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2001, 06-05 Permit App: 01004301 MH Project Number: 01004301 Inv: 1 Application Date: 6/5/01 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: NEW DOUBLE WIDE MANUFACTURED HOME Contact: YUKON TRANSPORT Address: P.O.BOX 1330 C-S-Z: RATHDRUM,ID 83858 Setbacks: Front 46 Left: 21 Right: 16 Rear: 59 Phone: (208)623-3432 Group Name: Site Information: Project Name Plat Key: 005998 Name: VALLEYWAY ADDITION District: F Parcel Number: 45133.2803 Block: 1 Lot: 3 SiteAddress: 511 N SONORA ST Owner:Name: TEAL VERADALE,WA USA 99037 Address: 12520 NE 145TH ST Location::VER KIRKLAND,WA 98034 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: 12,696 Sq Ft Width: 82 Depth: 153 Right Of Way(ft): 50 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Department Review BUILDING Site Plan Review �i.'Y4 Hold Reasons: > C. n1 .t-Sic !-_ Permit Conditions: BUILDING Plan Review Released By: Hold Reasons: � Permit Conditions: ENGINEER Approach/Drainage Released By: ' t_ ' "'' Hold Reasons: Permit Conditions: - 4 UTILITIES Sewer Review Released By: old Reasons: �T�LuT epucc,1 d V cf Permit Conditions: Permits: � r� 7 Project Number: 01004301 Inv: 1 Application Date: 6/5/01 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Manufactured Home Contractor: YUKON TRANSPORT Firm: YUKON TRANSPORT Address: PO BOX 586 Phone: (208)623-4092 RATHDRUM ID 83858 Item Description Units Unit Desc Fee Amount INSPECTION FEE 2 SECTIONS $100.00 COUNTY SURCHARGE 1 Y OR BLANK $22.00 Permit Total Fees: $122.00 Operator: RMB Printed By: RMB Print Date: 6/5/01 Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Manufactured Home $122.00 $122.00 $0.00 $122.00 $122.00 $122.00 $0.00 $122.00 Notes: �,.�� �: �. w. , : ,8.. , Cdr„ r o•` j 1 PROJECT`APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING&CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE LI SPOKANE,WA 99260 1 509-477-3675 SPOKAIV COWTY SPECIFIC SITE INFORMATION Street Address: �+ Si JC=.ti�CYZA. Assessor's Tax Parcel Number(s): Legal Description: 5 ( 2-- (). Project Description: PA Ai) ..Jam/'N L /4.,--‘, _ ,c :i 7r9/( ",Building Permit ❑ Change in Use ❑ Grading Manufactured Home Permit ❑Relocation El Sign ❑ Tenant(New/Change) Other Department Use Only Water District/Purveyor: , Sewer District/Purveyor Road width Setbacks Front Rear. School District: Fire District: Zonin • Left Right OWNER/APPLICANT INFORMATION 2p Indicate who should be contacted regarding this project CI0,net: l'hone3 e G I — 1 1 7 7' ❑ yAIL Phone: „Zr ( 2.3-31 3c) T /'"1-Cet I Fax: IL LOelim'-I/ l.ax: Mailing Address: !Mailing Address. a saw :N los 'ill-- 5i City,State,Zip City,State,Zip Icle(K(, U c,,.A oZ.03 4 Phone 23'.37� Phone Contractor Archi LIUs /2.4N5i Mail ng address Cf,50," G/ 'j2x ( ailing address Fax in ( 3 3�=) Cite,State Zip City,State Zip 1 4,_vko 2 '-, ro WA State Contractor license tt Contact name: >/,-46)-c; 7-- 69 4 O N al L C064-6-rz r PROJECT INFORMATION Building Information Building he cak #of stones Main floor sq.ft. Unfinished basement sq.ft. ♦ 4.. Dimensions Total habtta c 2"d floor sq.ft. I'inishe basement sq.ft. .2-1 XL(t-{ Occupancy group Construction type Garage sq.ft. Deck sq.ft. _Dc ve i— kt1L J r • CO 4)7,4— _ — . s Ti e Cost of project I Ieat source(elf. .),gas,etc.) Manufactured Home Sign Width: Length: What is the square footage of the sign 1 low high is the sign? face? Year: Make: #of signs Area of existing signs Relocation Fire Safety Previous address Fire Sprinkler Tent Paint booth Fire Alarm Fireworks display Proposed use Value Special(Inspections Required? Non-Residential Energy'Code Compliance? Firm Name �/'1.