1985, 04-24 Permit App: 00005097 Garage a
BUILDING PERMIT APPLICATION WORKSHEET
PLEASE PRINT AND COMPLETE ONLY THOSE PARTS OF THE FORM YOU UNDERSTAND
(Please return this original and your building plans to the Department of Building and Safety)
1 Owner' e , (last) (first) (m) I Department Use ly
Fes. Comm
2 Proj dr of Mailing Address)a d Name Space Zip
3 City •mmunity State Subdivision/Pla Name
.. .�"� n eit-i, SE (life? her( I ea6/
4 ;i..r Parcel No. Lot Block
42513! v * * * DEPARTMENT USE ONLY * * *
5 Sic Code � Zone Act.# Zone A�� Project No. J.�
1 ✓h
6 Dwell# No.of Buildings Sq.Ft./Acre Depth Frontage
i x- c 85 OCRe
7 Set Back-Fronit I(L)S-1 (R)S�_ Re Census Tract I Module No. Initials
C
* .16 Architect Firm Name Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Contractor Firm Name Street Address
Zip City I State Phone
( )
Contact Person License No. Phone if different than above
( )
8 Owner/Agent(if different than#1 above) Business Address
9 Zip City 1 State Phone
( )
12 Review Required Plan Check(Y/N) Other(YIN) J SEPA Exempt(Y/N) Date
15 Type Work C."-Ildg ❑ MH 1n-4-New ❑ Replace ❑ Other
❑ Fire ❑ Demo ❑ Add/Alter ❑ Move
14 Describe W rk
`t Y3� OetaCz,4 FCS C�`--fi 1-6.C�.-e
10 Applicant Name Street Address
11 Zip City State ' Phone
( )
*
Lender Street Address *
Zip City State Phone
( )
Contact Person Phone if different than above
( )
Additional Information
DEPARTMENT APPROVALS
This is not a Permit
Application Type
(Standard unless (Indicated approvals required in either"release"or"release with conditions"
otherwise indicated) space prior to permit issuance.)
❑ Fast Track !
❑ Early Start Release
Re ase w/cond 1 Hold 2
i
Environmental Health ❑ Commercial; ❑ Residential
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W.1101 College ❑ New Construction; E Bldg alteration/addition--p '`// v
Room 200 ❑ Addition r ructur
/
APPLICATION# �'
Conditions/Comments:
❑ Planning/Zoning: ❑ Commercial; ❑ Cert.of Exemption; ❑ Frontage;
N.721 Jefferson ❑ Setbacks; ❑ lot w/d; ❑ lot size; ❑ use/zone; _
❑ CU,variance,zone change;shoreline; ❑ fence;
❑ Other
Conditions/Comments:
❑ Engineers: ❑ Commercial; ❑ Residential; ❑ Flood Plain;
N.811 Jefferson ❑ drainage ❑ new access/approach; ❑ fence;
❑ road improvements
Conditions/Comments:
❑ Utilities:
N.811 Jefferson
Conditions/Comments:
❑ Other:
i________
111 Plan Exam
Fire Prey.
Conditions/Comments:
n
0)
-❑
` Project Representative Telephone
U
a Agencies Performing Special Inspection:
c 1.
Y o
N N
E
2.
coo
as E
u
3.
1 Indicate above or attach conditions relative to final as built approval
2 indicate above or attach reasons for hold
PLEASE PRINT OR TYPE
Applicant's Name:
Address: 0
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Legal Description of property for which this "Cert'Ffidate
for: Section :.18 Township 25 Range 44 R W.M.
APPLICATION FOR CERTIFICATE OF EXEMPTION ` -,/'r(
APPLICATION FEE - $10.00 65,...,/42.5-1#
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APPLICATION NO.
, ti/ 0 �.�K ,� Phone - Res: CJ, -Y
,t,C/r11),C Ci y S;,70 State:c-v4 ZIP: :1y_ -
of Exemption" is being appl iec
The South 1/2 of Lot 1,Except the South 105,71 feet of the Zest 101.00 feet, Toiether w
the South 1/2 of Lot 2 and the South 112 of the. Bast 1/2 of Lot 3 Block 22 of ::
Hutchinson's Addition.
