1976, 10-18 Permit App: L5913 MH�f q
County of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE. WASHINGTON 99201
(, APPLICATION FOR LAND USE OR STRUCTURE PERMIT
GENERAL REQUIREMENTS PERMIT FEE '3 '00 r
PERMIT REQUIRED. A land use or structure permit is required by County Resolution to erect a building or structure of any
kind or alter any building or structure already erected, or to change a land use. Construction most conform with the t
Spokane County Building Code and Zoning Ordinance. Construction is subject to inspection.
WATER. Water supply must be approved by the County and State Health Departments. Where work oawater connections disturbs
the surface. shoulders or ditches of County Roads, permission must be obtained from the County Engineer's Office.
SEWAGE SYSTEM. Permits are required in all cases by County Resolutions Noa. 45-133 and 47.235.
SET -BACK FROM PROPERTY LINES. In most zones and under most circumstances, a set -back from the front property line, of at
least 25' is required, a 5' side yard, 15' side yard from a flanking street, and a 25' rear yard are required.
STATE HIGHWAYS. Where the structure abuts a State Highway, clearance must be obtained pertaining to set -back and ingress
and egress,
COUNTY ROADS. Work on street right-of-way may not be performed until staked by County Road Department and work must be
performed in accordance with stakes. Points of ingress and egress must be approved by the County Engineer.
MOVING OP BUILDINGS. A permit Is required to move an existing building. When a building Is moved on a County or State
Highway, clearance must be obtained from the County Engineer and/or State Highway Department.
ACCESSORY BUILDINGS. Accessory buildings (garages, sheds, etc.) require a separate permit.
RESTRICTIVE COVENANTS. Builders should check provisions of covenants or dedications and easements running with the land
which are enforceable through civil action. County Officials can not bring action to enforce covenants or dedications.
J1PPLI ANT FILL IN BELOW THIS LINE 0- :4 O '.eteyt( 9 90.Z-7
Name Of Owner ��--�- -� ' '_1 Address . O. rl .i Phone
Architect Address Phone
Engineer
Contractor
Lotti a
Address
Addran
operty IGioe eempJpts dtjeriptian tram de$d. to reeai to
Ld�'11
nee rn� =J��J ham!
in A Ir V .eJ V 4 r f
•
Phone
aa,
DESCRIPTION
also of Lot
OF WORK! Now Addition
gotgot u /2 “.1
Romodol Moving BId. Zone / ./ Fire Ars 3
Sewage System ns � u'�
�/ / , r., `one, Br„ etc.)
Stories / Dimoncienn 14 L i f�� �e�llSq Ft Valuatie /.'LAG a e, p o
Rooms Baths gr Basement ` g CI Foundation Const rests++ iti w'i himne Fltepl Aid
port none) 1 n__.r� n INumb
Typo of Roofing i� Ext Finish Int Wall Finish
% z
iVasravadr. 650 No of units 1 Bedrooms
Heat. Systam
Use of Bldg.
411
PLOT PLAN
Draw sketch with dimensions showing; (1) property lines; (2) street or road locations; (3) location of existing and
proposed buildings; (4) distance to property lines and stroote; (5) dimensions of buildings; (6) location of sswago sys-
tem and water supply lines,
NORTH t`EBIDENTIAC— COMMERCIAL
as
• SOUTH
State Llceme No.
Ind. Ins. Acct. No.
REQUIRED
Plumbing Permit —
w Heating Permit
is Sewage Permit
-1
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
I hereby� e�tify information s bmi ed is correct and there are no other structures located on this property except
shown. �L 1 / �^'��/1 -/p-76.
�Mner or Agent Date
A LAND USE OR STRUCTURE PERMIT MUS BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
� 4to _ G DO NOT WRITE BELOW THIS LINE /J
Your street address will be C":( O ' ` O G4�`� �v �r/L� The zone is J .t t 1'it� -L[.aC..e.Y
Sewage Permit Number Issued Building Permit,S'11/,3
Remarks -'
Receipt 3 657 Issued
Form 523 Blda. Code
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RECORDER'S CLOCK
ICFnsilnc MANUFACTURED HOME APPLICATION
TITLE
_
–
OPTIONS
Original
Transfer
Duplicate
Reissue
r
--
TITLE ELIMINATION (Complete nil but section 3, below)
TRANSFER IN LOCATION (Complete ALL sections below)
REMOVAL FROM REAL PROPERTY (Complete all but eoction 4. below)
Rrconoro Ar
REQUEST OF:
I MANUFACTURED (HOME
YEAR
1976
MAKEI WIOTH+LENOIH JVEI•CLEIDENTIrICAIION NUMBERIVINI 1 ColOR /1 COLOR 12
Kingswood 114X70 1roron BUrTOMoR
6009 snout: I REAR COLOR:
LAND
• Attach a copy of the legal description of your land. It can be obtained from your County Assessor's office.
