2012, 08-06 Permit App: FAS-2012-003 Install MH Community Development Department (Staff Use Only)
-,,`''' Permit Center
crry ork �~^�.. 11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206 PERMIT NUMBER:
Spo
ane
Valle Tel: (509) 688-0036 PERMIT FEE:
Fax: (509) 688-0037
Y permitcenterPspokanevalley.org
Project _ -S-1 3
MANUFACTURED HOME PERMIT £i PPLICA a.
❑ OTHER I •
AUG 0 6 2012
SITE ADDRESS: ( -1 1 07 E, -3 -c7 1
ASSESSORS PARCEL NO.: LEGAL DESCRI1PTIOftgV PERMIT CENTER
BUILDING OWNER NAME: q...6 / ( ' f�L`•. I
NAME: 6 arbcrcv L . 0 rrI's�n I �- ..�_._.
ADDRESS: 6 Li /g Al, ..1 ►n 7,0v Rd,
CITY:j /S. ()r—r r- c4 r d 5 t� STATE: (A)6 • ZIP: Qqr (),—. •
PHONE: 5-0 c��9 �� - c25 J U FAX: CELL: q8I ,. `t 57
CONTACT NAME: ^� �7
PHONE: C 1) G/-- ,ems GX `•_7 ! 8 FAX: [ CELL:
CONTRACTOR NAME: Gene r01 .�' 1 / fl 5 'i l//+"L`"' • '
MAILING ADDRESS:
CITY: /_ / STATE: ZIP:
'7
PHONE: dy- q91 -- !FJ 9 0 to FAX: �5hN',z3 F- /50 / CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: 'I
h 1'a/ I -Fop-r /c Spa? r Pi1(19k Ups Pow E. ; C.)akcjp,� L Ja+er-iloUK up
MANUFACTURED HOME WIDTH: / W I
MANUFACTURED HOME LENGTH: 70 /
YEAR OF MANUFACTURED HOME: I g y
PIT SET: SEPTI /SEWS
MANUFACTURER: Fl ee 1-ton'0GI
PREVIOUS ADDRESS: art f /& j\f, b., mpsoY? )1f, 0fi,j Orckarc8. Wig `990.2-7
PROPOSED USE: '`Fp 1.„, 've i y)
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
C Usequently approved before this application can be processed.
Signature / ' ' ." .' 8V / 7�C�g-k7 Date: 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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