2014, 03-09 Permit App: FAS-2015-0001 MHCITY
Valley -
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@sookanevalley.orct
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
O OTHER
SITE ADDRESS: / 17/ E. fticky.
ASSESSORS PARCEL NO.: mazz,556e, f LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: -7-A 0/9-7 'QS 94 C.7,4Xe7[._ /-7/(/ /e 6 k--42) d
ADDRESS: /q 2 / 1- y
CITY:
66-'4 L._‘
STATE: al/a.._ ZIP:
PHONE: 0 ci et CH 79/
CONTACT NAME: -7-0A-7 /4///e,6frzz Cit
FAX: CELL:
PHONE: --6)47qq( 73 / /
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS: 5;1/77e
Cx-ry:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES! CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
feMe,e) ehoi-h(14
MANUFACTURED HOM ID
) e, rei 001
H:
o han
MANUFACTURED HOME LENGTH:
WAA
YEAR OF MANUFACTURED HOME: )
PIT SET: SEPTIC/SEWER:
MANUFACTURER:
PREVIOUS ADDRESS:
PROPOSED USE:
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, Dote. 3/9 /2
Project Ocx)(
RECEIVED
MAR 09 2015
Updated 1-11-11
http://www.spokanevalley.org/filestorage/124/938/
10/948/1U/Ya inpu Ic:t3uNFHPn_4745.-11-11.
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CSV PERMIT CENTER
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