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1995, 07-31 Permit App: 95005796 MHPROJECT NUMBER= 95005796 APPLICATION DATE= 07/31/95 PAGE= 01 ****** THIS IS NOT A PERMIT ****** PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT SITE STREET= 18913 E JACKSON IDR ADDRESS= OTIS ORCHARDS WA 99027 PARCEL#= 55082.0811 PERMIT USE= DOUBLE WIDE MOBILE HOME (REPLACEMENT) PLAT#= 000146 BLOCK= 7 AREA= OF BLDGS= 2 PLAT NAME= LOT= F/A= # DWELLINGS= BARKER ROAD MOBILE HOMES 1ST A 11 ZONE= UR -7 DIST#= G F WIDTH= 62 DEPTH= 137 R/W= 1 WATER DIST = OWNER= SUSSEK, JEAN R. STREET= 18913 E JACKSON DR ADDRESS= OTIS ORCHARDS WA 99027 CONTACT NAME= JEAN SUSSEK BUILDING SETBACKS: FRONT= 25 ****************************** DEPARTMENT LEFT= 22 REVIEW PHONE= 509 922 0754 PHONE NUMBER= 509 922 0754 RIGHT= 12 REAR= 30+ INFORMATION ***************************** REVIEW REQUIREMENT BUILDING SETBACK REVIEW REQUIRED COMMENTS: HEALTHDIST .?Mrt COMMENTS: Lahson 51 .q5 INCREASE IN LOT COVERAGE _79// /4 id:A.4/ ****************************** CONTRACTOR= OWNER MOBILE YR/MAKE= 1995 LAMPLIGHTER MODEL= SERIAL#= ITEM DESCRIPTION HOME PERMIT **************************** PHONE= WIDTH= 28 LENGTH= 56 HEIGHT= 10 INSPECTION FEE STATE SURCHARGE COUNTY SURCHARGE PERMIT TYPE FEE AMOUNT MANUFACTURED HM 122.50 122.50 PROCESSED BY: CAROL FRAZIER PRINTED BY: CAROL FRAZIER QUANTITY FEE AMOUNT 2 Y Y 100.00 4.50 16.00 AMOUNT PAID AMOUNT OWING .00 122.50 .00 122.50 PROJECT NUMBER= 95005796 APPLICATION DATE= 07/31/95 PAGE= 02 ******************************** THANK YOU ************************************ N 0 n 0 0 APPLICATION INFORMATION • number? What is the JOBSITE dress a' � Dr }ISO �rclSR / M --x ft /V �� J1 Legal description as tt appears on the property deed OWNER or OCCUPANT Phone Jean R. Su_ssek_ - q�a -r�7Sy Mailing address�� lg9/_3 6.1 so,-, City, state Zip Dr - tel; s (Drc-RaAtc) s, ton 9y(),...?-7 Who should we contact regarding this project? Phone What work is being done IV LIOWbOdthdui ! under this permit? (Na— Lone Inspector district Property size Hight atf wwaay,width . 0 Water district Building-- Building height #of stones 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: p / 0� Length: 6--(0/ What Is the square footage of the sign face? How high Is the sign? Year: ) 6/l J LS Make: / , y�Ylfi-PSV_.. Installer 0 Contractor Wa State Contractor license #Wa State Contractor license # Mailing address Mailing address Fire Safety (Relocation Previous address Fire Sprinkler Tent — f Paint booth _ Fire Alarm _ Fireworks display VALUE Contractor Contractor A State Contractor license # A State Contractor license # Mailing address 1 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 INFORMATION N a 4) pRE KS \NO1CNIEO OR P.. it PRGPER� QF'WpY RO : t NE OF lt\G�l SORIGI1V G_1 IS MOS'S RE RILE y,�1�HEOR O1 NECC-�Sp jH� GIHE_ ROPEarl Lltbe ADDRESS: 7.014E: wi (00 ROAO�RO;yT; W �VEWEC 6� . G;Lh 1; : p4 c. %S eAJ .D k El Please X STATE or WASHINGTON Department of MANUFACTURED HOME IJ�fflSIflG APPLICATION • check One TITLE ELIMINATION (Complete all but section 3, below) TRANSFER IN LOCATION (Complete ALL sections below) REMOVAL FROM REAL PROPERTY (Complete all but section 4, below) RECORDER'S CLOCK FILED AT THE REQUEST OF: NAME ADDRESS 1 MANUFACTURED HOME TPO/PLATE NUMBER YEAR 1995 MAKE MODUL1NE AREMORE WIDTH.'LENGTH 56'x28' VEHICLE IDENTIFICATION NUMBER (VIN) SERIAL i1-15450 2 LAND Attach a copy of the legal