2005, 10-18 Permit App 05003858 Set MHProject Number: 05003858 Inv: I
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: MANUFACTRED HOME SET
Setbacks: Front
Site Information:
Plat Key:
Left: Right: Rear:
Name: RANGE
Date: 10/18/2005 Page 1 of 2
Contact: WILLIAM MEYER
Address: 11303 E JACKSON #58
C - S - Z: SPOKANE VALLEY, WA 99206
Phone: (509) 921-9351
Group Name -
Project Name:
District: Sout
Parcel Number: 45092.9643 Block:
SiteAddress: 11303 E JACKSON ST #43
Location:: CSV
Zoning: UNKN Unknown
Water District:
Area: 0 Sq Ft Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Lot:
Owner: Name- WILLIAM MEYER
Address: 11303 E JACKSON #58
SPOKANE VALLEY, WA 99206
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Review
Site Plan Review
Released By
Plan Review
Originally Released: 10/17/2005 By: HKAUER
Released By:
N/A -PER MANUFACTURES SPECS
Originally Released: 10/17/2005 By: CJJANSSE
Sewer Review
Permits:
Released By:
Originally Released: 10/17/2005 By: CJJANSSE
Operator: CJJ Printed By: CJJ Print Date: 10/18/2005
Project Number: 05003858
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Inv: 1
Contractor: OWNER
Item Description
INSPECTION FEE
Notes: _.,_
Payment Summary:
Permit Type
Manufactured Home
Manufactured Home
Units
2
Date: 10/18/2005 Page 2 of 2
Firm: OWNER
Phone: (000) 000-0000
Unit Desc Fee Amount
SECTIONS $100.00
Permit Total Fees:
$100.00
Fee Amount Invoice Amount Amount Paid Amount Owing
$100.00 $100.00 $0.00 $100.00
$100.00 $100.00
$0.00 $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-17-2005 es:35 AM I H I
509 534 6466
P- 02
Permit Center
Sfibk ne 11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
" (509)688-0036 FAX: (509)688-0037
Community Development w Yw.spokantvallev•org,com
Manufact red Home
Permit A s , lication
1/3v3 •774 SON 4/3
SITE ADDRESS
ASSESSORS PARCEL NO: ' S Q 2 _ i.64f3/`J LEGAL DESCRIPTION:
Name: k)i (444.,
Address: (/ 3 U 3 ET. `77?'c 5 )/
City: ,rP4 /"</A ,{!- _ Zip: 99; Q
Phone: 4.2 t!- 9 33.5!/ Fax: 3 V. 6 4/4 4
''GtbnLA t~rst i
Name: GU/ I r4e-i E E7‹
Phone:
-7,„/2-(.
Describe the scope of work in detail?
•
Name:
Address:
City:
Phone:
Fax:
Zip:
Lic No: Exp. Date:
City Business Lic No:
MANUFACTURED HOME
Width: _ '7 Length: S",?
Manufacture: G pL ft—},/
Previous Address: l�
Proposed Use: /
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If thls permit is for construction of 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) This 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 may be required to be submitted, and subsequently approved before
this application can be processed.
Signature Date /e) .773-- US
/ f,a.0
Method of Payrnfnt: (Faxed permit applications will only be accepted with major benkcard)
Bankcard #: Expires: Other
❑ Cash l >a Check - /7'/ ❑ Mastercard ❑ VISAVINff: ❑
C JV s 7—
Year: _Qc5D S— Pit Set: A/a
Authorized Signaturo:
REVISED F123r:eee 1
OCT 17 2005 09:54
PAGE.02
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