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2005, 11-02 Permit App 05004092 Set MHPINECROFT MOBILE HOME PARK LOT 133 ROcK / r. SCALE: 1/16" = 1' fFfb-Atg(-1- Project Number: 05004092 Inv: 1 Application THIS IS NOT'A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: MANUFACTURED HOME SET Setbacks: Front Left: 20 Right: 6 Rear: 15 Site Information: Plat Key: MH004 Name: PINECROFT MOBILE HOME PARK District: Date: 11/02/2005 Page 1 of 2 Contact: JOHNSON, RANDALL J Address: 11920 E MANSFIELD AVE #133 C - S - Z: SPOKANE VALLEY, WA 99206 Phone: (509) 487-6945 Group Name: Project Name: Parcel Number: 45094.6122M Block: Lot: SiteAddress: 11920 E MANSFIELD AVE #13 Owner: Name: JOHNSON, RANDALL J Address: 11920 E MANSFIELD AVE #133 SPOKANE VALLEY, WA 99206 Location:: CSV Zoning: UR-7 Urban Residential-7 Water District: Area: .00 Acres Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 1 Review Information: Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Site Plan Review Plan Review Released By: Originally Released: 10/31/2005 By: CJJANSSE Released By: N/A -PER MANUFACTURES SPECS Originally Released: 10/31/2005 By: CJJANSSE Septic System Review Permits: Released By: AS PER BOB GALKE @ SRHD -11/2/05 Originally Released: 11/02/2005 By: CJJANSSE Operator: CJJ Printed By: MT Print Date: 11/02/2005 Project Number: 05004092 Inv: 1 Application THIS IS NOT'A PERMIT Penalties will be assessed for commencing work without a permit Manufactured Home Date: 11/02/2005 Page 2 of 2 Contractor: OWNER Firm: OWNER Phone: (000) 000-0000 Item Description Units Unit Desc Fee Amount INSPECTION FEE 2 SECTIONS $100.00 Notes: Permit Total Fees: $100.00 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 $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: MT Print Date: 11/02/2005 �� Permit Center Sp okane 11707 E Sprague Ave, Suite 106 4000 ValleY Spokane Valley, (509)688-0036 FAX: (509) (509)6$8-0 WA99206 Community Development w'ww'.spokanevallev.org.com Manufactured Home Permit Application SITE ADDRESS E C lE u \Yl l qZo e m ikon l % -b quV"" /33 3*-1.)' kliey w cr,Zct ASSESSORS PARCEL NO: LEGAL DESCRIPTION: Building owner Name: eR3IA1�---S 01'1N50 J Address: t t.c, 20 e- v€14tuA�.3s F 31Jt� ��It%' t' ., YX�� City: *F1i- Vklisy Zip: `i`Z'71a:G, Phone: Sal 't 33ZZFax: Contact Person Name: Jt cX-1 VhAN°�wJ Phone: 57 `3'2 L1 -7$ [C. Contractor Name: Address: City: Zip: Phone: Fax: Lic No: Exp. Date: City Business Lic No: Describe the scope of work in detail: " 5/4tLb wtoL24 +�t� — MANUFACTURED HOME Width: 2$r ' Length: ' 7L Manufacture: G40cD6-7.) We-51- Year: f`19$ Pit Set: XIC-) Previous Address: 1 a (25 C WALL S Ley Live ©-rT-ts C7facDeArz.)>S Proposed Use: PSTI:It:5N c6 DISCLAIMER The permitee 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) 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 n be processed. Signature Date !V/Y0_5- Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ VISA Bankcard #: Expires: VIN#: ❑ Other Authorized Signature: REVISED B/23/2005 P1NECROFT MOBILE HOME PARK MANSFIELD 41 0 1 12 14 5 6 11 s 19 es i 135