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2013, 09-27 Permit App: FAS-2013-0016 MHSpokane Valleyx Community Development Department Permit Center 11703 East Sprague Avenue, Suite B-3 Spokane Valley, WA 99206 Tel: (509) 688-0036 Fax: (509) 688-0037 Dermitcenter©spokanevallev.orq (Staff Use Only) PERMIT NUMBER: PERMIT FEE: MANUFACTURED HOME PERMIT APPLICATION ❑ OTHER / /' ' / % y� SITE ADDRESS: /U -2•14l IlipC�1,L�r( zSA 01c (� Uhl/( 1& 7. l -2/ ASSESSORS PARCEL NO.: LEGAL DESCRIPTION BUILDING OWNER NAME: NAME: ADDRESS: r -e felrIAu-ell (,), Dcit(j e ,4-L'e.. CITY: Q tc-7)--Q 65-00 3L 7 23 0 7 FAX: CONTACT NAME: PHONE: STATE: ZIP: Q7Q/ CELL: (c0 l pJ 3g9- �j l ? / PHONE: FAX: CELL: CONTRACTOR MAILING ADDRESS: CITY: NAME: Bo js %J /.S 906 £ Foci ve Ave � STATE: ZIP: 9.9Q_ l Gj Q J PHONE: (co y J tical ` / (J�J O FAX: i %� CELLA ) J -z613 �, l � l ,l CONTRACTOR LICENSE NO.: .),2..3- /7 EXPIRES: 3/1/2 / PUJeCt •zt V 6 CITY £SINESS LIC9r E ; V E D DESCRIBE THE SCOPE OF WORK IN DETAIL AND((( INDICATE US: 1=d/ \` Sir' 272013 i' 6> may, MANUFACTURED HOME WIDTH: .24s- CS PERMIT CENTER MANUFACTURED HOME LENGTH: 6;6 ,sub — -1- - _ --,—/ 1 YEAR OF MANUFACTURED HOME: '-_.-..-,. 4 PIT SET: SEPTIC/SEWER: kie y - MANUFACTURER: cA (Y\ f) PREVIOUS ADDRESS: PROPOSED USE: •Jl 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 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 .ro.P 1, Date:�f/.Z7 Updated 1-11-11 Page 1 of 1 http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Manufactured_Home_Permit_1-11-11.doc PLANNING DEPT. APPROVED BY (.' \ DATE: )-71i__ 2A14 N. tc)NAI-1 sH eo ; C r� 7413 --( 72013 ty h�. nEnrilr-r m o0 1�`1 t1 bkv,q--naI L�z�� 1 15