2008, 05-13 Permit App 08001740 MHProject Number: 08001740 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: 2008 26.8 X 60 VALLEY QUALITY HOMES
Setbacks: Front 34 Left: 58 Right: 8 Rear: 38.
Site Information:
Plat Key: 001866 Name: ORCHARD AVE ADD TR 1-228
Date: 5/13/2008 Page 1 of 2
Contact: BARNES ENTERPRISE
Address: PO BOX 141617
C - S - Z: SPOKANE WA 99214
Phone: (509) 921-9068
Group Name:
Project Name:
District: Nort
Parcel Number: 45072.6202
Block: 196 Lot:
SiteAddress: 8119 E JACKSON AVE
Location:: CSV
Owner: Name: PIKE, ROBERT
Address: 8203 E JACKSON AVE
SPOKANE, WA 99212-2259
Zoning: R-2 SF Res Suburban District
Water District: 002 ORCHARD AVENUE
Area: 11,090 Sq Ft Width: 75
Nbr of Bldgs: 1 Nbr of Dwellings: 0
Review Information: --
Hold:
Depth: 150 Right Of Way (ft): 34
Review
Landuse/Zonine/HE Conditions
Released By:
Sewer Review
Permits:
Originally Released: 5/8/2008 By: mpalaniuk
I Released By:
Contractor. BARNES ENTERPRISES INC
Address: PO BOX 141617
SPOKANE WA 99214
Item Description
INSPECTION FEE
Manufactured Home
Firm: BARNES ENTERPRISES INC
Phone: (509) 921-9068
Units Unit Desc
2 # SECTIONS
Fee Amount
$100.00
Permit Total Fees: $100.00
Operator. JD Printed By: JD Print Date: 5/13/2008
Project Number: 08001740 Inv: 1
Application
PHIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 5/13/2008 Page 2 of 2
Notes:
The space from the bottom of the home to the ground must be enclosed by concrete or an approved
product per SVMC 19.40.120 (B)(3)
Payment Summary: _ y
Permit Type
Manufactured Home
Fee Amount
$100.00
Invoice Amount
$100.00
Amount Paid Amount Owing
$0.00 $100.00
$100.00 $100.00 $0.00 $100.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: JD Printed By: JD Print Date: 5/13/2008
Permit Center
*Wane11703 E Sprague Ave, Suite B-3
r Spokane Valley, WA 99206
4000Valler (509)688-0036 FAX: (509)688-0037
ww w. spokanevall ev. org
Community Development
Manufactured Home
Permit Application
OTHER
PERMIT NUMBER: I 1`J
PERMIT FEE:
SITE ADDRESS: 8 1 1 9 E.
ASSESSORS PARCEL NO: 415-b7 Z . G 201
LEGAL DESCRIPTION:
Building Owner:
Name: 6 6$ P i K C
Address: 8 203 .
7 A-GKSo n
City: SQpK (11
State: �,et
Zip: q9 zit,
Phone: Q - ' _ S_0Z 9
Fax:
Contact Person
Name: 30 r N g/t24.e-3
Phone: So?- Z t 1- 3 G G Z
Contractor:
Name: (3)4-Al (-S fit.}.u'Pr,3e-S A c. (oF$5Por/kw )
Address: go 60X 1,i i` I i
City: lvl OkA+�. �� y State: Zip:.��
Phone: 501_ 92/- fit" 4. B Fax: Sa 9,� QZ, _ 8 ci, f
Contractor Lic No:6,4 R4 «r,o ixp Date: Alp. , - )1- a 8
City Business Lic. No: 6 4,r'4 4.c$ 00_5-496
Describe the scope of work in detail: P I C - ,,,,,t, o„v, 5; +-e
MANUFACTURED HOME
Width: Z6,'8 "
Length: &,p '
Manufacture: Pell t'j Q Ar 1T9-j
Previous Address:
Proposed Use: et,s r Q,u,,-1-;,¢-t-
Year:
Pit Set: I, S
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the
dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The
signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done
in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of
Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or
local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be processed.
