2005, 11-21 Permit App: 05004427 Safety InspectionesooN
St" akane "'
Valley
Community Development
Permit Center _
11707 E Sprague Ave, Suit* 1"06
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org.com
Manufactured Home
Permit Application
SITE ADDRESS
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ASSESSORS PARCEL NO: 21,S -4)1,5,01-z/ LEGAL DESCRIPTION: n Pp fL—
Buildin caner
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Name:
Address:
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City:, .O/iexQ �li Ot
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Zip: 619
Contact Pers (6.t.e&1/41,6_,P1-49e Name: l �%ll ,�
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Describe
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Describe the scope of work in detail:
Contractor.
Name:
Address:
City:
Zip:
Phone: Fax:
Lic No:
Exp. Date:
City Business Lic No:
MANUFACTURED HOME
Width:
Manufacture:
Length: 76'
Year: ." DO 4, Pit Set:
Previous Address:
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 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 b processed.
Signature
Date
Method of Payment: (Faxed Berrnit applications will only be accepted with major bankcard)
❑ Cash a Check 0 Mastercard 0 VISA
Bankcard #: Expires: VIN#:
0 Other
Authorized Signature:
REVISED 8/23/2005