2012, 08-15 Permit App: FAS-2012-0004 MH Community Development Department (Staff Use Only)
Permit Center
CITY OF 11703 East Sprague Avenue,Suite B-3 PERMIT NUMBER:
Jr Spokane Valley,WA 99206
�� Tel: (509)688-0036 PERMIT FEE:
Fax: (509)688-0037@
88 0037
41000
permitcenter(o sookanevallev.orq
MANUFACTURED HOME PERMIT APPLICATION
0 OTHER
SITE ADDRESS: 18106 E. 4th. Ave. Spokane Valley
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: Ken Daniel
NAME: Ken Daniel
ADDRESS:838 S. Shelly Lake Ln.
Cm: Spokane Valley STATE: WA. ZIP: 99215
PHONE: 509-921-9068 FAX: 509-921-8945 CELL:
CONTACT NAME: John Barnes
PHONE: 509-921-9068 FAx: 509-921-8945 CELL:
CONTRACTOR NAME: Barnes Enterprises Inc.
MAILING ADDRESS: PO Box 15226
CITY: Spokane Valley STATE: WA. zip:99215
PHONE: 509-921-9068 FAx: 509-921-8945 CELL:
CONTRACTOR LICENSE No.: barneeiOO5p6 EXPIRES: 6/11/14 CITY BUSINESS LicEN414199ei005P6
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
New Residential triple wide home.
MANUFACTURED HOME WIDTH: 40'
MANUFACTURED HOME LENGTH: 60'
YEAR OF MANUFACTURED HOME: 2012
PIT SET: yes SEPTIC/SEWER: sewer
MANUFACTURER: Valley Quality -----
PREVIOUS ADDRESS: none, new. -1--012- -0401
PROPOSED USE: residential Project # -RS
DISCLAIMER RECEIVED
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 per i nue o operty owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. ll io trjiii is to be done in 'ull 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 subseqLently appreeSIVeliallpiMpfRiceiEnNcirFprocessed
Signature .—ar-- SUB # ! ! REV. # I Dater 8/15/12
Method of payment: 0 Cash 0 CHeek—--a------- ❑Visa `- "--'❑ Mo3te.card
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 1 of 1
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Manufactured Home Permit App 10.28.07.doc
I8►ob E . 4-J Ave-.
Lot 4
GOR Q I ki A1JD. -to areenac res
• ,. • • A
PAL 111'
PLANNING DEPT. APPROVED
W BY: 'ti .df
DATE: 'g/isfz0iZ _ -o a
Z r1 ?
a
— ( ., = 601 > 1 - -->
I
I
0
cli
13' 19'
o Horne •- v lEasanevtt �El:kw-nen+'f +
I' b_ Ave
A� f'" `s 40'x 60'
1
Existi req �i Gamy,y, p
Z�OG
Narrkn Heod ir— �, a4 x 30'
a >
oI o 44'
Sb 1
1 ,
4---)4----)
cn At-a4' < 5l' 3
T4
-P64 I U,
1/d =gL ,i 4-'7.
T : Za36,
01
P/L i1 1' >