2007, 01-19 Permit: D250 Affidavit of Exception , F �.� CITY OF SPOKANE VALLEY (Staff Use Only)
Spokane Community Development Department
jValley Current Planning Division DATE SUBMITTED: t/( 'U T RECEIVED BY: M\
11707 East Sprague Avenue, Suite 106 Pius #:
Spokane Valley, WA 99206
Tel: (509) 688-0197
Fax: (509) 921-1008
plan ninqspokanevallev.orq AFFIDAVIT OF EXCEPTION
I,(PRINT NAME) 4 �. , the undersigned applicant for a Washington
State and Spokane Valley Master Business license, hereby swear that the following information
regarding the business listed on my license application and based at my home address at
116i E 10`v4v-2 is true and correct:
1. There are no exterior alterations to my residence or any accessory structure(s) which change the
residential character of the property;
2. There are no goods or commodities stored on the premises (including accessory structures);
3. Goods and commodities associated with the business are not delivered to the premises;
4. There are no business customers visiting the premises; and
5. There are no signs or window displays on the property related to the license for which I have
applied.
I acknowledge that any change in the in the foregoing conditions, resulting from change or expansion in
business conditions, will require the issuance of a Home Profession Permit. I further agree to report any
change in these conditions to the Spokane Valley Community Development Department, Planning
Division, within 30 days.
�•ir''���� Jew fat 20 0 7
Signature Date
Signed and Sworn to before me this ) day of l,(Q,i'L, , 20 67 .
Gitis
•ON
TARY u, . NOT RY PUBLIC IN AND FOR THE TE OF WASHINGTON
%+ at PUBLIC eResiding at l< � /(��. Liti�7`7L��cJ ���, Ce) �Q62
1 �lY� 2
� WAS° = My appointment expires: 7- i Cq
AFFIDAVIT OF EXCEPTION Page 1 of 1
1/10/2007