2007, 10-15 Permit App: MHCr.
10/12/2007 12:13 FAX 5093232365 PacificNorthwesuTitle
�''wya Permit Center RECEIVED BY
]iQ 11707 E Sprague Ave, Suite IOCITY OF SPOKANE VALLgIPERMITNUMBER:
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037 NOV 0 6 2007
Community Development www.spokanevallevQrg
,-s' PERMIT CENTER
Manufactured. Home Y
Permit Apgation
PERMIT FEE:
® 002/035
fOTHER
SITE ADDRESS: 6>/S 5- 14-c. i -re St"
wl1-9s9ni Z
ASSESSORS PARCEL NO: 3 5 23/ • iiYt
Bundle: Owner:
.
•
Name:
M ta-a
9 iwer
Address:
Address:
31 ( 5
lam_
State:
Zip:
City:
V
State: ta
Zip:
2
Phone:
2)b .553/
Fax:/ / _4L,S6
Contact Person
Name: i ir�L 9
Phone: fl I.6 - 13 3`10
Describe the scope of work in detail:
LEGAL DESCRIPTION: L l6 02 CAST -rare a i- aso,--lct,
Contractor: .S p, /,.t!'j .
.
•
A{(r>'ipS
Name:-ctk-e-
54...14 'CI—
Address:
City:
State:
Zip:
Phone: 737 _ /90$
Fax:
Contractor Lic No:
Exp Date:
City Business Lie. No:
/ rvt3l �• CA( ✓ak_
$edt-- b4r—i
1
MANUFACTURED HOME
Width: / Li length: Z�fj
Manufacture: .s kyI .2.
Previous Address: p f °v' -
Year: ,2 0 0 S
Pit Set:
Septicewer:
Proposed Use: Hr -yam r(77 -
•
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 cl )table 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 Cit. of Spokane Valley Development Code. Referenced codes are evailable for review at the City of
Spokane Valley Permit Centel. 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 can be processed. (�
MC -A— p4r{2 ee_
Signature
Method of Payment:
❑ Cash
Bankcard #:
- Authorized Signature:
REVISEDY.L3005
❑ Check
Q Mastercard
Expires:
Date c:)-7
❑ VISA
V1N#:
,-
MANUFACTURER'S
CERTIFICATE of ORIGIN
MANUFACTURED HOME
The undersigned manufacturer hereby certifies that the new Manufactured Home
described below, the property of said manufacturer, has been transferred this
28TH day of SEPTEMBER20 04 on Invoice No. 19482
to PETER'S MANUFACTURED HOMES, INC.
SPOKANE HOME CENTER
whose address is 4505 E. SPRAGUE
SPOKANE, WA 99212-0804
Trade Name Series or
of Home GREENBRIAR LIMITED Model Name 1200CT 3CK2B
SUGGESTED RETAIL: $50,780.00
Serial No 9U91 -0262-T AB
Shipping Weight
Date of Manufacture: SEPTEMBER 2004
No. Wheels 12
Width 28'
Length 44'
MONTH YEAR
Other Data 2005 MODEL
Said manufacturer hereby certifies that this written instrument constitutes the
first conveyance of said home after its manufacture and that the manufacturer's
serial number set forth above has not been and will not be used by the manufac-
turer on any other home manufactured by said manufacturer, and that there are
no other manufacturer's certificates issued by the manufacturer for the home
described above.
SKYLINE (HOMETTE CORPORATION)
MANUFACTURER
GENERAL MANAGER
TITLE or POSITION
FIRST ASSIGNMENT
t
FOR VALUE RECEIVED, the undersigned hereby transfers this Statement of Origin
an the Manufacturetd Home describeed�.i therein to.
tt 4tw. Cis!va\\a_ Ka s,-.Act,\1
Address (etC S 4,c20Lo 1/4.se '?914Z
and certifies that the Manufactured ome is new and has not been registered in this or
any other state; he also warrants the title of said Manufactured Home at time of delivery,
subject to the liens and encumbrances, if any, as set out below:
Amt. of Lien
Date To Whom Due Address
ln4r ,v ; U - 1443:3 t t re,i+Av-_
Dated c IUIL' 21 20c_ at
te / t/ t��
-..tttnfr. // 2 L.4
c�� By /f
Sign Here Position
thatthestatements set forth above are true
r� oc day of ` 20
efq (PIK!,dile)
efo* he rso . :app=ared
7h¢Ly � � 7C
ra I sworn upon oath says
orlkct No • Or.
ed worn to before me this
i, tary Public for All' i County, State of
•
3 -S -IO
SECOND ASSIGNMENT
FOR VALUE RECEIVED, the undersigned hereby transfers this Statement of Origin
and the Manufactured Home described therein to:
Address
and certifies that the Manufactured Home is new and has not been registered in this or
any other state; he also warrants the t>tie of said Manufactured Home at time of delivery,
subject to the liens and encumbrances, if any, as set out below.
