1995, 09-11 Permit App: 95007143 MFH PROJECT NUMBER= 95007143 APPLICATION '^ DATE= 09/11/95 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 207 N SHAMROCK ST PARCEL#= 45134 .1120
ADDRESS= SPOKANE WA 99216
PERMIT USE= DOUBLE WIDE MANUFACTURED HOME PLACEMENT
PLAT#= 005236 PLAT NAME= ARMSTRONG ESTATES
BLOCK= 1 LOT= 6 ZONE= UR-3.5 DIST#= F
AREA= 00010163 F/A= F WIDTH= 85 DEPTH= 120 R/W= 50
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST = VERA
OWNER= MCKNIGHT, C.W. PHONE= 509 924 2249
STREET= 207 N SHAMROCK ST
ADDRESS= SPOKANE WA 99216
CONTACT NAME= CONRAD MCKNIGHT PHONE NUMBER= 509 924 2249
BUILDING SETBACKS: FRONT= 39 LEFT= 24 RIGHT= 18 REAR= 38
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED e .F(27_1E(2- C
COMMENTS:
ENGINEER APPROACH/ DRAINAGE/ FLOOD 909574n/S.* et IA,-1115,
COMMENTS:
HEALTHDIST NEW OR ADDITIONAL WASTE WATER
COMMENTS:
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 95/LAMPLIGHTER MODEL=
SERIAL#= WIDTH= 28 LENGTH= 48 HEIGHT= 10
ITEM DESCRIPTION QUANTITY FEE AMOUNT
INSPECTION FEE 2 100.00
STATE SURCHARGE Y 4 .50
COUNTY SURCHARGE Y 19.00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
PROJECT NUMBER= 95007143 APPLICATION DATE= 09/11/95 PAGE= 02
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 123.50 .00 123.50
123.50 .00 123.50
50,D• .444
* PLAT NOTE: TOPIC = CONDITIONS DEPT = BUIL► '
*******************************************************************************
BUILDINGS RESTRICTED TO 14 UNITS UNTIL PROPOSAL IS CONNECTED
TO PUBLIC SEWER.
BUILDING SETBACKS SHALL BE MEASURED 25 FEET FROM THE EDGE OF
THE RESERVED FUTURE AQUISITION AREA.
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: BURRIS, ROBIN
******************************** THANK YOU ************************************
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APPLICATION INFORMATION ! 5 -7 l `�3
'What is the JOB SITE address? ASSESSORS tax parcel number?
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Legal description as it appears on the property deed
OWNER or OCCUPANT Phone
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Mailing address City,state Zip
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Who should we contact regarding this project? Phone
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What work is being done under this permit?
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tone :Inspector distr t Property size Rrght of way width
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Water district ;
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Building > Building height #of stories
Contractor dimensions TOTAL SQUARE FOOTAGE
WA State Contractor license# Main floor area Unfinished basement area
Mailing address .2nd floor area Finished basement area
Architect/Engineer Garage area Size of decks,etc.
What is the heat source? What is the cost of your project?
Manufactured Home Sign
g
Width Length: What is the square footage of How high is the sign?
G/-f / the sign face?
Year: Make:
:flier��� L,F� i7� �-IO LIT-� 2Inst4 :a:
Contractor
Wa State Contractor license# Wa State Contractor license#
Mailing address Mailing address
Relocation . Fire:Safety
Previous address Fire Sprinkler _ Tent _
Paint booth_ Fire Alarm _ Fireworks display _
VALUE
Contractor Contractor
WA State Contractor license# WA State Contractor license#
Mailing address Mailing address
Fuel Storage Tanks Swimming Pool
(Circle one) Above-ground Underground Size/gallons Private
Contents of tank(s) Size/gallons
Public/semi-private
Contractor Contractor
Wa State Contractor license# WA State Contractor license#
Mailing address Mailing address
COMPLETE ALL APPLICABLE INFORMATION
Spokane County does not discriminate on the basis of disability in the admission to, or treatment or employment in, its programs or activities.