description of land. It can be obtained from County your your Assessor's office or it may be typed or printed on an Additional Attachment Form (TD -420-732). Manufactured home will be AFFIXED REMOVED PROPERTY TAX PARCEL NUMBER 55082.0811 E I j 3 TITLE COMPANY CERTIFICATION I c u/j' 11, BLOCK 7.'r"^:„......,, ,nrl rnrrnrt nnr Shin rnnl nrnnort , rnrn..t- , BARD ROAD MOBILE HOMES FIRST ADDITION, ACCORDING TO PLAT RECORDED NA IN VOLUME 9 OF PLATS, PAGE 70, IN SPOKANE COUNTY, WASHINGTON. I I Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. BUILDING PERMIT OFFICE CERTIFICATION I certify that the manufactured home has been affixed to the real property as described, or a building per lit has ben issued for this purpose and the attachment will be inspected upon completion. BLDG PERMIT N 9'.--00 4r1(C NAM I , �R / SIGNATURE/TITLE SPOKANE COUNTY X • p UILDING AND PLANNING BLDG PE MIT OFFlCElPHONE N • % �.or,� }S fD-", 1r•N- 1 z lV/ I 9 DATE // L' /•� J f QS_ 5, OW ER INFORMATION FEES COUNTY • INC UNINC� ❑ [y" I II REGIS ERED OWNERS 1 # LEGAL OWNERS 1 Provide the Washington Driver's License or I.D. card number (PIC) for each owner: FILING FEE NAME OF FIRST OWNER E JEAN R SUSSEK E C f ,� / LS JJG-J/l 741 /v� / 354.1 APPLICATION G NAME OF SECOND OWNER I S T MOBILE HOME FEES E ADDRESS OF OWNER ELIMINATION E 18913 E JACKSON DR --OR-• if the owner is a business, Unified Business D CITY OTIS ORCHARDS STATE WA ZIP CODE 99027 provide the Identifier (OBI), found on the business Registration & Licenses USE TAX NAME OF FIRST LEGAL OWNER' t. WASHINGTON MUTUAL BANK 1 Document. 578049326-7 SUB -AGENT FEES E N H MAILING ADDRESS OF FIRST LEGAL OWNER 12005 E SPRAGUE AVE SECOND FLOOR More than Iwo owners or one lienholder7 Please use attachment TOTAL FEES & TAX LCITY STATE ZIP CODE form(s) #TD -420.732. $ l CO SPOKANE E WA 99206 DEALER'S REPORT OF SALE R •SIGNATURE OF LEGAL OWNER Di ATES CONS NT 1/1"‘ • OF TITLE/REMOVAL 1 certify that this information is correct. The vehicle is clear FROM REAL PROPERTY. X C --e , of encumbrances except as shown. Anyone who knowingly makes a false statement of a materia fact is guilty of a felony. and upon conviction may be punished by a fine of up lo $5,000 and/or to years imprisonment WA OLR NO V000 DATE %F SAL /0 r /V 1// 3/95 PURCHASE PRICE $ 5.36 14! (RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW THAT 1/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA- TION IS ACCURATE: Owner Signature(a) & Title(s): DEALER NAME I • • / C 1 erne6 .AJCP. TAX JURISDICTION/TAX RATE� X (' „ _ _ _ gr ` /J �j�/�-lam ffQ'r N ALER'S THORIZ tt SIGNATURE 11 • x 1 v X X ❑ USE TAX EXEMPT Sale to a Certified TripOgm ber on the reservation (attach notarized staoll :f li eY�� NOTARY OR LICENSE AGENT b NUMBER SUBi ED TO AN WORN BEFORE ME THIS DAY OF 1 l9.9j Residingin (County) ytiL V. 1' �/4 �'/ a.� AO (....?).C.:.. L/! iamin6, •.'-n•. `,j9A,INI t}�.CFZ o. _ ai .� _-Z22c - 6 COUNTY AUDITOR/ .41...--. rtei•T -!CE APPROVAL: (Not for use by Sub -Agents) .' �'".o •• i, _,y1- 1 r : Cl 0 -f A %j 'rte, . 3 N I certify that the above application appears to have been completed correctly, and the applicant h* stlfioie`ir t docunterifajion to proceed with the recording of this form. i p • * y `�: NAME SIGNATURE tL.�•-- 1XZ4 ii OFFICENFS OPERATOR r IMQ5 t1TE) © t- \ �- y0 ` ter. •�{�^ Q' ..i•-` /,� `� dam,,.• ,1 g.:��'Aw'ar� -420.729 MANUF HOME APPL (R/2/94)M Page 1 of 2 �Ir b1/AS\`#°r