2013, 06-23 Permit App: FAS-2013-0007 MHSpokane
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
permitcenterPsooka nevalleY.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
111 OTHER
SITE ADDRESS:
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: -AA)A-
ADDRESS: ),710/ ^%. 6]/ e-Z-11Rd
CITY:
PHONE:
k4.._
,'q- 954- -7557
CONTACT NAME:
STATE: (/q
ZIP: 1loi(
FAX: CELL:
PHONE:
FAX: CELL:
CONTRACTOR NAME: \ft,Lh9vt 5072--
MAILING ADDRESS:
'Po 60y ) 330
CITY:�
�CLlio-- STATE: .L) ZIP: •R'-
C3gSg
PHON . 755 FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOP/E OF WORK IN DETAI AND INDICATE U E:
i.
06 LI iii -04-1- 'IL ,..70 4 4,10.44...6,,,,F..."/„.o e_.,/,_,,, -.1/4,4„2„„J- l_j1Z t df..4AC,e
MANUFACTURED HOME WIDTH: 01(0
MANUFACTURED HOME LENGTH: 4 q ' 41"
YEAR OF MANUFACTURED HOME: o.O%/
PIT SET: ,/ SEPTIC/SEWER: /
MANUFACTURER: ./gd,"Plve_
PREVIOUS ADDRESS: p to -Z ock 4,525- 6 . . . e- Lip c 902/ a_
PROPOSED USE:ce__
DISCLAIMER --Zo13-0007
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 submi ed and subsequently approved before this application can be processed.
Signature, /'
1
Date: -7(3
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