2011, 11-01 Permit App: 11003477 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
permitcenter@spokanevallev.org
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
OTHER // ��//
SITE ADDRESS: / 7/3 /tJs // c/ 425 Lite
ASSESSORS PARCEL NO.: 5 -go y03 , %44O/ LEGAL DESCRIPTION:ZoLee4M;0,„h,_aQ„fs MH/0
BUILDING OWNER NAME: 70 *- ie via Scale) b -t-
NAME: /)// 5).011 m4te4to5 LLCC..
ADDRESS: /51/0 E, Ce9fy,�t�r� �J
CITY: S/22k M U�/ley STATE: WA ZIP: 9763 7
PHONE: y_ qs:, _ 3?2 3 FAX: CELL:
CONTACT NAME: eR>,"C%(16b4 j v)
PHONE: 5-0.q - / -3 -- 37 23 FAX: //'/y�� CELL:
Z714,4CONTRACTOR NAME: Z714,()Willey; �55j � LL
MAILING ADDRESS: 5 9lY'
CITY: S p & /t i% / STATE:
PHONE: 5–Off— %Lj 3 - 3 2
CONTRACTOR LICENSE No.:
/4 ZIP: %9�j3 -7
FAX: CELL:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK I DETAIL AND INDICATE USE:
MANUFACTURED HOME WIDTH:
MANUFACTURED HOME LENGTH:
z e/1
/ 0"
YEAR OF MANUFACTURED HOME: za//
PIT SET: y5 EWER:
MANUFACTURER: V411 -ex
PREVIOUS ADDRESS: V
PROPOSED USE: ►e e`�l G1r
ai
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 __,1121
Date:
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
GRADY LANE
LOT 84
1713 N. HODGES LANE
NORTH
Scale: 1 in = 20 ft
Home Manufacturer: Valley Quality Homes
Width 26'8" length 40'0"
P o . ective : eside Approval
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