2013, 04-17 Permit App: FAS-2013-0005 MH(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
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Spokane
Valleyx
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@ sookanevalley.orq
MANUFACTURED HOME PERMIT APPLICATION
❑ OTHER
SITE ADDRESS: -7,6 CD
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ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME:
ADDRESS:
(A- 476A) y Ams04)
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CITY: STATE:
ZIP:
PHONE:
rbY- F6 q- /5-5- 3
FAX: CELL:
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
PHONE:
124-1-1 I De
(A- 7 Li L/
P/v.j36x /
STATE: —TO ZIP: B SU
FAX: CELL:
CONTRACTOR LICENSE NO.: yulka,ci ( 0t'1.0)+ EXPIRES: / CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICA USE:
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A-AJ(iU(z Hoot e_
MANUFACTURED HOME WIDTH:
MANUFACTURED HOME LENGTH:
YEAR OF MANUFACTURED HOME:
�{5-2013 -60o5
PIT SET:
MANUFACTURER: t_e_T Wood
W4 �T
,-gv(
SEPTIC/ - EWER:
PREVIOUS ADDRESS: c ,t.yz_y
PROPOSED USE:
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 appr. : for any lol tion of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitted . d - bseq -ntllapproved before this application can be processed.
Signature
Date: 1/-1 7- /3
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
PLANNING DEPT. APPROVED
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DATE: 41H-113
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