1995, 06-08 Permit App: 95004076 MHPROJECT NUMBER= 95004076
******
APPLICATION
4
DATE= 06/08/95 PAGE= 01
THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 1516 N GRADY RD PARCEL#= 55172.0602
ADDRESS= GREENACRES WA 99016
PERMIT USE= EXISTING SINGLE WIDE MOBILE HOME SINCE 1981
PLAT#= 003502 PLAT NAME= MISSION VISTA
BLOCK= 2 LOT= 2 ZONE= UR -7 DIST#= G
AREA= 00000000 F/A= F WIDTH= 78 DEPTH= 138 R/W= 50
# OF BLDGS= 2 # DWELLINGS= 1 WATER DIST =
OWNER= REAGAN, VERN
STREET= 1516 N GRADY RD
ADDRESS= GREENACRES WA 99016
PHONE= 509 922 0019
CONTACT NAME= VERN REAGAN PHONE NUMBER= 509 922 0019
BUILDING SETBACKS: FRONT= 37 LEFT= NA RIGHT= 10 REAR= 37
****************************** REVIEW INFORMATION *****************************
DEPARTMENT
REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
l lr-
HEALTHDI
COMMENTS:
EW OR /AISDITIONAL WASTEWATER
D ,//ter �-
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER
YR/MAKE= 1981 KENT
SERIAL0=
ITEM DESCRIPTION
PHONE=
MODEL=
WIDTH= 14 LENGTH= 64 HEIGHT= 00
QUANTITY FEE AMOUNT
INSPECTION FEE 1 50.00
STATE SURCHARGE Y 4.50
COUNTY SURCHARGE Y 9.00
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 63.50 .00 63.50
63.50
PROCESSED BY: JULIE SHATTO
PRINTED BY: JULIE SHATTO
.00 63.50
PROJECT NUMBER= 95004076 APPLICATION DATE= 06/08/95 PAGE= 02
******************************** THANK YOU ************************************
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APPLICATION INFORMATION
'What is the JOB SITE address? / /�
N /5/G ,k�'a7y el
ASSESSORS tax parcel number?
55-77ZI6d2__
Legal description as it appears on the property deed
OWNER or OCCUPANT
(2-(X "/ ,-g5'G,,
Phone
92Aaa/r-r' .
Mailing address // /
A / 5/6 ' U'-Qiv' /7 ii1 ,
City, state k./A- -/ Zipc
eeAigcjas / %a/�
Who should we contact regarding t
�(./.--€is project?
4A/ /(-r' 9 cr Ar
Phone
% 2- 2 d' e / i
What work is being done under this permit?
Lone
Inspector distract
Property size
Hight of way width
Water district
Building
Building height -
#of stories
Contractor
Dimensions
TOTAL SQUARE FOOTAGE
WA State Contractor license # -
Main floor area
Unfinished basement area
Mailing address -
2nd floor area ..
Finished basement area
Architect/Engineer
Garage area
Size of decks, etc.
What is the heat source?
What is the cost of your project?
Manufactured Home
Sign
Width:
/ / 4
Length:
4 c
What is the square footage of
the sign face?
How high is the sign?
Year:
/ .
Make: '-
keN%
Installer
Contractor
Wa State Contractor license #
Wa State Contractor license #
Mailing address -
Mailing address
Relocation
Fire Safety
Previous address
Fire Sprinkler Tent
_
Paint booth _ Fire Alarm _ Fireworks display
VALUE ,
Contractor
Contractor -
WA State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
Fuel Storage Tanks
Swimming Pool
(Circle one) Above -ground - Underground
Size / gallons
Private
Contents of tank(s)
Size / gallons
Public/semi-private
Contractor
Contractor
Wa State Contractor license #
WA State Contractor license #
Mailing address
Mailing address
COMPLETE ALL APPLICABLE IN
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
El0%artmrni WASHINGTON MANUFACTURED HOME
ICEIIBSIIDG APPLICATION
RECORDER'S CLOCK
FILED AT THE REQUEST OF:
NAME
ADDRESS
Please check ono
IXj TITLE TRANSFER ELIMINATIONINLOCATIO(ComNplete all(Complete butALL sectionsections belo3, below)
II w)
REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
7i+,1". MANUFACTURED HOME
TPO/PLATE NUMBER
YEAR
MAKE -
WIDTH/LENGTH
VEHICLE IDENTIFICATION NUMBER (YIN)
022 LAND
Attach the legal description land. It be' from Coun
a copy of of
Assessor's office or it may be typed or
Manufactured home be
your
printed
can Obtained your y
on an Additional Attachment Form (TD -420-732).