• Land to which the manufactured home is being:1E AFFIXED 1-1 REMOVED �PROPERTY 7Ax PANG El NUMBER
55082.0917
i TITLE COMPANY CERTIFICATION
I certify that the legal description of tho land and ownership aro true and correct.
NAME 111LE COMPANY/PHONE NUMBER
1
ONA1 URE
lSIX 10A1 E
e3-8-c't(V
NOTE: Application must bo finalized with a Licensing Agnllt within 10 calendar days of the data signed by the Title Company Representative.
BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured horno Ilas,been affixed to the real property as described, or thef
following building permit has been issued for this purpose and will be inspected upon completion.
BLDGPCITMIT•
�L--`,3cA \S
NAME
s+OHATUREJII TLE
BLDG PERMIT OrrICEJPIIONE
NUMBER DATE
_ _ OWNER INFORMATION
*FEES
COUNTY• IINC UNINC
-_Opi
NUMBrR OFIItNUMa(n Or
REGISTERED OWNERS ��I LEGAL OWNERS
1
Plo nae provide the Depnrlmenl of Licensing IDOL)
Client "NUMBER' for each owner:
FILING FEE
NAME OF rinsr REGISTERED OWNER
Alma G. Clark
1 1�1K 1� IC�I�I ZI�1L'IL
APPLICATION
NAME OF SECOND REGISTERED OWNER
I._ I
....___I_______ .___I_
fab6iLr AoAAr FEES—
ADDFIRST OF REGISTERED OWNER
18818 E. Jackson Avenue
_L -J__ __I_1_.L.L_1_..1-J_
This 'NUMBER''mny be found on
your Washington Drivers License/
IINATION— _A_
ELM
CITY STATE 21PCOD(
Otis Orchards, Wa 99027
I.D. Card --OR-- 11 the owner Is a
business. provide the Unified
I
USE TAX
NAME OF Fins LEGAL OW.N-(rtt•• ,
business Identilier(UOI) number.
I I I f 1 1 I I 1 I
l
MAILING OGRESS OF f RST LEGAL OWNER
II
.--I
More thnn two registered or
SUBAGENT F((S
A CITY STALE IIPCODE
one legal owner? ...
Please use attachment forms
TOTAL FEES & TAX
' 'SIGNATIXiE OF LEOAI OWNER INDICATES CONSENT FOR IDATE
OF TITLE: X
LTD -420-7321
$ELIMINATION 1
Anyone who knowingly make. • Ial•e slate,nent of •mai er In: fact is gully
ole felony, end upon conviction may be punished by s line of no 10 15.00(1
end/or 10 yams imprisonment InCW 16.1 2.2101.1
f DEALER'S REPORT OF SALE
f
het thl• Information Is
PURCHASE PRICE
[.
7
UNDER PENALTY OF PERJURY LAW THAT I/WE
The vehicle Is clear of
OWNERS OF THIS VEHICLE AND THIS 1NFORMA ices •xcepl es shown.
r v
TAX JUNSDICI ION/TAX RATE
1/✓i/
X i .. A...,, s
i
DATE Of SALE
_
X ) 1 (
•
•DEALER'S
— �C( AUTHORIZED SIGNATURE
111c)1 X
e�r
0 TM
'
we,. ENT 6 NUMBER
--
`'
Subscribed r 1 ""��✓
�wIY�
USE TAX EXEMPT s•+. to lne.snthe
�-
•Y e - Canty
flemv•tion 1•IUch Retroed st•1•msnt 01 d.l,ya yl
_---
S 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
SIONATUnE
X
OFFICE/WS OPERATOR HUMBER
DATE
RECORDING OFFICE
This form has been recorded in the county l'ecords.
RECORDING NUMBER
COUNTY
I VOLUME/PAGEJ DATE