1978, 10-04 Permit App: N0904 Residence4110
County of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT
GENERAL REQUIREMENTS PERMIT FEE .0
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. Inmost -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 f- L. .0 C O t..:1 Address e7 �� k (7 Phone 53-r'' `"i 71 Y�
Architect Address Phone
Engineer Address Phone
Contractor ��Q. Address a r� A -on
Legal Description of Property (Give complete description from deed, tax receipt, etc.) Parcel Number 1 1 SE i -e0 Li a 1
11Ek-r PotrYnN of Lo -r6 of BLMCIC z6 of covill.1 APDrrinN Th eKEENA-CAE S (AMMFNUNG
NT THE -.- U) Cot or -SMD 1-a--[- 8 nNl Tf+E. NO TIf51DfE of FOUIC'l4 AVEL- FSE1NG 'fry` wl ,,
Te.t,1 c e_ H 00 o01l- /7 "P:--r-c_ Sgt ,4 T'TAcE}c9
DESCRIPTION OF WORK: a v
‹ Addition Remodel
Moving Bldg. Zor\e .—.�_ Fire Zone
Sewage System -0 '
CConst. c' 0
X
(Fr., Conc., Br.,.,et .) 0
StoriesS,F- Dimensions _ ♦ - _ X . a Total Sq. Et.___�aluation �n norl V
Rooms 1Q_ Baths Basement Foundation Const On C tt Chimney (Kind) FireplaceNu rly
el
J ( idle, rt, none
Heat. System Lt�- .t of Roof`ing Ext Finish O lint Wall Finish p'f''y tknk
Use of Bldg. J `+� 1 l Z tri We\ \ 1y (,.i NCy ar eek 2 Gk a ta�o of Units 4 Bedrooms
c� / % �oEGK
w J6l PLOT PLAN �r�µ
Size of Lot
ti tee- i3yY�
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
5t-4-aJk J
4114
SOUTH
COMMERCIAL
QUIRED
Plumbing Permit
m Heating Permit
NSewage Permit
N
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Pians Maned
I hereby cert�Yy information submitte,Q is orrectQndPthere are no other structures located on this property except
as shown. �IIv1
ti. 1
v
A-jr or Age
Date
ortr v�q-78
A LAND USE OR STRUCTURE PERMIT MUST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOTA PERIT.
OM Mac Pff �7P DO NOT WRITE BELOW THIS LINE
Tour street address will be S. .3 2,2,,, MOFki S'TRF-r iT The zone is Ara K.InIA LTLI R.A;1,_
Sewage Permit Number Issued Building Permit %j Receipt 2 3671 Issued
Remarks /V !) LI
Form 523 Bldg. Code
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County.'.! Ofojianc,',..State.:Of:Waphington,' EIS . pllOw;s:
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• 89 'dee '; . flirt,;.55 cc. Eat ara11e1 to Fth1tr, Avenue 111+.39 feet,
Or th 09:: itdIli...1. 1; '00 in21 sec. e3 7'.89 fet, thcnre : -
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APPLICATION
1S
APPLICATION FOR CERTIFICATE OF EXEMPTION
PLEASE PRINT OR TYPE
1. Applicant's Name: C, Al) 1134 Phone: Res: 53 g -/ 7 36 Bus: .4-4,,,<-4\i_._
Address: 6 010 r7 ILCity: op,1 k 0 n ,p State: Wal -t, ZIP: 9Q,,
2. Legal Descriptio �Qf property for which this "Certificate of Exemption" is being applied
for: Section `s Township a s Range ',.S
3. Parcel Number (From Tax Statement or Assessor's11)q.
Office): # / 9.-j j Oi/ a
1
4. Size of said property: Square Feet: '1 I 0 0 Or Acres:
Intended use of said property: + �� 1 t F Avr, d
6. 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 m a. and an ownership micro
run of your property, both obtainable from the Tax Assessor's Office, with your ap-
plication).
0 A. Division of land ten (10) acres or larger
DOCUMENTS OF PROOF: 1) Assessor's map and ownership micro run as requested
above.
0
B. Minor boundary or lot line adjustments
DOCUMENTS OF PROOF: 1) Adjusted legal description; 2) Copy of sales/contract
agreement.
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
Division of land created prior to March 13, 1978, which is
larger.
DOCUMENTS OF PROOF:
E. The purchase of one
DOCUMENTS OF PROOF:
no.
D D.
D F.
five (5) acres or
1) Copy of deed or dated copy of sales/contract agreement.
separate and distinct parcel of land prior to March 13, 1978.
1)) Copy of deed or dated copy of sales/contract agreement.
A division of land to a spouse, son or daughter
DOCUMENTS OF PROOF: 1) Copy of deed/Quit Claim Deed or dated copy of sales/con-
tract agreement. 2) Notarized affidavit attesting to said relationship.
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-
ation 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 willful misrepresentation
or willful lack of full disclosure on my part, Spokane County may withdraw any approval that
It might issue in reliance of this application.
NOTARY SEAL
Signed:
Notary:
Date:
Date:
T//R /2
F1/8 /.4
APPLICATION NO. }rU Z --7
•
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCE
NOTICE OF ACTION ON CERTIFICATE OF EXEMPTION APPLICATION
Whereas, the Board of County Commissioners did, after public hearing on March 9, 1978, adopt
the Spokane County Short Plat Subdivision Ordinance, and
Whereas, the Board of County Commissioners in adopting this
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 takes the following
action on this "Certificate of Exemption" application, pursuant to the Spokane County Short
Plat Subdivision Ordinance.
Ordinance did provide for certain
e o xemption -
The Short Plat Administrator finds that a
"Certificate of Exemption" should be and
hereby is issued for said property, as de-
scribed on the reverse side, pursuant to
Spokane County Short Plat Subdivision Or-
dinance Section
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.
4.
C074 -
—
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 / C_ DAY OF /cu �,, , 192J.L.
Sh�f t Plat Administrator
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
THIS CERTIFICATE MUST ACCOMPANY
YOUR BUILDING PERMIT APPLICATION
1
DENIAL
- Certificate of Exemption -
The Short Plat Administrator finds that a
"Certificate of Exemption" should not and
hereby is not issued for said property as
described on the reverse side, pursuant to
Spokane County Short Plat Subdivision Or-
dinance Section , for the follow-
ing reasons:
1.
2.
J•
According to 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 Administrator
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP
i