2014, 09-22 Permit App FAS-2014-0010 Set MHS#01se,
iblane
Community Development Department
Permit Center -
11703 East Sprague Avenue, Suite 6-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
oermitcenterPsookanevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
El OTHER Iproject14OCf
/
1;�
SITE ADDRESS: I Q E . IY� IU i��eki Ave y5 RECEIVED
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNER NAME:
NAME: S 1 loc, Ci c3- fro. ` f',LC�
ADDRESS: !!q a0 . fYlC.'?Rl�['e./4d 410'4
CITY:
PHONE:
�kcinip L'c�ller,i
&9- .35 t-5 33`7
CONTACT NAME:
PHONE:
�STTATE:f) 2A
FAX:5v -J►(C�s-d /5
FAX:
CELL:
CELL:
T CENTER
CONTRACTOR NAME: 12,aA A,
MAILING ADDRESS:
P.o. '714/
11(1n h: I e Herivio
STATE: Loft
FAX: /46 // d 7W
CONTRACTOR LICENSE NO.: f1411.:15 hpfl)g5"JL. XPIRES: jo ��a -JmITY BUSINESS LICENSE NO.:4,0 35`6os>
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
142 v 1 ta a AzI-4.7-,r, 5 IC i
ZIP: ggoit,
CITY: 590 +2 l)CCIl let �+
PHONE: .6q — 9 0 -3 ":7
CELL:
MANUFACTURED HOME WIDTH: /,4
MANUFACTURED HOME LENGTH:
YEAR OF MANUFACTURED HOME:
5-0
PIT SET: EPT , /SEWER:
MANUFACTURER: F.1.e.c+LAxAc- A
PREVIOUS ADDRESS:
PROPOSED USE: HemC
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.
Signature4L Date:
//
Updated 1-11-11 Page 1 of 1
http://www.spokaneva I ley.org/filestorage/124/938/210/948/ 1496/Manufactured_Home_Permit_1-11-11.doc