1981, 05-05 Permit: 81A-4370 MHIPLAM NUMBErt'
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
it72..4
LEGAL DESCRIPTION — SEE ATTACHED
LOT
BLOCK
SUBDIVISION
OWNER
STEN ) . SLY EN
PHONE
6i?J•(ei78
PARCEL NUMBER/S
'Tt\/ 2t54-4'GttIL,
ADDRESS
L. W7O1 lo'"
Actual Set Backs in Feet
North ?' !South 55 LEast t 5
West
CONTRACTOR
SOcAlti
PHONE
Size of Parcel
\DbX t3U
Zone Classification
ADDRESS
StMk
ZIP
Type Const.
CCN
Occupancy
R-3
Sprinklered
Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valua=ion Building Area in Sq. Ft.
12.000 ado
ZIP
Main Floor Upper Floors 1 Garage Area 1 Storage
'lgo
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
M.H.
❑ MVE.
❑ POOL
❑ OTHER
No.
Baths
No. Stories
No. Rooms
3
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'cy,
Rec'
Not Req'd.
DENCRIBE WORK
8. POME L14x10)
Enum. Dist.
Location (Area)
VALUATION
9. 1t2-,t)OU
SOURCE
OF
UTILITIES
GAS
ELECTRIC
WATER
SEWER
SEtItC..
Ownership USE CODE
Public 0 Private
I hereby certify that 1 have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
DATE OF APPLICATION
SPECIAL APPROVALS
NAME DATE
- z -8/
Eryv Hea h
Planning
Fire Marshall
7neer
Utilities
167ti
Plans Examiner
SEPA Checklist
Building Technician
SIGNATURE OF APPLICANT
SPECIAL CONDITIONS:
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building
Plumbing C1.60
Mech.
Plan Check
SEPA
Mobile Home w
Other (Specify)
TOTAL $ SCI.v6
PERMITr1UMRE'!
03* :9.9.0000
*9.00'6
*0,00
371.42
04-20-8.1
• 6479.
07* *5000
* 50.00 �-
* 50006
A *0.00
371.52
.4
04°-20-81
▪ 6.479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0E5;L8'5 8n1
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUED
43702 *5900.a172 -
PERMIT NO. TOTAL
•
1
APPLICATION FOR CERTIFICATE OF EXEMPTION
R „r ,s. e APPLICATION PEE j$10_.00
PLEASE PRINT OR TYPE ` t at -'
x•
1.. Appl icanl: s None . slm hrn ttattsk J Holten, .• .r. Phone; Res 92671978 Bus: same
Address: E. 141707lOtb Ave F: "` City{Spokane1 e' States,W4..a ZI2:992o6 );7_
2.Legal Description of property for which vthis'"Certificate of`txempt on!„' is being applied":4
for: Section 21 ' Township 25.44,- 'Range 44 a tt -1r y ' `'x,:. P+ 1;:e.i
The East 10o Feet of the Nortlr130 Peet Of .the West halfoftlie Northeast Quarter of,. the
Northwest Quarter oY tl a `Southe at a try` a n
Quarter of 8evetSon 21;'�Toirmhip'25Nortti, Range 44.7 '
East. EN.. in Spokane County, Wast in'gton, -k°R Z''• 1n. , i% 'n" "
: ?_S Y -
Parcel Number (From Tax Statement or A55essor's Office/. s ..
Size of said property: Square, Feet: 13.000 Or Acres:
, $• 4 N a L
x,.. . .4:.
3.
4.
5.
6.
7.
Intended use of said property: Residence
Zoning of said propertyr:Artitialturaf. .� +
For which of the following reason(s) do,t.
you believe you qualify for a "Cer ificate of
Exemption"7: 2 r
..
(For each box checked, p�l�ase'.submiE �tfie .fisted documentatio §;required'Lo substantiate
your exemption. In addition; 'please submit an as"se'ssor's ma; and an owherAi micro run
of your property,. both 'obtainable from the Tax Assessor's Office, with your application .
.. . :.o..• 't
— A. Division of land' ten 00) acres or larger a' :4. r' `V, 3.e' v=
DOCUMENTS NEEDED: '(13 Assessor's` map and ownership micro run as requested above.
B. Minor boundary or lot line adjustments t '' - " " 1 .`.« ,...-
DOCUMENTS
.DOCUMENTS NEEDED: (1), Adjusted legal description; 2) Copy cfesales/contract
♦, agreement., �, t'`Y.4. ,, -'wwr ";i+ aa `'^ C '=«3
"C. The or -old oold lots, tractsor parcels of land which were separate and
I, distinct when purchased; although the purchase thereof makes the `divisi ons,
w r-^' 4. x a a S r ..
'... xv`contiguous: rel• y i; Fr; , x ..'. ', St 6t, - As. t;„.,til -a:.
Y DOCUMENTS NEEDED (1)# y Copy of" Cax statement 2�ro,Copy of ed or dated, copy of.
.w -r "'sales/contract =agreement �, s ". "°`',r5 i^.,
7.