Amt. of Lien
Date To Whom Due
Dated 20
at
By.
Address
Transferor (Firm Name) Sign Here Position
Before me personally appeared
Who by me being duly sworn upon oath says that the statements set forth above are trut
and correct
Subscribed and sworn to before me this day of 20
Notary Public for County, State of
Notary Seal
RETURN ADDRESS
PACIFIC NORTHWEST TITLE
120 W CATALDO, SUITE 200
SPOKANE WA 99201
_SPO 1014577
ePL'EASE?CHECIGON Iii
®hh STATCOFWASHINGTON MANUFACTURED HOMEy
k'LY�°"""'"`°` .aI
t kEfS®fG APPLICATION
ITLE ELIMINATION
■TRANSFER IN LOCATION
• PROPERTY
Anyone who knowingly makes a false statement of a material fact is guilty
of a felony, and upon conviction may be punished by a fine, imprisonment, or both.
REMOVAL FROM REAL
(RCW 46.12.210)
igi MANUFACTURED HOME
TPO / PLATE NUMBER
YEAR
2005
MAKE
Skyline
LENGTH/WIDTH(FEET)
44 )(28
VEHICLE IDENTIFICATION NUMBER (VIN)
9U -91-0262T AB •
El LAND LEGAL DESCRIPTION ON PAGE •
MANUFACTURED HOME WILL BE 17
AFFIXED • REMOVED
REAL PROPERTY TAX PARCEL NUMBER
35231 .1146
LOT
16
BLOCK
2
PLATAM
-epiaFt ofblocks 12 to 13
SECTION/TOWNSHIP/RANGE
Di GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY NUMBER
NUMBER OF REGISTERED OWNERS
1
NUMBER OF LEGAL OWNERS
1
NAME OF REGISTERED OWNER
Kendall Andrew
NAME OF ADDITIONAL REGISTERED OWNER
Kendall, Orvella.
ADDRESS CITY STATE ZIP CODE
615 S. Howe Spokane' Val 1ey WA 99217
NAME OF LEGAL OWNER
GMAC MORTGAGE
NAME OF ADDITIONAL LEGAL OWNER
ADDRESS CITY STATE ZIP CODE
3808 N Sullivan Road Spokane Valley WA 99216
GRANTEE
NAME
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title, IFAPPLICABL /fir ./ / . './.----.-/ so ��. �� . L.',.....1;
�!1 rid' ' £,�,
Signature of Additional Registered Owner and Title, IF APPLICABLE 4�'.� i/.
NOTARY SEAL OR STAMP
NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S) SIGNATURE
State of Washington Signed or attested
County of,`J•y'; ,C -Y\4 before me on c�l,� 0
DAWN GREEN
TATE OF WASHINGTON
NOTARY --D-- PUBLIC
MY COMMISSION EXPIRES 08.282009
JJ ( /l��
by 11„6k_r-PLCr Signatures �i`1/\�.1.
li,D,�r1nQe
PRINT NAME OF REGISTERED OWNER NOT���mmm009 OR AGENT
by O\I a 1Ge.Y, r1 x.11 c v17r
PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY
Title 'k -U - AND: County/Office No. OR
t Dealer No. 011
-; ..')vi - (7 C)
DEALERSHIP POSITION/AGE /NOTARY Notary Expiration Date c
Ul TITLECOMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records
NAME (TYPED OR PRINTED) TITLE COMPANY 1 PHONE NUMBER
SIGNATURE / POSITION DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
a BUILDING PERMIT OFFICE CERTIFICATION
certify that: 0 the manufactured home has been affixed to the real property as described.
❑ a building permit has been issued for this purpose and the attachment will be Inspected upon completion
NAME (TYPED OR PRINTED) BLDG PERMIT,OFFICE/PHONE II
4- \\ t'U V\ - (I" (r�CSS). 04(.._.,O5
BLDG PERMIT q
CO t < Itl
.. SIGNATURE /P TION
C ,
DATE
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