2013, 04-01 Permit App FAS-2013-0002 MHNAME:
ADDRESS:
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
permitcenter1 spokanevaIlev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
❑ OTHER
SITE ADDRESS: ` (/ G gfl5 l e f d 5;6 G6
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME: h`Cco(Z 4fh{C)
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t '70 0 /4,l c,•n5 X re S0/te 2/
CITY: Co Sir A7e-s�j STATE: GA
PHONE:
FAX: CELL:
ZIP:
CONTACT NAME:
PHONE:
FAX: CELL:
CONTRACTOR NAME:
MAILING ADDRESS:
CITY:
A✓ij60k Y1 /ram yl.--5),::)ac e
STATE: ZIP:
PHONE:
CONTRACTOR LICENSE No.:
FAX: CELL:
EXPIRES: CITY BUSINESS LICENSE NO.:
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
7/6 C e /Vey Atdbil e- 4
MANUFACTURED HOME WIDTH: / /
MANUFACTURED HOME LENGTH:
YEAR OF MANUFACTURED HOME: 2Q/3
PIT SET:
MANUFACTURER:
SEPTIC/SEWER:
4`S - 7-0/3
3
2613
ri
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 Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The 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
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Date: 1 -/ - 2/5
Updated 1-11-11 Page 1 of 1
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Manufactured_Home_Permit_1-11-11.doc
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