2005, 11-22 Permit App: 05004445 MHPermit Center
S akane 11707 E Sprague Ave, Suite 1.
.00.0 Valley
Spokane Valley, WA 99106. �-
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.org.com
Manufactured Home
Permit Application
»
SITE ADDRESS
//o cz. Cis,
ASSESSORS PARCEL NO: __3 __ _ a, 9D `GAL DESCRIPTION:
Building owner
Name: E=` ri t,% (6,--,g,„1"---IN--
Address: / % iir, --Si Ii f S "-
City:sV-7S 7chiP: 9 9 0 D'
Phonj 99) 22‘,-1 1n. x:
Contact Person
Name:
Phone:
Describe the scope of work in detail:
0.1. (1
Contractor
Name:
Address:
City:
Zip:
Phone:
Fax:
Lic No:
Exp. Date:
City Business Lic No:
-0+1' -171(-k-s
MANUFACTURED HOME
Width:
Manufacture:
Length: moi%
Year:/ / 9 9 - Pit Set:
Previous Address / 2
Proposed Use:
DISCLAIMER
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 D- elopment Code. Referenced codes are available for review at the City of
Spokane Valley Permit C- er. 5) This City of •o -ne Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or or nces. 6) Plans or .dit'.nal information may be required to be submitted, and subsequently approved before
this application can b= • ocessed
Signature
Date /1— as
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 0 Check 0 Mastercard 0 VISA
Bankcard #: Expires: VIN#:
0 Other
Authorized Signature:
REVISED 8/23/2005