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1971, 10-14 Permit App: J1069 MH• } County of Spokane, Washington BUILDING CODES DEPARTMENT. COURTHOUSE, SPOKANE, WASHINGTON 99201 / @ / APPLICATION FOR LAND USE OR STRUCTURE PERMIT tY, >/ GENERAL REQUIREMENTS PERMIT FEE 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. NATER. Water supply must be approved by the County and State Health Departments. Where work onwater 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 47235. 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 iaoADS.,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. c-� - L ('+ APPLICANT FILL IN BELOW THIS LINE ' `f �/j Name of Owner 'TACkAUL ]rola. Address I,, 19106 Iii Phone L3 C1 -'f-`"",) Architeci _Phone Engineer Phone 1 MIKE CHASTER Phone Contract' E. 19221 Montgomery Address 1 Ot.e Orchard. Wash. 99023 Legal De; _ _. .. ,__ie come ete d-scription frog deer, tax receipt, etc.) O9- 9' of =ins DESCRIPTION OF WORK: New `Addition Remodel Size of Lo 1 S e X // 7 i Const. Dimensions i st 6a ' (Frame, ncret e,b rtek , et c.) Rooms Baths 1 Basement __ ,L Foundaton Const. cb4 - a of o Chimney 6 -Fireplace l' /" v a (Kind), (�`ljumber) Ext Finish 'Thy t Int. Wall Finish ly [- Ce No. of Units 1 Bedrooms Z• Moving Bldg. pine / Sewage System �q�Q^.#C. Total Sq Ft. J "0 Fire Zone Stoe Valuation �o S'bd 3 �. �� (Full, part, none) Heat. System_o A' , ' Typet. p�fRoofing Use of Bldg. IV 1 0.11`4'4- Cnrnge or Carport At(nched Private Detntched 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 etoo, " I hereby certify in as shown. SOUTH submitte State License No. Ind. Ins. Acct. No. REQUIRED Plumbing Permit Heating Permit Sewage Permit Plans Received Plans Checked Plans Returned Plans Picked Up Plans Mailed correct qpd there are no other structures located on this property except �a. /d// V- 7/ Owner or Agent Date A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES. THIS 1S HOT A PERMIT. Your street address will be DO NOT WRITE BELOW THIS LINE ., l4/06 Thiaha Sewage Permit Number Issued Remarks Building Permit\ 1 the zone is A Receipt e, ,/Issued W tp ((Issued Form 523 Bldg. Code RETURN ADDRESS ���LSTATE OF entWASHINGTON ICEBS DG MANUFACTURED HOME APPLICATION afalse statement ofamaterlalfact Isguilty may be punished by a fine, Imprisonment, TITLE REMOVAL (RCW ®a 4w;rxa'�v'r.� TION IN LOCATION FEELIRIIN LOC FROM REAL PROPERTY 48.12.210) Li ■TRANSFER • Anyone who lmowinglymakes of a felony, and upon conviction or both. El MANUFACTURED HOME TPO/ PLATE NUMBER YEAR 1775- MAKE fAclf/c,A LENGTHAVIDTH(FEET) 2t X Go VEHICLE IDENTIFICATION NUMBER (VIN) . SJ& 2s /7,10 LAND LEGAL DESCRIPTION ON PAGE ,fJ MANUFACTURED HOME WILL BE AFFIXED REAL PROPERTY TAX PARCEL NUMBER 5,)--' $'2. /20 1 Ei ■ REMOVED LOT l BLOCK 1l PLAT NAME tkr' Ri /L .'c a 0 MD h,L6 home rile sr Ann, nom SECTION/TOWNSHIP/RANGE El GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER • NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS A - NE5, //'' NAME OF REGISTERED GWei_.) `_ PGA Xt OW ,L- mAIn.e/— i I NAME OF ADDITIONAL REGISTER OWNER ADDRESS CITY STATE ZIP CODE NAME OF LEGAL OWNER MiC-11O't C c i4(Jer% LEGAL NAME OF ADDITIONAL OWNER Nit vicy 41-4 r/ CZ- /I-,7zF2i cmOxf6Link i -14,S- ? fl7 ADDRESS CITY STATE ZIP CODE /x//06 E /1"/ta/YQ%7d or' 5 e,/.7 G. hc'r./.f _ LL''/4. 