D. Division of land created'. -prior to March 13, 1378 '"y, a'as„9.a u sva
'^4F�„
.E. Division of land for the'purpase of housing public utilities fact' lite -el:«-
F... the purchase ,of one separate and distinct parcel oft' land' priorfi to March 3, 1978
DOCUMENTS NEEDED.;;;AIL 1.i.„ Copy of deed or dated copy, of sales/contract agreement,`
V rw .P i'i .. ... iRyr S T %...q„_ ]L H , N.4
G. A division'of land to``a='spouse,1 s'on or daughter `'ps %, fiY„^'rS.Sg(r�`>-'� •' l
DOCUMENTS`SEEDE7 ji) of deed/ 't Claim Deed pr dated copy of sale 7contract
- agreement. 2 Notarized affidavit` attesting to said
relationship t. ; b.rm..rxk,Y *t ,;;e' "h ;'-
, t sy «. •.�,
H. A division of land within properties zoned Residential Office ocal Business,
Commercial, Industrial, Manufacturing, or Freeway Commerdial,I ea=x4114.1)1t)13
DOCUMENTS NEEDED: (1) Copy of survey A`,+ ,
8. Additional convents which may substantiate your qualification for an exemption`:' '`y
Given In consideration of love and affection to Stephen J. Holten by Doris N, Holten * ;
and Vernon 0. Holten (parents) Y
I, the undersigned, swear under 'the penalty of perjury, that the above responses are made
truthfully and to Che best of my knowledge. I also agree to furnish any further documenta-
tion 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 Ordina cel f further information
is required., I also understandx .that, should theresbe any willful iithrepreaentation or
wiIlfuI lack of full disclosure on my part, Spokane County may witfidraw`eny°approval that it
F
might issue in reliarice'of this application. l '=fie 4,.,0
'1s.,` v's. 0.++ SIGNED.' "( P -try .0 DATE q /.18.1±
NOTARI' *.f.LI, I .b..' , DATE 1 7 b /St.'
NOTARY SEAL
r1),
7;
.07
�� leo 149n1re
dt 8 tc g2
v Liz 4. .
' v '
P
�J
A=te"• 7Ct1 :iO.CEV 8/
SPOKANE COUNTY SHORT PLAT SUBDIVISION ORDINANCE
NOTICE CF ACTION ON CERTIFICATE OF EXEMPTION APPLICATION
Whereas, the Board „of County Commissioners did, after public hearing on March 9, 1978,- adoyt?
the Spokane County'•Short Plat Subdivision Ordinance, and . ,
s ±,
Whereas,, the"Board"of County Commissioners, in adopting this Ordinance, didAprovidejor`certaJfr
activities to be exempt from short platting activities; and -i`4 _ '"°
Whe?eas-the Board of County Commissioners, did further provide for these:Certain activities
to `receive -a "Certificate of Exemption"•from the Short Plat Administr for prior to the release
of a building permit, _and +s, Fa. . - "�+ 3'. ,Xx�+ `� '` nt`.Y"+." i
Whereas, the Short Plat Administrator has received a requestfor a 'Certifticate of Exemption'!
for certain property located in the unincorporated territory of the County of Spokane,, and?.
r f R `..a ^ L. Vifi, i' s< ^,(a f .,4 ,^»r - .. - e 9b: "t -0? ren
e-
Whereas, the Short Plat Administrator has reviewed [he evidehce,p resented `8y the app<•licat • tan:
Pier A
all other information availabiel the Short Pladministrato? hereby/Cakes 'the• fdllowing actic
on this ('Certificate of Exemption" application, pursuant to the Spokane County Siiort Platr
Subdivision Ordinance. 0--'- — w-4.4.
,/n Y1 ,.dMry
APPROVAL
Certificate of Exemption `�i` - t
The Short Plat Administrator finds that a••
"Certificate of Exempti"on" should be and here-
by is issued for said property, as described
on the reverse side, pursuant to Spokane
County Short Pt suadiyi on Ordinance
Section ,� (f�
i�t
,3 3
A1.
pproval of said "Certif a of Exemption"
and issuance of building permits, shall be
subject to the following conditions:
1. The applicant shall comply with all require-
ments and'regulationsof. the Spokane County
Zoning Ordinahce;
2. The applicant shall comply with all require-
ments of the Spokane County Health District'
regarding` the placement of on -site -water
and/or sewage systems, r
3• tettenaLtOcieGU�QfitLL
r
DENIALw,.,yYs,. .e
- Certificate of Exemption -
c •
The Short Plat Administrator. finds ;tHafi a
"Certificate of Exemption" should not and here
by is not issued for said), property, as describe
on the reverse side, pursuant to Sookanee Count
Short Plat Subdivision Ordrnance gectiOn=J-x
, for the following ),reasoni: "t
7r1%
"
According to the Spokane County Short ,Plat 'Sub
divi ion Ordinance, the division of land that
ropose to develop is defined as a Short
Plat and you will be required to comply with
requirements of said Ordinance prior to
uance of building permits:,
.,.,,
This "Certificate of Exemption" is and shall
run with the land and shall be applicable to
the appl icant, owner, their heirs, successors,.
or
the,
APPROVED THIS Z DAY OFAP IL,_
SPOKANE COUNTY:'
PLANNING DEPARTiy*
MENT STAMP p''
4
DENIED THIS _ DAY OF , 19'
z
° Short Plat Administrator•
SPOKANE COUNTY
PLANNING DEPART-
MENT STAMP,
/ s
.THIS CERTIFICATE` MUST ACCOMPANY
YOUR BUILDING PERMIT APPLICATION
1