1977, 02-18 Permit App: L7217 MH•
k,
County of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT
GENERAL 'REQUIREMENTS PERMIT FEE'..f1.7o d
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 must conform with the
' 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 on water 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 Nos. 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 OF 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.
APPLICANT FILL IN BELOW THIS LINE
Name of Owner v! �it�,t ��� Address
Architect Address
Engineer A Address
Contractor 'llMin a..1...ta Addres�a..
Le Dina' tion o ' erty Div,symp)-te =r 'ptionn ffro, m deed, tax re ipt et I - �-
i��rtoti-'16i.4 7j-0 8/ I
Phone
Phone
Phone
hon
DESCRIPTION OF O : �Navy �v __ Addition
Size of Lot/� / /
Remodel
Moving Bldg. Zone ' Fire Zone 1
♦ Sewage
U/� (Fr., Conc., Br., etc.)
stories imensions l y' � of -I S• Ft. 6 Valuation /a. O Q-�
Rooms 7 Baths -�-- Basement Nn Foundation Const a'f!!!!�IJ,A•_ -imney Fireplacg r x C�
/ I, part, none1 - A� _ � md) //(Number
Heat. System Type Roofing _2-1--t- IExerVt//pppp-im�sh !%�_LZ
Use of Bldg. QO 0_ A.6G
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 streets; (5) dimensions of buildings; (6) location of sewage sys-
tem and water supply lines. p -p- "0
NORTH .A,.Ga cGti..i(tc-
Int Wall Finis((
No of Units _ Bedrooms
dt-e_ 07-'-e-le-PIS A
A --t11-4-7
SOUTH
I hereby ce f informa ion submit• -d is correct and there are no other structures located on this property except
as shown.
State License No.
Ind. Inc. Acct. No.
REQUIRED
Plumbing Permit
tm Heating Permit
NSewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
Ata♦Ya_i a Lim
r or Agent
A LAND USE OR S UCTURE PERMIT MUST BE
THIS IS NOT A PERMIT.
(4-A1 iiate
Date
THE PREMISES BEFORE CONSTRUCTION COMMENCES.
DO NOT WRITE BELOW THIS LINE
Your street address will beg/ pg
Sewage Permit Number Issued _
Building Permit
vi
The zone is R2.4 VA -At. .174114a -
Receipt 0 -
'Lt -
Receipts3 tS'i Issued
Remarks
Form 523 Bldg. Code
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STATE Of WASHINGTON
Deportment of
ICEfSIAG MANUFACTURED HOME APPLICATION
RECORDER'S CLOCK
TITLE
—
—
OPTIONS
Original TITLE ELIMINATION (Complete all but section 3, below)
Transfer TRANSFER IN LOCATION (Complete ALL sections below)
Duplicate REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
Reissue
RECORDED AT
REQUEST OF:
MANUFACTURED HOME
YEAQ!n' •
11 /�
MAKE.- .:. .'.. .
S/4{7({/ 1 kre)'2TTH
WIDTH/LENGTH - --
VEHICLE IDENT,1RCATIONN'UMBFA MNL..., .' ...
OSd`Y Ie-E'/N K
COLOR/1 '- - COLOR s2 "-: -t:
TOP OR BOTTOM OR
FRONT: �'�r 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: -AFFIXED ".
. REMOVED
PROPERTY TAPARCEL NUMBER •_
I TITLE COMPANY CERTIFICATION •
I certify that the legal description of the land and ownership are true and correct., • '
NAME
TITLE COMPANY/PHONE NUMBER
6IONATURE '. -
X .
DATE
NOTE: Application must be finalized with a Licensing Agent within 10 calendar days of the date signed by the Title Company Representative.
BUILDING PERMIT OFFICE CERTIFICATION
-to
I certify that the manufactured home has been affixed' the real property as described, or the
following building-• permit has been issued for this Pctea will be iPeDG pl t
BLDG PERMIT .
NAM e/2C S 4 -------NO
OFFICE/PHONE T
ATURERITIE IT NUMV9 PG
room"..�tDe f- i fln (x93
OWNER INFO ATION
'FEES -'
HUNG FEE
COUNTY ZINC UNINC
^
5f9 n
NUMBER OF ..
REGISTERED OWNERS
i
NUMBER OF
LEGAL OWNERS
.(
`
' .Please provide the Department of Licensing (DOL)
Client'NUMBER'foreachowners-
I I
NAME OF FIRST REG STEREO OWNER
E Bernie -e. 4, GJaldro..-
L,,
..JJIP% IL IDiRi5iMIG' IG drin Il
APPLICATION
G NAME OF SECOND REGISTERED OWNER
I!
s
I I I I I I I I I I I�.
MOBILE HOME FEES
T ADDRESS OF FIRST REGISTERED OWNER .-- .This
*NUMBER* may he found on
- I
'\
o;. E • /$1'/%, rucks//, Uel"• '
' your Washington Drivers License/
ELIMINATION
ECITY STATE ZIPCODE - -
o O-1/5 0 'GA
I.D. Card --OR-- if the owner is a
business, the Unified
, -d5 , l,..14 . 99oz .7
provide
USE TAX
NAME OF FIRST LEGAL OWNER•
^
Sem-nice A• bcdldr°A
business identifier(UBI) number.
1 1 1 I 1 1 1 1 1 1
FL MAILING ADDRESS OF FIRST LEGAL OWNER
G: C , 2_39 /.7 ' Ja ck m . - t- •
.I
More than two registered or
FEES
I
A, CITY A STATE ZIPCODE
t' O/5 Orcha#-s L,..A 1 902 7
one legal owner? ...
Please use attachment forms
TOTAL FEES & TAX
•SiGNATURE OF LEGAL !Vie INDICATES CONSENT FOR " 1DATE
ELIMINATION OFTITLE: ' ]W11)4 -••"•(a W4Ztar.. 1d -/8-q3
(TD -420-732)
1
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 of up to 35,000
and/or lO years imprisonment(RCW 46.12.210). I DO SOLEMNLY ATTEST
UNDER PENALTY OF PERJURY LAW THAT I/WE ARE THE REGISTEREDcorrect.
OWNERS OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE:
Registered Owner Slgn.n nisi: .. i ITltIel
X „
DEALER'S REPORT OF SALE
I thnt this Information le
PURCHASE PNCE
certify
The vehicle is clear of
encumbrances except as shown.
TAX JURISOICTION/TAK RATE :
DEALER NAME,'.
DATE OF SALE
X
WA DLR O. , .
DEALER'S AUTHORIZED SIGNATURE' .
X
X
NOTARY CR UCENSE AGENT & NUMBER
X ... ..
SuMaibed end Sworn to Before Me This
Day of10
Res.din0 In
• •. CownY
USE TAX EXEMPT SW to Indian on the
. Reservation Roach notarized statement of delivery,
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
1 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. -
. .... .:. :. . ... _. ..:.-
SIGNATURE.-. : .::.":.... :.: - .. .•. • ...':..
X.'
OFFICENFS OPERATOR NUMBER -
DATE
RECORDING OFFICE
This form has been recorded in the county records. -
RECORDING NUMBER ..... .:.. :. .. ,. ..' '.'t::"'
COUNTY ' —
VOLUME/PAGE -
DATE .'
-720 MAW OF HOME APPLIR/7/631OR Pace 1 of 2