1978, 09-13 Permit App: M0488 ResidenceCounty of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT �y
GENERAL REQUIREMENTS PERMIT FEE._AV._�_,.
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 lCagineer'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 L o 1A 1 -5 e S Address To.'_r0 rrxo` W01— Phone
Architect Address Phone
Engineer Address qoZ �e Phone
Contractor s o(E:, Address / d I �! $ r -d Ad G.i P-rV Phone 102-6 ` -7 P-5 01*
Legal Description of Property (Give comp) description from deed, tax receipt, etc.) Parcel Number /01 q — 0 )'ZS
DESCRIPTION OF WORK: New "� Addition Remodel Moving Bldg. Zone �— Fire Zone 3
Size of Lot /o 8 ' X .700 Sewage System ' ` onst.2.
xFR., Conc., Br., etc.)
Stories Dim si s y = ! :L 5..�. 1� ZZ = 1-.2p FR.,
4/0,10,0 '0. 0 0
Ft. V luation
Rooms 0-71L Be ':::l
"`� �' Foundation Const.. �-� c - Chimney Fireplace
Fu I, part, none (Kind) / (Number
Heat. System r�l- f _ Type of Roofing Q Ext, Finish < -� Int. Wall Finish `'.T�---mac -,
Use of Bldg. •1--� No. of Units L Bedrooms
R/GAJ 60 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 / State License No.
Joe
Ind. Ins. Acct. No.
N.
RESIDENTIA COMMERCIAL
REQUIRED
Plumbing Permit
n� Heating Permit
—a N Sewage Permit
LN
Plans Received
Plans Checked
Plans Returned
a) Plans Picked Up
Jf Plans Mailed
SOUTH
rvl;Ss;ori ���7�
I hereby rtify infor ion subm ed is correct and there are no other structures located on this property except
as shown. - /' 3 1�,9
Owner AgentDate
A LAND USE OR STRUtTURE PERMIT MUST4//E ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
DO NOT WRITE BELOW THIS LINE
Your street address will be % $ % 3� ��The zone is
Sewage Permit Number Issued Building Permit Receipt. ?O Issued
Remarks
T k
t
Form 523 Bldg. Code
i
APPLICATION FOR CERTIFICATE OF E MPTION
LE PRIM TYPE L�
1, _ . Q E S"3f� Bus:
Is
City: -d f)J 1V F State: W fi
2. Legal Description of property for which this "Certificate of Exemption" is being applied
for: Section I' O C Township �.? Range 1446E �
_.P_arcel-Number. (From. -Tax Statement or Assessor's Office): S444 , O
_4. Size od .said_proper-ty;_. Square Feet:62:1 �z 0 Or Acres: -
5. 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 maw and an own! errsshi�P micro
run of your property, both obtainable from the Tax Assessor's Office, with your ap-
plication).
QA. Division of land ten (10) acres or larger
DOCUMENTS OF PROOF: 1) Assessor's map and ownership micro run as requested
above.
QB. Minor boundary or lot line adjustments
DOCUMENTS OF PROOF: 1) Adjusted legal description; 2) Copy of sales/contract
agreement.
QC. The reconveyance of old lots, tracts, or parcels of land which were separate
and distinct when purchased, although the purchase thereof makes the divisions
contiguous.
DOCUMENTS OF PROOF: 1) Copy of tax statement; 2) Copy of deed or dated copy of
sales/contract agreement
D. Division of land created prior to March 13, 1978, which is five (5) acres or
larger.
DOCUMMiTS OF PROOF: 1) Copy of deed or dated copy of sales/contract agreement.
E. The purchase of one separate and distinct parcel of land prior to March 13, 1978.
DOCUMENTS OF PROOF: 1) Copy of deed or dated copy of sales/contract agreement.
F. A division of land to a spouse, son or daughter
DOCUMEN'T'S OF PROOF: 1) Copy of deed/Quit Claim Deed or dated copy.of sales/con-
tract agreement. 2) Notarized affidavit attesting to said relationship.
6. Additional comments which may substantiate your qualification for an exemption:
I, the undersigned, swear under the penalty of perjury, that the above responses are made
truthfully and to the best of my knowledge. I also agree to furnish any further documen-
tation that may be required by the Short Plat Administrator.and I hereby agree to waive
the five (5) day approval period as specified in the Short Plat Ordinance if further infor-
mation is required. I also understnad that', should there be any wi ful misrepres n tion
or willful lack of full disclosure on my part, Spokane County ma thdraw any a t
it might -issue in reliance of this app ation.
3v
Signe Date: /f�
NO'WY'�+m - - ` Not y: at _g` 3d7 -d
APPLICATION NO..
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCE
NOTICE OF ACTION ON CERTIFICATE OF EXMPTICN APPLICATION
Whereas, the Board of County Commissioners did, after public hearing on March 9, 19789 adopt
the Spokane County Short Plat Subdivision Ordinance, and
Whereas, the Board of County Commissioners in adopting this Ordinance did provide for certain
activities to be exempt from short platting activities, and
Whereas, the Board of County Commissioners did further provide for these certain activities
to receive a "Certificate of Exemption" from the Short Plat'Administrator prior to the re-
lease of a building permit, and
Whereas, the Short Plat Administrator has received a request for a "Certificate of Exemption"
for certain property located in the unincorporated territory of the County of Spokane, and
Whereas, the Short Plat Administrator has reviewed the evidence presented by the applicant
and all other information available, the Short Plat Administrator hereby taken the following
action on this "Certificate of Exemption" application, pursuant to the Spokane County Short
Plat Subdivision Ordinance.
APPROVAL
- Certifica mption -
The Short Plat Administrator finds that a
"Certificate of Exemption" shod be and
hereby is issued for said property, as de-
scribedwon the reverse side, pursuant to
Spokane County Short Plat Subdivision Or-
dinance Section 1.331 1F&M 59 /? 210
Approval of said "Certificate of Exemption"
and issuance of building permits, shall be
subject to the following conditions:
The applicant shall comply with all re-
quirements and regulations of the Spokane
County Zoning Ordinance.
The applicant shall comply with all re-
quirements of the Spokane County Health
District regarding the placement of on-
site water and/or sewage systems.
3.
4.
This "Certificate of Exemption" is and shall
run with the land and shall be applicable to
the applicant, owner, their heirs, succes-
sors or assigns.
APPROVED THIS DAY OF 19ff—.
rt Plat Administrator
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
DENIAL
- Certificate of Exemption -
The Short Plat Administrator finds that a
"Certificate of Exemption" sherd not. and
hereby is not issued for said property a_s
described on the reverse side, pursuant to
Spokane County Short Plat Subdivision Or-
dinance
rdinance Section , for the follow-
ing reasons:
1.
1 2.
Accordingto the Spokane County Short Plat
Subdivision Ordinance, the division of
land that you propose to develop is defined
as a Short Plat and you will be required to
comply with the requirements of said Ordin-
ance prior to issuance of building permits.
DENIED THIS DAY OF , 19 .
Short Plat Admi�tFator
3�
SPOKANE COUNTY
PLANNING DEPART- ,� •�1
MENT STAMP '