2013, 09-11 Permit App: FAS-2013-0011 MHCommunity Development Department
Permit Center
5166& a 11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Valley " Tel: (509) 688-0036
Fax: (509) 688-0037
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permitcenter so okanevalley.org
(Staff Use Only)
[PERMIT NUMBER: ERMIT FEE'
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MANUFACTURED HOME PERMIT APPLICATION
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SITE ADDRESS: /0
ASSESSORS PARCEL NO.:
BUILDING OWNER/NAME: %� %
NAME: L9 ey`L] 11L-yi U; l �f ek-
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LEGAL DESCRIPTION:
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PHONE: 5-z),f- - ZZ(P " 30&5 FAX' CELL:
CONTACT NAME: L V lG9l.t�l fQ �yI
PHONE: FAX: N4- CELL: SLPme
CONTRACTOR NAME: /i'J/`55jyh %�l Q�( u�5 �-L G (LQdrirl DV -)nay)
MAILING ADDRESS: ZS2,/Z2
CITY: 11i2 A0,4 STATE: W14 ZIP: L7 b3%
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PHONE r :/ C/ /J Z� FAX: /s) CELL: Saiz,
CONTRACTOR LICENSE NO : NA EXPIRES: 5/211 CITY BUSINESS LICENSE NO.:�Q% �15� OZJ
DESCRIBE THE SCOPE OF WORK IN D,EETAIL AND INDICATE USE:�n l� �O l'
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MANUFACTURED HOME WIDTH:
MANUFACTURED HOME LENGTH:
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YEAR OF MANUFACTURED HOME: 219/3
PIT SET: ve5 SEfEWSEWER•
MANUFACTURER:
PREVIOUS ADDRESS: /V#
PROPOSED USE: e5ja411-4
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.
Updated 1-11-11 Page 1 of 1
http://www.spokanevaIley.org/filestorage/124/938/210/948/1496/Manufactured_Home_Permit_1-11-1l.doc
LOT 122
1817 N. Meadows Place
Prepared for: Fred & Gerry Vanguilder
North
Scale: 1" = 20'
Home Manufacturer: Marlette
Width: 26'8" Length: 62'8"
Resident approval of site plan
Signature date
Signature date
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