1978, 11-13 Permit App: N1527 MH® n -
County of Spokane, Washington
BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 89201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT //
GENERAL REQUIREMENTS PERMIT FEE .e;64__..._______
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 44235
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 he
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
t
Name of Owner V .n.cir _ .y?.(1 Address
Strim
Architect Addressj Phone
Engineer
. an
ru'l
Contract. ...i . / il, . Address $ 21-4-4/1/44114,20%.01 Phone 9x / / Td
Legal Des tion of Property (Give complet scription from deed, tax receip etc.) P cel, u (bm
Q�e �i tR Gpc//,I, "ss2 `/Tit ir%S',0 h /�,a,IJ /7
.i eae /'z diQ 6
Address
Phone
DESCRIPTION OF WORK: New _4__ Addition Remodel
Size of Lot pip Y /SC
Stories 4_Dimension� AV X .S(
Rooms 58etha / Basement er
„h (toll, part. srm none
Type of Roofing
Foundation
Foundation Const
Heat. System
Use of Bldg.
e -A1 l7?z/
/e/ -i ?P'/
Moving Bldg. Zone `' Fire Zone
Sewage System
of onst.
Fr., Conc., Br.. etc.) d_
_Total Sq Ft i34f I Valuation _.,Zre
-P Chimnend) Firreeplace(Num
beru
Ext Finish /,,7 Int Wall Finish /`per
No of Units .Bedrooms 07" --
,50( 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
I he
as shown.
SOUTH
State License No.
Ind. Ins. Acct. No.
RESIDENT! L — COMMERCIAL
REQUIRED
Pluritbing Permit
w Heating Permit
to Sewage Permit
-1
Plans Received
Plans Checked
Plans Returned
Plans Picked Up
Plans Mailed
rtify information submitted correct and there are no other structures located on this property except
-nue 2-1
///s3/7A
Owner or Agent Da e
A LAND USE OR STRUCTURE PERMIT MUST BE ON' THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS NOT A PERMIT.
(qA 144,42'90 ``A�DO NOT WRITE BELOW THIS LINE�4
Your street address will be f , / 74—Q l „517-A, (Z4.41 The zone is
Sewage Permit Number Issued Building Permit Receipt ge)g4 Issued
Remarks
Form 523 Bldg. Code
i
Manufactured Home:
Year' 1978
Make SANDP
Vehicle Identification Number
Registered Owners: //gyp
Names DALE & CATHY LAUGEN Signatures'L�-�'a
Signatures`-2�_i
:c�RS
, � ,P g
Lvi
ORFLIXB25381226
Wid
Length
Legal Owners:
NamB8 ,CLAUDE K. IRWIN, JR.
'SIGNATURES OF OWNERS INDICATE TERMINATION OF INTEREST IN THEMANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 4SY1 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 15115
BEING AFFIXED. .. '
Land to Which Manufactured Home -is Being Affixed:..
Property -.Tax Parcel Number 55192.1804
Legal Description LOT .4 IN BLOCK 3 OF APPLE VAL'LEY.ESTATES SECOND ADDITION, AS PER PLAT
TgHTEAREOF RECORDED IN VOLUME 12 OF PLATS, PAGE 31;.$ITUAT IN THE COUNT OF 0K5pE
OWnB I'm 15HINGTON. DALE & CATHY LAUGEN SighWalrhs V;(gnt / A77�QQ^^—
'SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED TO THE R PROPERTY LISTED.. OVE. //
Building Permit Office Certification:
I certify that the manufactured home has been affixed to the real property'as described above and/or building permit
number . has been issued fix. the purpose of affixing the manufactured home to the land and wilt be
inspected upon completion.
SIGNATURE
BLDG. PERMIT OFFICE
PHONE NUMBER
County Auditor/Agent Licensing Office Approval: (Notfor use bysutiag"e'riis) ••
I certify that the above application appears to have been completed'correctly; and that the applicant has sufficient
documentation to prgceed with the recording of this form,
NAME
SIGNATURE
OFFICE/GAAP-OPERATOR NUMBER '
DATE
Recording. Office:
I certify that this form has been recorded in the county records.
NAME SIGNATURE
COUNTY'
DATE
RECORDING NUMBER
.1•
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishable `in accordance with RCW 9A.20.021.
en.47n.i20, am unMF TTI E EUM 0/11901 Pane 2 of 7