AFFIXED REMOVED
PROPERTY TAX PARCEL NUMBER
4^'r��+ ,/, 7
will
I
s}3'' TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME
TITLE COMPANY/PHONE NUMBER
SIGNATURE
x
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
r.4 t BUILDING PERMIT OFFICE CERTIFICATION
I city that the manufactured home has been affixed to the real property as described, or a building
.6rmit has been ft ed for this purpose an. ; r,�¢lef Lw�IJ ie inspected upon completion.
BLDG PERMIT
lja //t t' 7
SIGNATURERITL itlt-Grt1 I� I Y
`��� u_/ x DIVISION OF BUILDINGS
BLDG PERMIT
6'50 %
FFICE/PHONE M
¥�5Go E(&/5
DATE
�„l//l/5
40c OWNER INFORMATION -
FEES
COUNTY 4 WC UNINC
1 1 1 1
li REGISTERED OWNERS
M LEGAL OWNERS
Provide the Washington Driver's License or I.D.
card number (PIC) for each owner:
FILING FEE
EKJ
NAMED FIRST OWNER
-e g %et1 'q,1
PFA6ALek( '3'1(. is
APPLICATION
at'
i.l'
nsyPa
NAME OF SECOND OWNER
7. !
''277. �7e°t..;,.;
f
REI.,C; 04ter i✓.4D'%*4
MOBILE HOME FEES
• EU;
EA
ADDRESS OF OWNER
5 - ` = i
F
--OR-- it the owner is a business,
ELIMINATION
D:¢
('`
ZIP CODE
93 9.0,x 'a
provide the Unified Business
Identifier (UBI), found on the
business Registration & Licenses
USE TAX
t'w
iLN
,t ty
NAME OF FIRST LEGAL OWNER'
Document.
SUB -AGENT FEES
t fl
JNyI
N`[
Cr ST'
MAILING ADDRESS OF FIRST LEGAL OWNER
More than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
CITY
STATE
ZIP CODE
form(s) NTD -420-732. -
$ I
hELF
I
I
DEALER'S REPORT OF SALE
'R-
'SIGNATURE OF LEGAL OWNER IINNDI ATES CONSENT FOR ELIMINATION OFTITLE/REMOVAL
FROM REAL PROPERTY: x (`m a pr.,„
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
7 ..
Anyone who knowingly makes a false statement of a material lilt! Is guilty of a felony, and
upon conviction may be punished by a fine of up to $5,000 and/or 10 years Imprisonment
(RCW 4612 210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
THAT UW E ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
TION 15 ACCURATE: Owner Slgnature(e) S. Tltle(s):
X
WA DLR NO
DATE OF SALE
PURCHASE PRICE
$
DEALER NAME
TAX JURISDICTION/TAX RATE
DEALER'S AUTHORIZED SIGNATURE
X
USE TAX EXEMPT Sale to a Certified Tribal member on
the reservation (attach notarized statement of delivery)
X
NOTARY OR LICENSE AGENT &NUMBER
X
SUBSCRIBED TO AND SWORN BEFORE ME THIS
DAY OF 19 -
Residing In (County)
, COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
I certify that the above application appears to have been completed correctly, and the applicant has sufficient documentation to
proceed with the recording of this form.
NAME
SIGNATURE
X
OFFICE/VFS OPERATOR NUMBER
DATE
TD -020.729 MANUF HOME APPL (R/12i94)M Page 1 of 2
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