Signature 6.2(4.- (300 P;1<e,
Method of Payment:
❑ Cash ❑ Check ❑ Mastercard
Bankcard #: Expires:
Authorized Signature:
REVISED 8/23/2005
Date 5-- 7- 0 8
❑ VISA
VIN#:
Sci„.
jUalley
For City Use Only
PLUS Project Number Jay.%C'fl4
Project Address
11703 E Sprague Ave Suite B-3 • Spokane Valley WA 99206
509.688.0036 • Fax: 509.688.0037 • permitcenter®spokanevalley.org
As part of our on -going commitment to customer service during the review process of your project
application, we are providing you with a TARGET DATE for the initial technical application review. If for
any reason we cannot meet this date, we will contact you with a revised target date.
Your application review TARGET DATE is
The TARGET DATE is the date we estimate your project application will have had its initial technical
review. It is not the date for approval or permit issuance.
Tips for a Smoother Project Application Review
Submit complete, accurate plans and documents.
Extra time may be required for re -submittals as project application reviewers work on multiple applications and it
may be several days before they can look at your new or revised information.
➢ Designate a specific contact person to communicate with the City.
While the person designated as the applicant's contact person with the City can be changed, one individual with the
expertise for dealing with reviewer comments would be the best choice for the entire review process.
i Call staff regarding the status of your project only after the target date shown at the top of the page.
Although you should be contacted on or by the target date, please feel free to contact us if you haven't heard from us
by your target date. Staff may contact you before the target date if the initial review is complete. By following this
procedure, you will save time and allow the reviewers to complete the work more expeditiously.
Steps in the Permit Process
1. Counter Complete. Your application has been accepted as counter complete. This means all of the required
documents, as indicated on your Pre -Application Checklist have been submitted or have been approved for deferred
submittal. This does not prevent technical staff from requesting additional information as a result of their technical review.
2. Quality Check. The next step in the process is a quality check to make sure that the application is reviewable and free
from substantive flaws that would prevent technical staff from completing the technical review once it is started. When
this step is complete, your application will be routed to the appropriate staff and remain in their review queue until it
comes up for review.
3. Technical Compliance. Once an application is administratively complete, it is routed to technical staff for compliance
review. Depending on the type of project, technical staff may include multiple reviewers. You should be contacted by
phone, fax, email, or mail by your TARGET DATE once the initial technical compliance review is complete.
4. Permit Issuance. When the technical compliance review of the application is complete, including any subsequent re -
submittals, each reviewer will approve their section of the application and route it to the Permit Center. When all sections
of the application are received, a Permit Specialist will process the application and contact the person specified on your
application for permit pick-up. Information regarding fees and pre -construction meetings (if required) will be provided by
the Permit Specialist at that time.
WHITE -APPLICANT PINK - BUILDING FILE
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RECEIVED BY
CITY OF SPOKANE VALLEY
JUN 0 5 2009
BY:
0sDrr=ortre,nnFrnt wolsxt`cTON MANUFACTURED HOME
ICEnS nG APPLICATION
PLEASE CHECK ONE
53.TITLE ELIMINATION ■
TRANSFER IN LOCATION ■ REMOVAL FROM REAL PROPERTY
1 MANUFACTURED HOME
TP((��.P AT NUMB
�ER
EAR
6
MAKE\�t� LENGTHWIDTH(FEET)
,a8 X C, O
VEHICLE IDENTIFICATION NUMBER (VIN)
V Nn iWi4 J 2 e I2 W 'sI 98 A 0
Q LAND ADDITIONAL LEGAL DESCRIPTION ON PAGE
TITLE FEES
MANUFACTURED HOME WILL BE f-AFFIXED
MIREMOVED
PA.PgeTY ThZ Rc NX6R -
FILING FEE
APPLICATION
LOT
BLOCK
PLAT NAME
SECTION/TOWNSHIP/RANGE
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.
