1978, 05-16 Permit App: M6420 Residence `O 0 Countyof Spokane, Washington
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BUILDING CODES DEPARTMENT, N. 811 JEFFERSON, SPOKANE, WASHINGTON 99201
APPLICATION FOR LAND USE OR STRUCTURE PERMIT
J
GENERAL REQUIREMENTS PERMIT FEE
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. 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 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.
I' APPLICANT FILL IN BELOW THIS LINE
Name of Owner /�' �J/ .5"-- • Address Phone
Architect Address Phone
Engineer Address Phone
ContractorAddress &AA' 'i 9 '""` _Phone 9 a6- 9,'3S)
Legal Desc tion of Property (Give c plete description from deed, tax receipt, etc.) Parcel Number ` 3.5 4 "'- d 7 .2 o ^ /
"iv/1 ie/ir' .770
DESCRIPTION OF WORK: New &..-- Addition Remodel Moving Bldg. Zone / Fire 9ne 1
Size of Lot XA 4/ X / 3 Sewage SystemConst. --4-- -e
w� `; (Fr., Conc., Br., etc.)
Stories Dimensions G9 1( 2q G ,,
Total Sq. Ft. " Valuation -4d1 "el. o +ti
Rooms Baths a�i Basement r.2-7,
Foundation Const.. C°-' �� Chimney Fireplace
(Full, part, no (Kind) , (Number
--7n,Heat. System �, Cite,. Type of Roofing -5-/-4-40-1Ext. Finish St e("7‘ ,- .^- Int. Wall Finish ' �414..-
Use of Bldg. A..,P.41.0 1- L_d.-f -E . No. of Units Bedrooms 3
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.
0 NORTH State License No.
0K ON /4-:---44-45--
Ind. Ins. Acct. No.
Ate„i_ ° SIDTIA
ENL-COMMERCIAL
REQUIRED
65 i
r-----16— Plumbing Permit
Porr. m Heating Permit
rn I '
' G ►kt,L" 27. �* N Sewage Permit
4,'
-4
Plans Received
Plans Checked
Plans Returned
"70 l Plans Picked Up
Plans Mailed
Si23/7T
6, 7.74 ya', gA /4
I her-tify informatioi submitted is correct and there are no other structures located on this property except
as shown.
4/ '
iy Owner • Kgent Date ,
A LAND"E OR STRUCTURE PERM` UST BE ON THE PREMISES BEFORE CONSTRUCTION COMMENCES.
THIS IS OT A PERMIT
110 Pi—A-1— (-j/i DO NOT WRITE BELOW THIS LINE
Your street address will be✓ &�rr
Cm A y�t% 7 Z,, •�� T �_ cc,� The zone s A .. - . . ..`. ._. 41-411`,--
Sewage Permit Number Issued Building Permit Receipt ssued i
Remarks 01 - 74ef
Form 523 Bldg. Code
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APPLICATION FOR CERTIFICATE OF EXEMPTION V,'
PLEASE PRINT OR TYPE " ��e. //7j-
1 . Applicant's Name:l,,f,,,,,t .d APO' - Phone: Res:9„2. 9 - SA./V Bus: "�'"'ga '"'f
ZIP: 9c1 /6 y: S�
Address: Yi
1 of 3 Fi �� . O��e�-dw Ala' � /c' State:
2. Legal Description of property for which this "Certificate of Exemption" is being applied
for:p �
Section Township Range Range
/
3. Parcel Number (From Tax Statement or Assessor's Office): # .0 .r* V - C 7,2,.0 - ,
4. Size of said property: Square Feet: 9'9 4 _3 Or Acres:
5. 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 documentatio required to substantiate •
your exemption. In addition, please submit an4ssessor's maz d an ownership micro
run of your property, both obtainable from theaffice, 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 •
pabove.
a .
1 Li B. Minor boundary or lot line adjustments
DOCUMENTS OF PROOF: 1) Adjusted legal description; 2) Copy of sales/contract
agreement.
QC. The reconveyance of old lots, tracts, or _Parcels of land which were separate
and distinct when purchased, although the purchase thereof makes the divisions
M contiguous.
DOCUMENTS OF PROOF: 1) Copy of tax statement; 2) Copy of deed or dated copy of
sales/contract agreement
0 D. Division of land created prior to March 13, 1978, which is five (5) acres or
larger.
DOCUMENTS OF PROOF: 1 ) Copy of deed or dated copy of sales/contract agreement.
LelE. The purchase of one separate and distinct parcel of land prior to March 13, 1978.
DOCUMENTS OF PROOF: ;-i) Copy cf deed or dated copy of sales/contract agreement.
0 F. 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.
6. Additional comments which may substantiate your qualification for an exemption:
774;C /o 7- ij 7_ 6, .,/// /0 r iPerr,,.IArt ii v5 1'
0.'1‘)4'e... a i(. 4040' d .-vi e71 ke .
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-
tation 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 Si.y„ /S-£e6/�}
s / / 2 � � �
Sed . . ��, Date:
NOTARY ;SEA.L Notary: .J,.c. �/W ./ bz.,--_"Date: .—/ /? / .
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SPOKANE COUNTY
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APPLICATION NO.('(=O J/5-7Y
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCE
NOTICE OF ACTION ON CERTIFICATE OF EXEMPTION APPLICATION
'r $ 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 Ordina"ce did provide for certain
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 Txemrtion" 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.
r . APPROVAL DENIAL
- Certificate' Exemption - - Certificate of Exemption -
The Short Plat Administrator finds that a The Short Plat Administrator finds that a
"Certificate of Exemption" should be and "Certificate of Exemption" should not and
hereby is issued for said property, as de- hereby is not issued for said property as
scribed on the reverse side, pursuant to described on the reverse side, pursuant to
Spokane County Short Plat Subdivision Or- Spokane County Short Plat Subdivision Or-
dinance Section, 3,3(i) - dinance Section , for the follow-
1 Approval of said "Certificate of Exemption" ing reasons:
and issuance of building permits, shall be
subject to the following conditions: 1 . �'
1 . The applicant shall comply with all re-
quirements and regulations of the Spokane
County Zoning Ordinance.
1 2. . •
2. The applicant shall comply with all re- k
quirements of the Spokane County Health
District regarding the placement of on-
i site water and/or sewage systems.
3.
P1;4-
3. �l .cu n-c.e. Lod a ti C 1 O -c,0
.0t .t..... _- 1_tlf 4 - _4 -
According to the Spokane County Short Plat
. Subdivision Ordinance, the division of
1 land that you propose to develop is defined
as a Short Plat and you will be required to
I comply with the requirements of said Ordin-
ance prior to issuance of building permits.
IThis "Certificate of Exemption" is and shall
run with the lard ,,-,qshrll be applicable to ;
1 the applicant, owner, their heirs, succes-
1 sors or assigns. .
APPROVED THIS 2 z DAY OF , 19.22L. DENIED THIS DAY OF , 19
. .
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.6L\Short Plat Administrator Short Plat Administrator
SPOKANE COUNTY SPOKANE COUNTY
PLANNING DEPART- PLANNING DEPART- • a
MENT STAMP MENT STAMP •
' f,,, . .
THIS CERTIFICATE MUST ACCOMPANY illYOUR BUILDING PERMIT APPLICATION