2005, 10-18 Permit App 05003860 Set MHProject Number: 05003860 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Protect Information:
Permit Use: MANUFACTURED HOME SET
Setbacks: Front
Site Information:
Plat Key:
Left: Right: Rear:
Name: RANGE
Contact:
Address:
C - S - Z:
Phone:
Group Name:
Project Name:
Date: 10/18/2005 Page 1 of 2
WILLIAM MEYER
11303 E JACKSON #58
SPOKANE VALLEY, WA 99206
(509) 921-9351
District: Sout
Parcel Number: 45092.9629 Block:
SiteAddress: 11303 E JACKSON ST #29
Location:: CSV
Zoning: UNKN Unknown
Water District:
Lot:
Owner: Name: WILLIAM MEYER
Address: 11303 E JACKSON #58
SPOKANE VALLEY, WA 99206
Hold: ❑
Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 0
Review Information:
Nbr of Dwellings: 0
Review
Site Plan Review
Plan Review
Released By:
Originally Released: 10/17/2005 By: HKAUER
N/A -PER MANUFACTURES SPECS
Sewer Review
Permits:
Released By:
Originally Released: 10/17/2005 By: CJJANSSE
Released By:
Originally Released: 10/17/2005 By: CJJANSSE
Operator: CJJ Printed By: CJJ
Print Date:
10/18/2005
Project Number: 05003860 Inv: 1
Application
THIS IS NOT PERMIT
Penalties will be assessed for commencing work without a permit
Contractor: OWNER
Date: 10/18/2005 Page 2 of 2
Manufactured Home
Firm: OWNER
Phone: (000) 000-0000
Item Description Units Unit Desc Fee Amount
INSPECTION FEE 2 SECTIONS $100.00
Permit Total Fees: $100.00
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Manufactured Home $100.00 $100.00 $0.00 $100.00
$100.00 $100.00 80.00 $100.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: CJJ Printed By: CJJ Print Date: 10/18/2005
OCT— 1+►�-2005 08 _ 36 AM
�
I H I
509 534 6466
r
Width: �" ,2 ' g " Length; `YY/ Year: a? o a 5-- Pit Set: 4/0
Manufacture: K A 4 •7-C N
Previous Address: ,(1/
Proposed Use:
DISCLAIMER
The permitoe verifies, acknowledges and agrees.by their signature that: 1) If this permit is for construction of or on a dwelling, the
dwelling is/will be served by potable water. 2) Ownorship 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 Clty of Spokane Valley Development Code. Referenced codes are available for review at the City of
Spokane Valley Permit Center. 5) This Clty 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 subsequently approved before
this application can be processed.
Signature .7-7(.4ti� Date 10-13 OS --
Method of Payment: (Fexed permit applications will only be accepted with major bankcerd)
❑ Cash Check /52 ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VMN#:
`,!!` Permit Center
Snt okane 11707 E Sprague Ave, Suitt 1.06
ySpokane a,
ile(509)688-0036SpoknVlleyFAXWA : (509)99206688-0037
Community Development www.suokanevallev.org,com
Manufactured Home
Permit Application
SITE ADDRESS
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ASSESSORS PARCEL NO: 4'5 2 ,16 Z. ri LEGAL DESCRIPTION:
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Address:
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Phone: ',.? / — 9. 3
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Fax: _5"31-74- /-
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Name: l / G_! ( N1 1f'�C—mac
Phone: 9 �1— /.z /?
Describe the scope of work in etail:
Name: < e
Address:
3a cO
1 (5'
City:
Zip:
Phone:
Fax:
Lic No: Exp. Date:
City Business Lic No:
MANUFACTURED HOME
Authorized Signature:
REVISED 8'23/2COS
OCT 17 2325 09:55
PAGE.04
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