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2014, 09-26 Permit App FAS-2014-0012 Placement of MH
Community Development DepartmentLPERIT aff Use Only) Permit Center �I crry of 11703 East Sprague Avenue, Suite B-3 pokane Spokane Valley, WA 99206 EF - C E I V E D Valley Tel: (509) 688-0036 Fax: (509) 688-0037 i)ermitcenter(a)spokaneva Iley.org MANUFACTURED HOMEPERMIT A PLrCATIOIT CENTER Ej OTHER / %V SUB # REV. # SITE ADDRESS: 9 V E C� JeC(� ASSESSORS PARCEL NO.: 7,?, © LEGAL DESCRIPTION: '�p 2L r�1 BUILDING OWNER NAME: NAME: ADDRESS: CITY: STATE: ZIP: PHONE: lJ FAX: CELL: CONTACT NAME' /6 kA1, p�&J tV , ,rJ 6% PHONE' So9 [�C7 O FAX:,57 �} 617,� /pI 9 CELL: O9 q9 C? -46 CONTRACTOR NAME: <iv yu j -g:: 9OY5 d MAILING ADDRESS' a / 15-9106 � SP444-(.C%�e � CITY' 670 S V STATE: G<7—w w ZIP: q9 LV:�_7 PHONE' 5Z9 - /,/ �? / -,FY o 3 0 FAX' CELL: CONTRACTOR LICENSE NO.: EXPIRES: CITY BUSINESS LICENSE NO.: DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE: MANUFACTURED HOME WIDTH: MANUFACTURED HOME LENGTH: 114.$ —Q �r YEAR OF MAN FACTURED HOME: PIT SET: SEPT /SEWER: MANUFACTURER: PREVIOUS ADDRESS: PROPOSED USE: 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 Developmcode. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of Spokane Valley permit is a mit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be requir mitted and subsequently approved before this application can be processed. Siqn Date: 9/ � ./�_ Updated 1-11-11 Page 1 of 1 http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Manufactured_Home_Permit_1-11-1l.doc a \ %.o I., moo• �� C' 4 Pr '�ct1^�L4_ o �' W RECEIVED r { SEP 2 5 2014 PLANNING DEPT. APPROVED ! C V PERMIT CENTER BYi - LL::, ,�lQL ()•.Vi.� SUB # l j R E V DATE: (fit a \ %.o I., moo• �� C'