m4%z Zip:TOGO
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Phone: J Fax:
I Contact Person `Z��lfvt�- h L,7C
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Phone: (SO(7
Name: r . 6- 6 - `t'�:'
Describe the scope of work in detail:
Contractor:
Name:
Address:
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City:.
State:
Zip:
Phone: Fax:
Contractor Ltc No: Exp Date:
City Business Lic. No:
"9-L5
3 a5 h6s`er (0ci -Ern' MO -i 7 `l'H� L l im't-&•wov)
MANUFACTURED HOME
Width: ( I
Length: /_Li
Year: /99s
Pit Set:
Septic/Sewer:
Manufacture:
Previous Address:
Proposed Use:
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The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be processed.
Signature fy Date .�r,� p
Method of Payment: , ni-- � L- I$)e1✓'I i-- 1 cat Q� !!
❑ Cash Check ❑ Mastercard VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 8/23/2005