`t
ELIMINATION FEE
J he, We,if. 18 '4ee.i-- o Nock 1 7 .., Oti-�l•,tc' AveVIVA
" W a iitt G - '+4 5 eo 14Q to s p-z,r p `ct f E' G'c-- V'e.Co a-4 ec•(r i h
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.4. ti _ Ec'4 5 t 7.3 4 e t- c, (% r ock / 9 E v( _E_ , ',.5/�'Yt t{ jCk. L. „..., 6.,,,TOTAL
6C " 1 .1 Cr." lb L5.17).7 k6 1 -c . Si i V ->, Y _e i N -i-t �N 4 i-v 0 l' J 190 ko, �..
FY �- ,59,-)k�..c iice4ie s}4-e. C� . ui I.., rv,.' -p.
USE TAX
SUB -AGENT FEES
FEES & TAX
�i
GRANTOR(S) .1SZFRF�/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGEGAttc<.11 y,{e..,f- Pr . li✓
COUNTY k
S eo K/a fJ L
kINCOFRATED UNINCORPORATED
a REGISTERED OWNERS
:'-
k LEGAL OWNERS
NA OF FIRST REGISTERE&V1�1NER DOL CU TOME CCOUN-T NUMBER
Kr) be"}- 1 i J�e-, I'iI<UA-`NX 466 6. a7
ADDgES F IRST REGISTERED OWNER CI.,_STATE ZIP CODE
�ac%aa�. /}fie_ 1;.kuwe \I\IIz UJ/ q . (2
NA `f FIRST LEGAL OWNER i DOL CUSTOMER ACCOUNT NUMBER
YY O bri.i Pike.
ADD S OF FIRST LEGAL OWNER CITY STATE ZIP O E
I l q 6 0kck.5a,-,.. %4'v e S a m �, c �4 I l�� �+' I `�i 2 i
GRANTEE(S) AD ITIONAL NAMES ON AGE
NAME OF FIRST GRANTEE DOL CUSTOMER ACCOUNT NUMBER
Anyone who knowingly makes a false statement of a material
fact is guilty of a felony, and upon conviction may be
punished by a fine, imprisonment, or both. (RCW 46.12.210)
I DO SOLEMNLY ATTEST UNDER PENALTY OF PURJURY
LAW THAT I / WE ARE THE REGISTERED OWNERS OF
THIS VEHICLE AND THIS INFORMATION IS ACCURATE:
SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR
ELIMINATION OF TITLE / REMOVAL FROM REAL PROPERTY: X
SIGNATURE OF FIRST REGISTERED OWNER AND TITLE, IF APPLICABLE
X X
SIGNATURE 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/Agent/NOTARY 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
DATE OF SALE
PURCHASE PRICE
TAX JURISDICTION/TAX RATE
DEALER'S AUTHORIZED SIGNATURE
USE TAX EXEMPT Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery).
171 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
certify that the above application appears to have been completed correctly, and the applicant has sufficient documentation to
proceed with the recording of this form.
NAME (TYPED OR PRINTED)
COUNTY OFFICENFS OPERATOR NUMBER
SIGNATURE
DATE
TO-420.729 MANUF HOME APPL (R/12/96)OR Page 1 of 2
INSTRUCTIONS AND ADDITIONAL INFORMATION ON REVERSE SIDE
Y 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
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
6 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
„r� /tK BLDG PEREILTOFFICE/PHO. A`._,,
NAME y ' 1 c -a.)
(VL(/ 1N�r1t({'�F'-7 ,SPt�pAA/E,��-vljtLE-1 L` It'< 6/1-locg.003co
SIGNly'�URE1( D�E
LPL2/hCr
5-( 2",VW S'CGCl/IC.1 Sr lV o /
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 Horne 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 the Manufactured Home Application,
paying all required fees.
The Department of Licensing has a policy of providing equal access to its services.
If you need special accommodation, please call (360) 902-3600 or TDD (360) 664-8885.
TD-420-729 MANUF HOME APPL (R/12/96)OR Page 1 of 2