2011, 10-04 Permit App: 11003150 Final Inspect Community Development Department (Staff Use Only)
Permit Center 11 �15O
Spokane 11703 East Sprague Avenue, Suite B-3 PERMIT NUMBER: ` J
Spokane Valley, WA 99206
Valle40• y Tel: (509) 688-0036 PERMIT FEE: Cel.
Fax: (509) 688-0037
oermitcenter@ sookanevalley.orq
MANUFACTURED HOME PERMIT APPLICATION
El OTHER /
SITE ADDRESS: 43 /5 Czs/ l/��G�'C�` C. , D/e6}7� U/YI W A 99o��oZ
ASSESSORS PARCEL NO.: 3, 03
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3 Q,47/, OLEGAL DESCRIPTION: 'p L/U ever,f- r_zh
BUILDING OWN
ER NAME:
NAME: ^/ilC � Y1 O ) ^
C hipirdr) •
ADDRESS: / &)LA.1-1/' 3rActC
?OOc
CITY: rho Ap3 STATE: b ff\ ZIP: 99bOq.
PHONE: , 1>-3' 0 -- -9( 7 FAX: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME: .
MAILING ADDRESS:
CITY: STATE: ZIP:
PHONE: FAX: CELL:
CONTRACTOR LICENSE No.: EXPIRES: CITY BUSINESS LICENSE NO.:
ESCRIBE Ttl E SCOPE OF WORK IN DETAIL AND INDICATE USE:
ul -2 Per ry d IJ /<335 S NQ uer i ri 01 led i n • /9 73,
MANUFACTURED HOME WIDTH:
MANUFACTURED HOME LENGTH: (o(�
YEAR OF MANUFACTURED HOME: /973
PIT SET: SEPTIC S�WE . 3pok rle Courv\J (14-j I "\--1e�
MANUFACTURER: ()L rv' IQ
PREVIOUS ADDRESS: --- ea_
PROPOSED USE: f� • r1- 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 maybe required to be submitted and s ,.se uer __
y q q .pproved bei'orethls application can be processed.
Signature A -OPF Date: / 2/Z///.
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