99eJ2 % GRANTEE NAME 1 DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title, IF Signature of Additional Registered Owner and Title, IF THAT I / WE AM/ARE THE REGISTERED OWNER(S) OF THIS APPLICABLE APPLICABLE NOTARY SEAL OR STAMP State by by Title NOTARIZATION/CERTIFICATION of Washington County of FOR REGISTERED Signedorattested before OWNER(S) SIGNATURE me on Signature PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT PRINT NAME OF REGISTERED OWNER PRINTED NAME OF County/Otace AND: Notary NOTARY No. OR Dealer No. OR DEALERSHIP POSITION/AGENT/NOTARY Expiration Dale fl TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership Is true and correct per the real property records. NAME (TYPED OR PRINTED) TITLE COMPANY / PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 5: BUILDING PERMIT OFFICE CERTIFICATION 1 certifythat O the manufactured home has been affixed to the real property as described. Xa building permit has been Issued for this purpose and41leattachmentwill-be1nspeetedvpefeompletton. Ny^ (TYPED OR PR ED) BLDG PERMIT OFFICE/PHONE B 41(1 l ti i'c�i,S6"i SPOxnxe 7 121% BLDG PERMIT 4 S IO/p ¢7 / COUNTr Sir! / o MON 4,q 3 $UILDING & CODE ENFORCEMENT D/�I /� In / 0-42 29 MANUF HOME APPL (R/area)OR Page o rj SIGNATURE OF LEGAL OWNER ' SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE / REMOVAL FROM REAL PROPERTY. Owner Title, IF APPLICABLE Signature of Legal and Additional Legal Owner Title, IF APPLICABLE Signature of and NOTARY SEAL OR STAMP NOTARIZATIOWCERTIFICATION FOR LEGAL OWNER(S) SIGNATURE State of Washington Signed or attested County before me on of Signature by PRINT NAME OF LEGAL OWNER NOTARY OR AGENT by PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No. OR Title AND: Dealer No. OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Dale Ea LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office 0 DEALER'S REPORT OF SALE 1 CERTIFY THAT THIS INFORMATION IS CORRECT. THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAME (TYPED OR PRINTED) WA DEALER NUMBER DATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALERS AUTHORIZED SIGNATURE ❑ USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). a COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) I certify that theabove application appears to have been completed correctly, and the applicanthassufficient documentation to proceedwith the recording of thisform. NAME (TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE DATE 3 L'j TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES A TAX IMPORTANT: Once the application has been approved by the County Auditor / Vehicle Licensing Office, take your application form to the County Recording Office. Retain proof of the recording fees paid. If the Recording Office retains your original application form, obtain a certified copy of the recorded form. APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the Manufactured Home Application, paying all required fees. Vehicle licensing subagents charge a service fee. For . _.or full Instructions on completing this form for Title Elimination, Removal from Real Property Transfer.in, location, see form TD -420-730, Manufactured Home Application Instructions. The Depadmen/ of L icens/ng has a policy ofpro v/ding equal access Io //s sewices //youneedspec/a/accommodation, pfeaseca/(360)902.3600otTOD(360) 664-6665 TD -420-729 MANUF HOME APPL (R/er98)OR Page 2 at 2 kf ( Mita EJaL s INCORPORATED • --Sia ( .0 • 3 y'1,1 a. f, t.vt ,it. Lu 1 Barker Road and Buckeye Greenacres, Washington 99016 WA 4-9880 . l l:\. r.. �- 4- l frock li � / = 11-'