�4I4K Phone Plans Examiner Phone yzAr.,;Pc,-zf � C i 3 --3 It 3 Inspectors: Address Inspector Phone Concrete O Welding O Bolting O Reinforcement Address ADDITIONAL SITE INFORMATION Are there structures on the property? O Yes No What is the current property size? If yes,identify on site plan (square feet or acres) Is any part of the property within 250 feet of a shoreline? What is the current use of this property? If yes,identify on site plan O Yes No Is your property in a designated wildlife habitat area?�.,/ Will the site be served by a septic system?0 Yes 0 No 9P 0 Don't know 0 Yes No Is any part of the property within a 100 yr flood plain? Are or will there be wells located on the property? I f yes,identify on site plan I_/yes,ident j,on the site plan 0 Yes 0 No 0 Maybe 0 Don't know 0 Yes X No Are there any wetlands,streams or ponds within 200 feet of the property? Is there evidence of fill or excavation on the property? If yes,identify on,site plan 0 Yes 'No 0 Yes 0 No Are there slopes greater than 30%on the property?(30 ft rise in 100 ft) Are critical or hazardous materials used or stored on site? O Yes No O Yes O No DEPARTMENT USE ONLY Is the property in a designated Stormwater Control Area? Is public sewer available to the site? 0 Yes 0 No Yes 0 No Is the property inside the ASA? 0 Yes 0 No Is public water available to the site? 0 Yes 0 No 0 Yes 0 No Is the property inside the PSSA? 0 Yes 0 No Is the property located within 1000 feet of a Natural Resource Area? O Yes 0 No Date Received: Staff Representative: METHOD OF PAYMENT of SUB l O l':U VISA ❑ LASH I ❑ CI II{CK ❑ ❑ 0 -: FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD D.VFI{: 1(YPI RES: TOTAL FEE IS\NM:ARI)NUNIBI R: MINIMUM PERMIT FEE IS$35.e 1'1.1. E \t\KE CHECKS P.U-AI3LH TO SPOKr\NE. \t1I l R)RI/Fl)SIGN.VI'URI COUNTY N.1R _ G' CL.L. j C_I'i p-4-1 o v--) \,(0,11-a1100-1,11-10 in � ''AA ADDRESS N .Sul Salvo-2 ZONE u - c5 _.�.._ ....._ __...._..__ _..._ .v....�._��.�..._..,_.r _... __... ROAD IDN THSo � This site pan is being submitted for the purpose of j;1.0 obtaining a building permit and is a true and correct tol FRONT c41° FLANKING representation of the proposal.All known property COM lines/dimensions ► 'I- . . _. :. :'- - / ------____RFV1E have been identi'ed. Also indicated are wetlands, bodies of water, •teep s-aes or other critical areas. y U k0 A) Signed: �a..., OP. Date: ._._ CI 0 Aec.tuse..bb,•„__-_--0 ;a / I Niv\z101 fie.. oV— e ' -.? xu(4 s ' q y..1, 1 v-,c- 1 / 66'4).e io 1 8276,( I - - -1 I I I ADDRESS NI . IS CruAIa., ZONE '' 73 ,i This :te pian is being submitte5foi the p ,Jose or 20' BUILDING SETBACK ROAD WIDTH _'1 s obtait ing a building permit and is a true a d correct repre frentation of the proposal.All known roperty FRONT ' LA VKING f NOMMEN S lines/limensions,curb lines,structures a easements have been identified.Also indicated are I. tlands, / " 'REVIEWED ' bodies of water,steep skies oro. er critifal areas. (k i �� Signed: 7):14 S ;irk /� Date: 6-c"---O( 1 1 '. r , (7,, ),/:j-- , , .2-7yqii / 6 Atc) :1 ()LtAL-,1,,)k.C-1 s '---'77---- 41 1 I 1 i I V50 469 ' cs-i ) . i 1 14.0 , 36' BUILDING SETBA K –1 4_7__—____7:7__ 4 UTILITY EASEMENT BOTTOM f' 2� 4' EL=2028.42 f TYP. BERM EL=2029.5 0( ,N r— . _ _____ -___T 1DRAINAGE ` . I o I BORDER EASEMENT r EAS- C...,- I ZD si4wA)k 82.79' — — _i- i kms: i . 1 - - `fix M. 0 til S O N O R A ST. 14+52.42 14+64.42 - � I •�, / 4' CURB DROP 4' CURB DROP q -1IE=2028.75 IE=2028.80 tc 1 o• r SIDEWALK INLET SIDEWALK INLET Z IE=2028.56 IE=2028.61 • i. G 34271,Z) q t 'S, %TE 1� JANUARY 21,1999 SIONAL NORTH LOT 3, BLOCK 1 EXPIRES: AUG. I, 2000 SCALE 1" = 20' V JIFYWAY ADDITION a' RETURN ADDRESS C. Jon Nees 323 S. Pines Spokane, Wa 99206 207-6710 E7(1�° ,oisrrl- "N MANUFACTURED HOME IICEflSIflG APPLICATION Li y 53-7 a. PLEASE CHECKONE TITLE ELIMINATION ❑TRANSFER IN LOCATION 0 REMOVAL FROM REAL PROPERTY a MANUFACTURED HOME TPO/PLATE NUMBER a1 g6a l Mbldnwest LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) LAND vl/ ADDITIONAL LEGAL DESCRIPTION ON PAGE