2006, 10-18 Permit App: 06004172 Safety Inspect Permit Center ( j
Spanokane 11707E Sprague Ave, Suite 106 i I IIT NUMBER: `7
�'� a11eY (509)Spokane688-0036 Valley,FWAAX:9(509?_096 P • T FEE: C
)688-0 0
OCT ' �� 6 S�
Community Development www.spokanevalley.org i
Manufactured Home
Permit Application OTHER
SITE ADDRESS: 2'12 I ki . �/V i I k)1�-►� Rd . 5p o ko VM4
ASSESSORS PARCEL NO: 4 5091 , oZ I Io- LEGAL DESCRIPTION: (/qz2V4G265 Mb3/LE 9--Ibiv)E5 5K$
Building Owner: ; Contractor:!Lit: �hCis�l�S
Name: J.ed1/t rIO LOU S Name: ECO'N /Q .I Moth,dav
Address: /A 91 �t'� � + !Lib Address:
City: 5pc J State: war Zip: qctv6, City: PoS,f't'01(5 State: j Zip: gm,sq
Phone: 50 •l,11Fax. Phone:30q G,S4 7/0!7 Fax:
Contractor Lic No: Exp Date:
Contact Person City Business Lic.No:/
Name: L bi+Yi i e C-7a/I tLk11 DYe
Phone: 550`3 9 3 4'I 81`37
Describe the scope of work in detail:
S pk-Ci 411o14JvLS -mot `I-wLc h 3w 1 el- Ce cit c,
MANUFACTURED HOME
Width: 02 g Length: 1.v 0 Year: / g 5 Pit Set: Septic/: 5 W 2
Manufacture: 10 ood-Pel d 5 ky Li✓u
Previous Address:
Proposed Use:
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 or ordinances.6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be processed.
Signature G7�Z.EL !.i. ; ,i 1;t(,;Y1 (DV Date /6/0 sicv
Method of Payment:
0 Cash 0 Check 0 Mastercard 0 VISA
Bankcard#: Expires: VIN#:
Authorized Signature:
REVISED 8123/2005