1974, 09-24 Permit App: K5857 GarageCounty of, Spokane. Washington
BUILDING CODES DEPARTMENT; N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT
3
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.
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¢edicatiy.s.
o0
APPLICANT FILL IN BELOW THIS
Name of Owner D �--�� Addressc-47
" -- —Z. •
Architect Address
Engineer Address
Contractor Address
• Legal Descriptinp of Property (Give com lets description fr m deed, xceipt, et
LINE 6jt'��a.
�.e O
1
ss -
Phone
Phone
Phone
o _i
DESCRIPTION OF WORK: New Addition Remodel Moving
Size of Lot t�i( /2 S -et- Sewage syste
Stories / Dimensions , xTotal
'
Rooms / BathsBasem-,j_ Foundation Const Cf '1
Full, part,
Bldg. Zone / Fire Zone '-
Heat. System fb"
Use of Bldg.
Ext Fin
PLOT PLAN
1
i
Chimney
(Kind)
one Br., etc.)
Valuatior�-t5 4 0
Fireplace
(Number
Int. Wall Finish
No of Units _ Bedrooms
Draw sketch with dkmmnnsions 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-
t and water supply lines.
NORTH
F---- L er9N
co
SOUTH
State Licenseo.
Ind. Ins. Acct. No.
REQUIRED
Plumbing Permi
Heating Permit
Sewage Permit
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
. I hereby cert formation. it d is correct and there are no other structures located on this property except
as shown. y_oak//
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Owuer or Agent Date
A LAND US R STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
�y-
Your street address will be
Sewage Permit Number Issued
Remarks
DO NOT WRITE BELOW THIS LINE
Building Permit
The zone
Receipt
Issued
Form 523 Bldg. Code
STAartmeTE Of nt o1Y, SHINGTON MANUFACTURED HOME
til Dep
IrCEnSinGAPPLICATION
RECORDER'S CLOCK
FILED AT THE REQUEST OF:
NAME
ADDRESS
Please check one
X
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)
1 MANUFACTURED HOME
TPO/PLATE NUMBER
) 5N'►'a��
YEAR
fl O
MAKE
l--rL,L;i)
WIDTH/LENGTH
C) �z- \'a- --j
tnv
VEHICLE IDENTIFICATION NUMBER (VIN)
Li FOtY� 110"\C)
LAND
ii
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
s z 0.(c, 15
>'<
l`
3 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.
4 BUILDING PERMIT OFFICE CERTIFICATION
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 N c�,
J ) (S `
.NA f
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SIGNATURE/TITLE SPUKANE COUNTY
X DIVISION OF BUILDING AND PLANNING
BLDG PERMIT OFFICE/PHONE 0
(r
i 5_/ ---3( 7J-
DATE
r //d -_9
a-r
OWNER INFORMATION
FEES?
COUNTY a INC UNI NG
[ 1
a REGISTERED OWNERS
s LEGAL OWNERS
Provide the Washington Driver's License or I.D.
card number (PIC) for each owner:
FILING FEE
NAME OF FIRST OWNER
R
E `ai yA Lr - Frisk,
Dy4F A. 53 D9
,.fll_
APPLICATION
G NAME OF SECOND OWNER
I
T L._\' nc.a :� EAcki
e°Dv L-a- S 11--S
MOBILE HOME FEES
E ADDRESS OF OWNER \
E \� C)-2-Lk C �`( 2 A.\ `/`��\
CJ
--OR-- if the owner is a business,
ELIMINATION
�—
D CITY
0A-- 5 O 0.cA a+2 a
STATE
1 '.6\
W k
ZIP CODE
0")-71
provide the Unified Business
Identifier (UBI), found on the
business Registration & Licenses
USE TAX
NAME
`
OF FIRST LEGAL OWNER'
L L. EA�y
Document.
SUBAGENT FEES
e MAILING ADDRESS OF FIRST LEGAL OWNER
N M
H ICI 0 2--`"` f' l ' 1- p,\' n g.
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More than two owners or one
lienholder? Please use attachment
TOTAL FEES & TAX
L CITY
ST TE
ZIP CODE
form(s) #TD-420-732.
D
E 0k k S CI QC-VVaaa S
W
9-i -0-D__.-?
DEALER'S REPORT OF SALE
R 'SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINA ION OF TITL C=AL
,�14.(1‘,44•+ FROM REAL PROPERTY: X Z�14_42...0-- C f�
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
Anyone who knowingly makes a false statement of a materiayfct is guilty of a felonand
upon conviction may be punished by a fine of up to $5,000 and/or 10 years imprisonment
(RCW 46.12.210). I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY LAW
THAT I/WE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
1ION IS ACCURATE: Owner Signatures) & Tltle(s):
X /1-1v / %J/%
WA DLR NI
DATE OF SALE
PURCHASE PRICE
$
DEALER NAME 111111/
���1 /sti.
S,,1,
tax JURISDICTION/TAX RATE
DEALERS AUTHORI ;FSA 1N J+ ',0
•
X� f,e.� -d-.
�
'
r •
e�ified Tribal member on
I L U5@ �X SalFitiq a Car
iii. the i servatio r('Jlrl'3ch notarised slSlement of delivery)
)
X
NOTA-Y OR LICENSE` AGENT &NUMBER
X ak (�,7YsAj-f'� I°----
rnp
B ty Z E 1
SUBSCRIBED TO AND SWORN BEFORE ME 1aIS(j) 1 ResU, •
C� ,• ? 4Crl F L ,//�
, DAY OF J -. L els _ 19a(•� . Fly �£
6 COUNTYAUDITOR/AGENT LIC LASING OFFICE APPROVAL: (Not for use by Sub-Ag fti sfs0****************,A ,•••
I certify that the above application appears to have been completed correctly, ancifhvi p111AN.Itts sufficient documentation to
f 1
proceed with the recording of this form.
NAME
SIGNATURE
X
OFFICENFSOPERATOR NUMBER
DATE
T0-420.729 MANIJF HOME APPL (R/12194)M Page 1 of 2