2014, 05-16 Permit App: FAS-2014-0004 MH Community Development S)epartment (Staff Use Only)
Permit Center
Spokane 11703 East Sprague A;Jenue, quite B 3 PERMIT NUMBER:
Spokane Valley, WA 99206
Valley Tel: (509) 688-0036 PERMIT FEE:
'� Fax: (509) 688-0037
oermitcenter@sookanevallev.orq
MANUFACTURED HOME PERMIT APPLICATION
NI OTHER14SITE ADDRESS: yAS -00110
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: 66.9 /4.4- -,4- e9.)()
NAME: ,� /`Y�4) 5 t) /�
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ADDRESS: /()<C7 I
CITY: SiC'o/ x1 V7t� E-2 STATE: izt ZIP: <7'?G-e2t7
PHONE: ,i. 0 <j - 5S-'5-7_ FAX: CELL: 22'c3 - 0›
CONTACT NAME: :=1")-7-2,1,44"2-77-,‘.>;!/t/
PHONE: S -1-% e; Stec-7 FAX: CELL: -i',4f
CONTRACTOR NAME:
MAILING ADDRESS: 7t L.�Q,(.J11 �I/L,c)/j4nE,� x,
CITY: `��/,/,> E^, E-- STATE: ZIP:
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PHONE: -�S}` O 4=4---t--4---t--7-� 6�C� FAX: CELL:
CONTRACTOR LICENSE No.:TtIL41 ('(5 7e/f/9 EXPIRES: 3�/-I C/ CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN/DETAIL AND INDICATE USE:
MANUFACTURED HOME WIDTH: /- II .
MANUFACTURED HOME LENGTH:
YEAR OF MANUFACTURED HOME: 2c-kli cs . �'T;1?0
PIT SET: JC�� SEPTIC/SEWER:
MANUFACTURER: fits,74;x,
PREVIOUS ADDRESS: ,-'/ 4/ ---
PROPOSED USE:�t , ,c •
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 . alu6 -„ Date: 5 //b //i
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
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