TITLE FEES MANUFACTURED HOME WILL BE AFFIXEDFILING FEE �] 0REMOVED P 451337A28p�ELNUMBER APPLICATION LOT BLOCK PLAT NAME • SECTIOWTOWNSHIP/RANGE 3 1 VALLEYWAY ADDITION MOBILE HOME FEE A legal description can be obtained from the local County Assessor's Office.It there is not enough room here, use the Application Attachment form,TD-420-732,available at your local County Auditor's Office. ELIMINATION FEE Lot 3 in Block 1 of VALLEYWAY ADDITION as per plat thereof recorded in Volume 25 of plats, pages 91 and 92; USE TAX SUB-AGENT FEES Situate in the COunty of Spokane, State of Washington TOTAL FEES&TAX • ©GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY N INCORPORATED UNINCORPORATED N REGISTERE2OWNERS N LEGAIOWNERS ,.y_ n. �+, Spokane 1: NAME OF FIRST REGISTERE OWNER DOL CUSTOMER ACCOUNT NUMBER Tipton, Belinda G. ADDRESS OF FIRST REGISTERED OWNERC STWTa ZIP CODE �! 511 N. Sonora Vera`aale, 99037 NAME OF FIRST LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Oakwood Homes Inc. ADDRESS OF FIRST LEGAL OWNER CITY STATE ZIP CODE GRANTEE(S) ADDITIONAL NAMES ON PAGE NAME OF FIRST GRANTEE DOL CUSTOMER ACCOUNT NUMBER Anyone who knowingly makes a false statement of a material I DO SOLEMNLY ATTEST UNDER PENALTY OF PIJRJURY fact is guilty of a felony, and upon conviction may be LAW THAT I/WE ARE THE REGISTERED OWNERS OF punished by a fine,imprisonment,or both.(RCW 46.12.210) THIS VEHICLE AND THIS INFORMATION IS ACCURATE: SIGNATURE OF LEGAL TITLE REMOVAL INDICATES CONSENT FOR �y n (+ ELIM OF TITLE REMOVAL FROM REAL PROPERTY: X r,�{p W A ,� JA_FICUY\,,,„) X SIUrFIATUURRE"OF FIRST REGISTERED OWNED TITLE,IF PPLICABLE_ SIGNATURE OF °�l'9C ° NE AND TITLE,IF APPLICABLE / LI SIGNATURE OF SECOND REGISTERED OWNER AND TITLE,IF APPLICABLE NO,ui IIAL O)STAArP II I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE Li 4 ® .'Saw`s �tp 6 State of Washington Signed or attesle ,. �QT -o v� County of balers me on U �•/®,,, , tgl Belinda C C . Tipton ® ��,,` o I Signatur .� ' _ 1' F4j tC a y Printed Name of Applicant 6 ® Notory oea No.OR r %,,,e, 01,...-°o if Title AN.:County/Office Nu •: • °.28„••° _ DEALERSHIP Position/AgenVNOTARY Notary xpiration Date DEALER'S REPORT OF SALE I certify that this information is correct.The vehicle is clear of encumbrances except as shown. DEALER NAME WA 0 ALER NUMBER DATE OF SALE Oakwood Homes Inc. 4-25-01 _ PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S i IZ SIG ATU 56495.00 0 USE TAX EXEMPT Sale to a Certified Tribal member n the reservation It h notarized statement of delivery). piCOUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents) 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(TYPED OR PRINTED) COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE DATE TO.420.729 MANUF HOME APPL(R/12/96)OR Page 1 of 2 INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE ©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/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. BUILDING PERMIT OFFICE CERTIFICATION I certify that the manufactured home has been affixed to the real property as described,OR a building permit has boon issued for this purpose and the attachment will be inspected upon completion (�7L�j //OFFICE/PH/�� NAt ( `` Lh I. to ���"" llr� (JBLOCa 01 00PERMIT `R CJI E x SIG NT E/P.: SPOKANE COUNTY DAT "f mraDING&CODE ENFORCEMENT INSTRUCTIONS COMPLETE THE APPROPRIATE BOXES ON THE FORM AS INDICATED BELOW, DEPENDING UPON THE TRANSACTION YOU WISH TO PROCESS. A. Manufactured Home Title Elimination Application(complete boxes 1,2,3,4 and 6). Use to eliminate a title for a manufactured home which is to become real property. B. Manufactured Home Transfer In Location Application(complete all boxes). Use only when a manufactured home(whose title has been eliminated)is being moved to land with a different legal description AND will become part of