2008, 09-12 Permit App: 08003602 MHPermit Center
ookalt0 e 11703 E Sprague Ave, Suite B-3
li�lll Spokane Valley, WA 99206
j`Talley' (509)688-0036 FAX: (509)688-0037
JJ www, spokanevalley.org
Community Development
Manufactured Home
Permit Application
OTHER
SITE ADDRESS: S- (/
ASSESSORS PARCEL NO:
St.
PERMIT NUMBER: S 367`::
PERMIT FEE:
LEGAL DESCRIPTION:
Building
��Owner:
Name: �ib,0. / a
cc, b II
` cPi r •'.,_
Address: 5'/ ( p
(4-®d5 , S
City: 5-, V �q �( eY
r'"
4Sate: yg Zip-
P /
oneX 13 >/4. 3
//,
Fax:
C.
7
/ k 33s—
Contact Person
Phone: 7 /c2 013 3 S
Describe the scope of work in detail:
k,, '2
A
99(6
Contractor:
Name: &( ,f- 1)7 .5-
---wkabe (-e
A .e co/'V
Address:
City:
State:
Zip:
Phone: 7 a J 2‘� ,
Fax:
Contractor Lic No:
Exp Date:
City Business Lic. No:
MANUFACTURED HOME
Length:
Manufacture: ��� � '(-
Previous Address:
Proposed Use:
Year:
Pit Set: Ivy,
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 nances. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this applicatio can be p ocessed.
Signature
Method of Payment:
0 Cash
Bankcard #:
Authorized Signature:
REVISED 8/23/2005
0 Check
❑ Mastercard
Expires:
Date
❑ VISA
VIN#:
ds�s
5'