Loading...
1991, 04-03 Permit App: 91001557 MH Spokane County DEPARTMENT OF BUILDING & SAFETY West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675 INFORMATION WORKSHEET PARCEL NUMBER: . f Z_ /51> STREET ADDRESS: //2// 1Z _ - - CITY/STATE/ZIP: pi , �if.L 91Z-'Ljr SUBDIVISION: i. /4 /lil/ //,,t -d /L J�iY/. /Ll�/ .T BLOCK: 7 LOT: ZONE: DISTRICT: LOT AREA: F/A: WIDTH: DEPTH: R/W: # OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT: OWNER: ( /474:.G`c.2'G' 1404, ; G � � PHONE: - - 3 I f MAILING ADDRESS: -17-4W -Z/7/ %' 4t 264/e, S 3/c /4211 :f CITY/STATE/ZIP: � L C/' 4 ,eeG.7 J (.7;;A/;44 CONTACT: l"` G;L-/t_'1/ PHONE: -3Z7 - Sd6 SETBACKS: - FRONT: LEFT: RIGHT: REAR: PERMIT USE: **************************************************************************** BUILDING INFORMATION CONTRACTOR LICENSE NUMBER: CONTRACTOR: PHONE: - - MAILING ADDRESS: ARCHITECT/ENGINEER: PHONE: - - MAILING ADDRESS: NEW: REMODEL: ADDITION: CHANGE OF USE: DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES: BUILDING DIMENSIONS: % (WIDTH X DEPTH) SQ. FT. : REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL: P.03 Manufactured Home: Year /9 > Make A i )1-:-J---Lie _._Width V Length w(/ _ Vehi/,le Identification Number L L /10 i / x 0 Regi:;^tired Owners: Names. rZ® ' ,v •JP-Ott Signat,res' .1 __/ .Z Lega► Owners: `-';•`, di. Names'�� � _ Signa re �Qv,i"Le44,7.)94) `SIGNATURI`.S O''OWNERS INDICATE TERMINATION OF INTEREST IN THE MANUFACTURED HOME T OUGH TITLE PROVIDED BY C8.12 RCW ANO INDICATE INTFN r TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH HE LAND HE/SHE/THEY OWN AND TO WHICH IT(8/1S BEING A:1IX(i0: Land to Which Manufactured Home Is Being Affixed: Property Tax Parcel Number ,.1.5/9.•�, ASO , f!�1! A ,"74- Legal De;cription i . A M.7 i / J 9I fiwners' Name+ !�� / ' �1/_� . / -1-�'� .Egnatures2 ' { 'SIGNATURES OP 0 8 IN011 TE CONSENT TO HAVE THE MANUPACT RED HOME ADDED TO THE REAL PROPERTY LISTED ABOVE. I ., Building Pemit Office Certification: I certify that the manufactured home has been affixed to the real property as described above and/or buildingpermit number?f i 5 S 7has been issued for the purpose of affixing the anufact d home to the land anwill be 4 inspected upon completion. 6 pogk L=_-es.,2_, . --/,,c2_443 ,O;u. 6 -' ��zx NAME SIGNATURE BLDG.PERMIT DFFICE DATE PHONE NUMBER County Auditor/Agent Licensing Office Approval: (Not for use by subagents) • I certify that the above application appears to have been Completed correctly, and that the applicant has sufficient documentation to proceed with the recording of this form. NAME • SIGNATURE - OFFICE/CRAP OPERATOR NUMBER DATE Recording Office; • .1 certify that this form has been recorded in the county records. • NAME SIGNATURE COUNTY DATE RECORDING NUMBER Note: Every person who falsifies or intentionally omits material information required in an affidavit is uilt misdemeanor punishable in accordance with RCW 9A.20.021. 9 Y of a gross • TD-420.750 MFG HOME TITLE EUM IN/1!901 Page 2 of 2 i 1 . 1