2014, 09-22 Permit App FAS-2014-0011 Place MHADDRESS:
CITY:
PHONE:
SIi�1t'ane
Valley
Community Development Department
Permit Center
11703 East Sprag:ie Averi;ie, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
nermitcenter@spoka nevallev.orq
(Staff Use Only)
PERMIT NUMBER:
PERMIT FEE:
MANUFACTURED HOME PERMIT APPLICATION
ID OTHER rr !!,, -
SITE ADDRESS: r/9 C•d v -J CUot YI 7°
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION:
BUILDING OWNERNAME:
J �^
NAME: PI.Ncf -/204 r "t LL l_
)icie20 E. Moucc; a icJ A Ire
ket. € U t it
5r�c--3`mac--5337
CONTACT NAME: ETC R& S )
STATE:
FAX:50q - 916 6 ). CELL:
PHONE: j T - 3 a 4 _ 5 33 7 FAX:SO9 -! of /
CONTRACTOR NAME: Lt13 10610
> 7'� gttiJ
MAILING ADDRESS: P.. boy', 7 / y
CITY:
PHONE:
WCt Ock.VIeLt
` ato -3(Alo
STATE:
FAX: ('sg2— 7 —OW/
CELL:
CELL:
RECEIVFD
1' ►1'4
Zip: g4''0t
CONTRACTOR LICENSE No.: 15(4c1 pbifg5/ LXPIRES: (Q , —J5 CITY BUSINESS LICENSE NO.:jain 3.5/9o'
DESCRIBE THE SCOPE OF WORK IN DETAIL AND INDICATE USE:
MANUFACTURED HOME WIDTH: t y
MANUFACTURED HOME LENGTH: sJ („, I
YEAR OF MANUFACTURED HOME: o1ol'
PIT SET:
MANUFACTURER: F/reiL weir r1
PREVIOUS ADDRESS:
It:I/SEWER:
PROPOSED USE: Home'
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if thls permit Is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of thls 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 Na/j\A.00
Date: 2A.:>.))/$/
Updated 1-11-11 Page 1 of 1
http://www.spokanevaliey.org/filestorage/124/938/210/948/1496/Manufactured_Home_Permit_1-11-11.doc