1979, 07-17 Permit: 79-529 MHPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 4 COPIES
OB ADD.RE
S
LOT
2.
BLOCK
AL)) v.
SUBDIVISION
7553-- 0709
OWNER
3. loo 20`T R,PI N W/! i ER_
ADDRESS
E. 19115 ALKI AIM , CREENAc Es
CONTRACTOR
4. s/}ME
ADDRESS
PHONE
6128 -11075
LEGAL DESCRIPTION — SEE ATTACHED
PARCEL NUMBER /S / 7...5 . 3 9, 'aB7 )' P-TN of
l6rLOCkI
TItA -r PTN of VAe -ANAL R /Ui N of �{-
ADJ, co213 /N GRE.ENAcKES C-ARWOOD 5 NB
ZI P
Required Set Backs in Feet
North /4 7 1South *—
East �—
•
West/3c'
PHONE
Size of Parcel
155.3 x2.50`
Zone Classification
C -C,e,t1a4c -1l e.
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation
ZIP
DWL ea
de)
Building Area in Sq. Ft.
Soo
Basement Area 1 Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Split Entry
Split Level
Rancher
TYPE
7. OF
WORK
❑ ALT. ❑ AD'N. ❑ RPL. ❑ MVE.
❑ PLMB. ❑ MECH: ❑ POOL
❑ OTHER
No. Baths
No. Floors
No. Rooms
Rec. Room
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
DESCRIBE WORK
8. Mo81LE HOME. UsEP AS RESIDENCE
ELECTRIC
WATER
SEWER
SEPTIC--
VALUATION
9. 42560 k.X
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction.
DATE 2 -9 -79 SIGNATURE
Source
of
Utilities
DEPT.
SPECIAL APPROVALS
REQ'D. REC'D.
Env. Health
J r79
Planning
9
Fire Marshall
Co. Engineer
Utilities
Zone Clearance
SEPA Checklist
Not Req'd.
FEES COLLECTED
Single $
Building
Plumbing
SPECIAL CONDITIONS:
R/.,
r-- t3t9 J JL-Y
MAP i P.
DATE 7--/ 7-77 OFFICIAL .7 it&c.y4, i g
APPROVED FOR ISSUANCE
Plan Check
SEPA
19 '161
Mobile Home
Other (Specify)
TOTAL $ ioc•
PERMIT NUMBER
7�-
52,9
DATE N1 UL�/
07* 17, I' 7�1
* 25,00
* 25.00
*4Q006
B *15.00
52.82
07-17-79
2 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
07 -17 -79
52.9 *25.00
TAX SEGREGATION APPLICATION FORM
(Applicable to the division of one or more parcels of real property into
two or more parcels under different ownerships, also applies to
aggregatio of arcels.)
NAME
ADDRESS / 1)
J6PaLt;
PHONE NUMBER / 2 2T-41‘) 9s DATE 2/6/7 7
DELINQUENT 17 Q � O
TAXES PARCEL NO(S) 7
I. Enter legal descriptions of all portions to be segregated. Also
include legal description of portions remaining (use supplemental
sheet if needed).
II. Make drawing of entire property. Indicate approximate dimensions
of all property lines. Indicate on which portions of property any
buildings should remain. If a copy of a survey is available, please
attach to this form.
III. This application is to be completed in its entirety before processing.
NOTE: The approval of this application by the County Assessor or his
appointee shall not be construed as authorizing the division of lands for
the purposes of sale or subdivision in violation of RCW 58.17 (Plat and
Subdivision Act). The taxpayer is hereby advised that no segregation
will tak . e until this f o r m i s c. •• • • ted.
_4
Applicant Signature
THIS AREA FOR USE BY APPLICANT FOR LEGAL
DESCRIPTIONS AND DRAWINGS. USE REVERSE SIDE IF
NEEDED.
4_0.ro--/giced,46_/„a„-ti„/
Td3f-6-clei
-z)�� av2 /� Yz Yt
6°1 Lai,,SsL
L - .:EIVEiti
JUL 5 1579
ASSESSOR
4-
(r)
ET
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