the real property to which it will be moved and affixed. If the transfer in location is between two different counties,prepare this form in duplicate and have each recorded in its respective county. C. Manufactured Home Removal From Real Property Application(complete boxes 1,2,3,4 and 5). Use when titling a manufactured home whose title has been previously eliminated. Once properly completed and recorded,this application becomes a supporting document along with others required to apply for a Certificate of Title for the manufactured home. IMPORTANT: SIGNATURES OF THE OWNERS ON THE MANUFACTURED HOME APPLICATION INDICATE TERMINATION OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND INDICATE INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY OWN AND TO WHICH IT IS/WILL BE AFFIXED. IF THE MANUFACTURED HOME IS BEING REMOVED FROM REAL PROPERTY,SIGNATURES OF THE OWNERS PER THE REAL PROPERTY RECORDS INDICATE CONSENT TO THE REMOVAL. THE FORM MAY THEN BE USED FOR MAKING APPLICATION FOR TITLE WITH THE DEPARTMENT OF LICENSING AS PROVIDED BY CHAPTER 46.12 RCW. Note: Owners of the manufactured home must own the land when the application is for a Manufactured Home Title Elimination or a Manufactured Home Transfer In Location,as provided by Chapter 65.20 RCW. SECTION 1 Enter the description of the manufactured home. SECTION 2 Place an"X"in the appropriate box and enter the property tax parcel number,lot,block,plat number and section/township/range,when applicable.Write a legal description in the space provided. If there is not enough room, use the Title Application Attachment(TD0420-732).When processing a"Transfer in Location Application,"both boxes should be checked.The application must then be accompanied by two separate land descriptions. SECTION 3 This area must be signed by all registered owners of the manufactured home when processing a title elimination. If the manufactured home has been sold and is being removed from the real property,the owners per the real property records must complete this eprtion to obtain a Certificate of Title. Signatures of the owners must be notarized or certified by the selling dealer or a vehicle licensing agent. Fees will include a filing and application fee plus sales or use tax due. Additional fees may include:a title elimination fee and a Mobile Home Affairs Fee. Subagents will charge an additional service lee. (Fees are subject to change without notice.) • SECTION 4 Take the properly completed Manufactured I lome Application and all necessary supporting documents to the County Auditor/Licensing Agent Office for approval. Supporting documents may include but are not limited to: proof of ownership or a Manufacturer's Statement of Origin(MSO),proof of taxes paid,and applicable release(s)of interest. Subagents may not complete the approval portion of this form. SECTION 5 The"Title Company Certification"box must be completed when processing a'Transfer In Location"or a"Removal From Real Properly"application. Important: The final recorded application form must be submitted to a vehicle licensing agent within 10 days of the title company's certification. SECTION 6 When processing an"Elimination"or"Transfer In Location"application,a city or county office (depending upon the location of the manufactured home)must certify that the home is affixed to the tand;or,issue a building permit to affix the manufactured home to the land,inspecting the completed attachment. The issuing office must sign the application,adding the permit number if the inspection has not yet occurred. IMPORTANT: Once the application has been approved by the County Auditor/Licensing Agent 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. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation,please call(360)902-3600 or TOD(360)664-8885. TD•420-729 MANUF HOME APPL(R/12/96)OR Page of 2