3. Parcel Number (From Tax Statement or Assessor's Office: #
4. Size of said property: Square Feet: 37,200 square feet Or Acres: 0.85 acres
5. Intended use of said property:
6. Zoning of said property: A(.7
7. For which of the following reason(s) do you believe you qualify for a "Certificate of
Exemption"?:
(For each box checked, please submit the listed documentation required to substantiate
your exemption. In addition, please submit an•assessor's map and an ownership micro rui
of your property, both obtainable from the Tax Assessor's Office, with your application
-- A. Division of land ten (10) acres or larger
DOCUMENTS NEEDED: (1) Assessor's map and ownership micro run as requested abo
Minor bou QrJQt line adjustments
DO- Cl1ENTS NEEDED: (1) Adjusted 1egaf escription; 2) Copy of sales/contract
agreement.
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C. The reconveyance of old lots, tracts, or ace1s of land which were''separate an
distinct when purchased, although the purchase thereof makes the divisions
contiguous.
DOCUMENTS NEEDED:
D.
E.
(1) Copy of tax statement; 2) Copy of deed or dated copy of
sales/contract agreement
Division of land created prior to March 13, 1978
Division of land for the purpose of housing public utilities facilities
F. The purchase of one separate and distinct parcel of land prior to March 13, 197,
DOCUMENTS NEEDED: (1) Copy of deed or dated copy of sales/contract agreement.
G. A division of land to a spouse, son or daughter
DOCUMENTS NEEDED: (1) Copy of deed/Quit Claim Deed or dated copy of sales/cont
agreement. 2) Notarized affidavit attesting to said
relationship
H. A division of land within properties zoned Residential Office, Local Business,
Commercial, Industrial, Manufacturing, or Freeway Commercial
DOCUMENTS NEEDED: (1) Copy of survey
8. Additional comments which may substantiate your qualification for an exemption:
1, the undersigned, swear under the penaity of per.' ;that the above responses are made
truthfully and to the best of my knowledge. i also agree to furnish any further documenta-
tion that may be required by the Short Plat Administrator and I hereby agree to waive the
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' •APDL;ATION NO. _ - F
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCEION \
NOTICE OF ACTION ON CERTIFICATE OF EXEMPTION AP 1978, ado
Whereas, the Board of County Commissioners did, after public hearing on March 9, f
the Spokane County Short Plat Subdivision Ordinance, and provide for certain
Whereas, the Board of County Commissioners, in adopting this Ordinance, did p
activities to be exempt from short platting activities, and
Whereas the Board of County Commissioners did further provide
mfnrsthesere certaintactiviti sase
es
to receive a "Certificate of Exemption" from the Short 1
at of a building permit, andof
Whereas, th" Short Plat-'Adminl trator has received aerequest foif the"Certificofatepokane atd n"
for certain property located in the unincorporated territory applicant- and
Whereas, .the Short Plat Administrator has reviewed the evidence presented by the .app
all other information available, the Short Plat Administrator hereby takes the following actio
on this "Certificate of Exemption" application, pursuant to the Spokane County Short Plat
Subdivision Ordinance.
DENIAL
APPROVAL - Certificate of Exemption -
- Certifi of emption -
The Short Plat Administrator finds that a
The Short Plat Administrator finds that a
"Certificate of Exemption" should be and here- "Certificate of Exemption" should not and
r
by is issued for said property, as described by is not issued for said property as aea Crrib
kan
on the reverse side, pursuant to Spokane
on the reverse side, pursuant to Spo
County Short Plat Subdivision Ordinance Short Plat Subdivision Ordinance Section
Section
for the following reasons:
Approval of said "Certificate of Exemption" 1 .
and issuance of building permits, shall be
subject to the following conditions :
1 . The applicant shall comply with all require
ments and regulations of the Spokane County
Zoning Ordinance.
2. The applicant shall comply with all require
ments of the Spokane County Health District
regarding the placement of on-site water
and/or sewage systems.
3•
According to the Spokane County Short Plat S
division Ordinance, the division of land tha
you propose to develop is defined as a Shortt
Plat and you will be required to comply
the requirements of said Ordinance prior to
issuance of building permits.
This "Certificate of Exemption"
is and shall
run with the land and shall be applicable to
the applicant, owner, their heirs, successors,
or assigns.
APPROVED THIS 7 DAY OF -7201/`0" , 19R. DENIED THIS DAY OF
0 e&ii"ii°4
Short Plat Administrator
Short Plat Administrator
SPOKANE COUNTY SPOKANE COUNTY
PLANNING DEPART- PLANNING DEPART-
MENT STAMP
MENT STAMP
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.THIS CERTIFICATE MUST ACCOMPANY
YOUR BUILDING PERMIT APPLICATION
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