1971, 03-04 Permit App: I3596 MHCounty of Spokane, Washington
BUILDING CODES DEPARTMENT, COURTHOUSE, SPOKANE, WASHINGTON 99201
APPLICATION FOR. LAND USE OR STRUCTURE PERMIT 'Cr
GENERAL REQUIREMENTS PERMIT FEE ,2
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
Sppkane 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 regress.
COUNTY "ROADS. Work on street right-of-way may not be performed until staked by County Road Department and work must be
performer 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.
hn _ APPLICANT FILL IN BELOW/1 THIS LINES
Name of Owner &1C /// �n'lef Address '6t /Z6S5 //! Phone to A"b bagi
Architect Phone Engineeer Phone
Contractor M tt
• cku_ h_ Address get Tumid OtLa 29014. Phone 10 �' Q �-y� 1�
Legal Description of Property (Give comuleteGdeeiscription from deed, ,tax regeipt, etc.)
nt
DESCRIPTION OF`WORK: Newl'eV\ Addition Remodel Moving Bldg. Zone //' Fire Zone
C
Size of Lot S //7 f Sewage System wVq Stories /
't
Const. AOMnE, Dimensions r -of 1_S-6 / Total Sq. Ft. / //Z0 f Valuation¢ 9 /DO
(Frame, concrete, brick,/gtc.) t�,��� // 1
Rooms5 Baths / Basement �(% Foundation Const �Q'�GQ Chimney /UO Fireplace A% 0
(Full, part, none)
(Kind)
(Number) ,
Heat. System C. Type of Roofing n„ d�'
Ext Finish lint -41 Int. Wall 'Finish 02:1;74 • '
Use of Bldg. 14 -tryst
' ., Garage or Carport Attached /NO Private Detalched
No of Units / Bedrooms 2-•
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.
NORTH
m
m
N
y
SOUTH
State License No.
Ind. Ins. Acct. No.
REQUIRED
Plumbing Permit
m Heating Permit
NSewage Permit
-4
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
I hereby certify infortion $ubmitt i correct a d there a
as shown. /� jno. othe structures located on this property except
3 %r-7/ �/
y -
Y wner or Agent P( / Date
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
Your street address will be
Sewage Permit Number -
Remarks
DO NOT WRITE BELOW THIS LINE
Building Permit
The zone is
3. Receipt3/3
Issued
form 523 Bldg. Code
TD.420-729 MANUF HOME APPL (R/12/94)M Page I of 2
intTdaE
in
1
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fi/SIIDG
ISNI-GTON MANUFACTURED HOME
NGAPPLICATION
RECORDER'S CLOCK
FILED AT THE REQUEST OF:
TitleAME pokane
Please check one
p1010TITLE ELIMINATION (Complete all but section 3, below)
TRANSFER IN LOCATION (Complete ALL sections below)
REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
5210 7(61510
ADDRESS
N. Normandie
Suite 203
Spokane, WA 99201
MANUFACTURED HOME
TPO/PLATE NUMBER
$81083
YEAR
1971
MAKE
MARL
WIDTH/LENGTH
60T/20
VEHICLE IDENTIFICATION NUMBER(VIN)
01021AB
all LAND
Attach a copy of the legal description of your land. It can be obtained from your Coun y
Assessor's office or it may be typed or printed on an Additional Attachment Form (TD -420-732).
PROPERTY TAX PARCEL NUMBER
55082.0408
Manufactured home will be AFFIXED 1 I REMOVED
iiiii TITLE COMPANY CERTIFICATION
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME
TITLE COMPANY/PHONE NUMBER
SIGNATURE
X
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
5241 BUILDING PERMIT OFFICE CERTIFICATION
I certify that the manufactured home has been affixed to the real property as described, or a building
permit has been issued for this purpose and the attachment will be inspected upon completion.
BLDG PERMIT
13596
N �
�
X NATURERITLE SPOKANE COUNTY
X DN(SInNOFBUILDING AND PLANNING
BLDG PERMIT OFFICE/PHONE Y
509/456-3675
DATE LIq/
/ - 23 -/rte
, f
G.G'�/ 1Yj
n�%
1 5i ; OWNER INFORMATION "'
FEES
COUNTY 11 INC LINING
❑ ❑
p REGISTERED OWNERS
11 LEGAL OWNERS
Provide the Washington Driver's License or I.D.
card numbe (PIC) for eachowner:.,3„
FILING FEE
I
-"4 NAME OF FIRST OWNER
• 1R
E.. Ethel L. Tyler
ley
����
TGiwh,u /
APPLICATION
.'O,,( NAME OF SECOND OWNER
'µl 't'.
:'S)i
MOBILE HOME FEES
gr,,.. ADDRESS OF OWNERELIMINATION
rR;' 14025 e
--OR-- if the owner is a business,
Ed Cow 1e 1-4—
+8513 n
"E- y'—(r I L-��'
1, D l CITY
k Otis Orchards
.,ate
STATE
WA
ZIP CODE CODE
99027
provide the Unified Business
Identifier (USI), found on the
business Registration & Licenses
USE TAX
NAME OF FIRST LEGAL OWNER'
kL /+
;lwi Same as above -
Document.
SUB -AGENT FEES
I
- c MAILING ADDRESS OF FIRST LEGAL OWNERMore
N.i
; II;;
than two owners or one
lienholder7 Please use attachment
TOTAL FEES & TAX
. O..i CITY
STATE
ZIP CODE
form(s) #TD -420-732.
$ 1
+'p ,,
DEALER'S REPORT OF SALE
;,,lin, 'SIGNATURE OF LEGAL OWNER INDICATES CONSENT OR ELIMINATION OF TITLE/REMOVAL
3~; 1 /p' I//' {
FROM REAL PROPERTY. X is )\ ),- 7 L�, vp.,/
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
WA DLR NO.
DATE OF SALE
PURCHASE PRICE
�j
Anyorakes a false enl of a material tacit is guilty of a felony, and
upontion1reey'ge bbll11(si'�ty'y a fine 1 up to $5,000 and/or 10 years imprisonment
(RCWS2.1Ukk DtiWSV �n ST UNDER PENALTY OF PERJURY LAW
THAT INJEA l rj•Fr9hSt E SOF THISVEHICLE AND THIS INFORMA-
TION IS 4€ ,S Own .13,...v (e] & TIile(e):
{y /,, E` 2 / • n
DEALER NAME
TAXJURISDICTION/TAX RATE
DEALERS AUTHORIZED SIGNATURE
o u �--_— j oli
%( •' PUSL1�
-X
USE TAX EXEMPT Sale 10 a Certified Tribal member on
the reservation (attach notarized statement of delivery)
• 4.2A, CS/ O)
X i f1,4....1-
�7
SUUBBSCCRIBED TO AND SWORN BEFOE ME THIS
1i U"Y.Z DAV OF (/�.Ll.sibu 19
Resiting m(Coun/ry1 )/%' 1I,^
/�–R+ -i.'--� -
"
tip l t tt --
J54
/
LINTY AUDITOFVAGEN LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents) //µµ
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
SIGNATURE
X
OFFICENFS OPERATOR NUMBER
DATE
TD.420-729 MANUF HOME APPL (R/12/94)M Page I of 2