2012, 05-10 Permit App BLD-2012-0618 MHYEAR OF MANUFACTURED HOME:
Spokane
Valley
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@spokanevalley.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
El OTHER
SITE ADDRESS: s(s ' c_DU`Q
ASSESSORS PARCEL NO.: o'5-* Q 01 LEGAL DESCRIPTION:
BUILDING OWNER NAME: `53-(2ey' p3D'C
NAME:
ADDRESS:
CITY: II V'�. V STATE: �i,\-•
�C
PHONE: .b - 0°1`3 U FAX: CELL:
ZIP: \- l oQ KJ
CONTACT NAME: fjW` A \\C)31\;
FAX: CELL: Z pFN -- b 10c
PHONE: 'tc)v\ — 6
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE U E:
rY\ob lrow-e. "ki\s% ,
MANUFACTURED HOME WIDTH: lLl
MANUFACTURED HOME LENGTH: `7OI Set
PIT SET: SEPTIC/SEWER:
MANUFACTURER: 'c\CLivk
PREVIOUS ADDRESS: rtfck
PROPOSED USE: bi2Ak1y\i,1
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 p= i i a permit or approval f. -• violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information ma be submitted and bseque.tly approved before this application can be processed.
Signatu - ��� +' �� Date: 5((01 lc
Updated 1-11-11 Page 1 of 1
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