PROJECT NUMBER= 95007143 APPLICAT]:ON DATE= 09/11/95 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 207 N SHAMROCK ST PARCEL#= 45134 . 1120
ADDRESS= SPOKANE WA 99216
PERMIT USE= DOUBLE WIDE MANUFACTURED HOME PLACEMENT
PLAT#= 005236 PLAT NAME= ARMSTRONG ESTATES
BLOCK= 1 LOT= 6 ZONE= UR-3 .5 DIST#= F
AREA= 00010163 F/A= F WIDTH= 85 DEPTH= 120 R/W= 50
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST = VERA
OWNER= MCKNIGHT, C.W. PHONE= 509 924 2249
STREET= 207 N SHAMROCK ST
ADDRESS= SPOKANE WA 99216
CONTACT NAME= CONRAD MCKNIGHT PHONE NUMBER= 509 924 2249
BUILDING SETBACKS: FRONT= 39 LEFT= 24 RIGHT= 18 REAR= 38
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED e '1 Z1E,R- 9-11 c13
COMMENTS:
ENGINEER APPROACH/ DRAINAGE/ FLOOD 9i/1s5-PN/I %58 6T .,J _�..../ /
/ '
COMMENTS:
HEALTHDIST NEW OR ADDITIONAL WASTE WATER e/W
COMMENTS: 9//i gj
III
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 95/LAMPLIGHTER MODEL=
SERIAL#= WIDTH= 28 LENGTH= 48 HEIGHT= 10
ITEM DESCRIPTION QUANTITY FEE AMOUNT
INSPECTION FEE 2 100. 00
STATE SURCHARGE Y 4 . 50
COUNTY SURCHARGE Y 19. 00
PERMIT TYPE FEE AMOUNT AMOUNT PAID AMOUNT OWING
81.7 g�, �I
141 A SPECT CATIONS /, A
TYPE OF SEWAGE SYSTEM: ra 1 i J .
LINEAL OR SQUARE FOOTAGE: ....__6f' `
19- TRENCH WIDTH: 36 h _.
DEPTH FROM ORIGINAL GROUND SURFACE TO BOTTOM
OF SEWAGE SYSTEM: .:=,.---,/4
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SHAMROCK S, ,
RETURN ADDRESS
Home Mortgage, Usa
909 South 336th Street
Federal Way, WA 98003
STATE14� or WASHINGTONDeDepartment of MANUFACTURED HOME
lICEnSInG, APPLICATION
PLEASE CHECK ONE
fixJ TITLE ELIMINATION 0 TRANSFER IN LOCATION 0 REMOVAL FROM REAL PROPERTY
1 MANUFACTURED HOME
TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN)
%132533 1996 MDISN 48 X 28 115516
2 LAND ADDITIONAL LEGAL DESCRIPTION ON PAGE TITLE FEES
MANUFACTURED HOME WILL BE AFFIXED ❑REMOVED Ptj%fFRTy T.X PARCEL NUMBER FILING FEE
LOT BLOCK PLAT NAME 4 S4 lL SECbjTION/TOWNSHIP/RANGE APPLICATION
6 1 Armstrong Estates MOBILE HOME FEE
A legal description can be obtained from the local County Assessor's Office. If 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 6 in Block 1 of Armstrong Estates,
USE TAX
as per plat thereof recorded in Volume 22 of Plats, pages 64 and 65,
Situate in the County of Spokane, State of Washington. SUB AGENT FEES
TOTAL FEES&TAX
3 GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE
COUNTY It INCORPORATED UNINCORPORATED s REGISTERED OWNERS k LEGAL OWNERS
Spokane 1 1
NAME OF FIRST REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER
McKnight, C.W.
ADDRESS OF FIRST REGISTERED OWNER CITY STATE ZIP CODE
North 207 Shamrock Veradale, WA 99037
NAME OF FIRST LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER
Pan American Bank 601821513
ADDRESS OF FIRST LEGAL OWNER CITY STATE ZIP CODE
1300 South El Camino Real San Mateo, CA 94402
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 PURJURY
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 OWNER INDICATES CONSENT FOR
ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY: X
X.
-20 SIGNATURE OF FIRST REGISTERED OWNER AND TITLE,IF APPLICABLE
SIG TURE OF FIRST LEGAL OWNER AND TITLE,IF APPLICABLE SIGNATURE OF SECOND REGISTERED OWNER AND TITLE,IF APPLICABLE
NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE
State of Washington Signed or attested
County of before me on
by Signature
Printed Name of Applicant
Dealer No.OR
Title AND:County/Office No.OR _ __
DEALERSHIP Position/AgenVNOTARY Notary Expiration 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 DEALER NUMBER — I DATE OF SALE
PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S AUTHORIZED SIGNATURE _ll
E]USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery).
COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents)
I certify that the above application appears to have been completed correctly,and til;applicant has'.uffir,rent r lura in nrmt;rhnn In
proceed with the recording of this form
1 f /i r,l•I fIAl {1 tiiiMII f
S G'vATUnE DATE
TD-420-729 VANUF HOME APPL(R/12/96)OR Page 1 of 2 INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE
U 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
DFinalize this application with a Licensing Agent within 10 calendar dus 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 been issued for this
purpose and the attachment will be inspected upon completion
NAME BLDG PERMIT OFFICE/PHONE 0
Cit/ ' SC/1/1 P'ric. 7 vq y5(� 3G;'7S
SIGNAT E/POO TION SPOKANE COUNTYPeat-1,14f �,
7DATE
DIVISION OF BUILDINGS R5-°° /11t3 1°-�`�``l�
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 portion 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 fee. (Fees are subject to change without notice.)
SECTION 4 Take the properly completed Manufactured Home 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 Property"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 land;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 theManufactured Home Application,
paying all required fees.