1994, 09-02 Permit App 94008588 MHPROJECT NUMBER= 94008588 APPLICATION DATE= 09/02/94 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 19106 E CANE CIR PARCEL#= 55173.2521
ADDRESS= GREENACRES WA 99016
PERMIT USE= EXISTING DOUBLE WIDE MOBILE HOME
PLAT#= 001407 PLAT NAME= LABERRY MOBILE PARK ADD
BLOCK= 6 LOT= 21 ZONE= UR-7 DIST#= G
AREA= 00000000 F/A= F WIDTH= DEPTH= R/W= 50
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= JOUANNE, ELSIE
STREET= 19002 E VALLEYWAY AVE
ADDRESS= GREENACRES WA 99016
CONTACT NAME= DONNA EMERSON
BUILDING SETBACKS: FRONT=
LEFT= 5
PHONE= 509 926 6639
PHONE NUMBER= 509 926 6639
RIGHT= 5 REAR= 15
****************************** REVIEW INFORMATION *****************************
DEPARTMENT REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRE
COMMENTS:
ok Tha 44tctied
sOre, plan &AAA,' 9-0-eiLi
HEALTHDIST INCREASE IN LOT COVERAGE
COMMENTS:
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER
YR/MAKE= 86/ROYAL OAK MODEL=
SERIAL#=
ITEM DESCRIPTION
PHONE=
WIDTH= 24 LENGTH= 50 HEIGHT= 10
QUANTITY FEE AMOUNT
INSPECTION FEE 2 100.00
STATE SURCHARGE Y 4.50
COUNTY SURCHARGE Y 18.00
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 122.50 .00 122.50
122.50
PROCESSED BY: BURRIS, ROBIN
PRINTED BY: BURRIS, ROBIN
.00 122.50
PROJECT NUMBER= 94008588 APPLICATION DATE= 09/02/94 PAGE= 02
******************************** THANK YOU ***********************************
APPLICATION INFORMATION
Site address / 7 /O / 6 da ice_ _ e_ : Parcel number� /
Legal descriotion _
Lei-F.2-I 5i f�'ery'� l�'10b/e PDX k
Property size
ater district
v�'�,o afG{ .ZY
2
:::.:;:::
Owner Phone:.:::..;:
Address t 410 .2 Val(C'ty7K:e_E/iaeitiA (44 % /dit
PERMIT USE
Building New_ Change of use
Add Remodel_
Building height
Stones
Dimensions
Total square footage
Main floor
Untinished basement
Second floor
Finished basement
Garage
Decks, etc.
Value
Manufactured Home
Sign
Width:
Length: Se)
Square footage
Height
Year: eg-/o
(
Make:016i Oa k
Contractor
Contractor
License / J 4 O (ye) 3 Gj3
License
Address / q/ /, 6, eL,O /1��� /� , , , /c
v
(G`it/� l
Address
City, state,
yy�� ��C�� //,, `, /
Y ii a,c -L aJ ! 7O/
City, state, zip
Relocation
Fire Safety
Previous address
Fire Sprinkler Tent
Fire Alarm Fireworks display
VALUE
Contractor
Contractor
License
License
Address
Address
City, state, zip
City, state, zip
Fuel Storage Tanks
(Circle one) Above -ground Underground
Swimming Pool
Contents
Size / gallons
Size / gallons
Private
Public/semi-private
Contractor
Contractor
License
License
Address
Address
City, state, zip
City, state, zip
ADDRESS:10 to NE cla-
ZONE:
ROAD WIDTH: 5d
FRONT_ FLANKING:_.....
RFVIFWED
Manufactured Home:
Year
Vehicle Identification Number
Registered Owners: (
Names i•/ V.���� - Signatures'
Legal Owners:
Names ifSi°
Property Tax Parcel Number
Make Afat!0 oak Width -21
I DA 0g93 93
• Length
Signatures'
'SIGNATURES OF OWNERS INDICATE TERMINATION OF WTEREST 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 LANO HE/SHE/THEY OWN AND TO WHICH IT ISI15
BEING AFFIXED.
Land to Which Manufactured Homo Is being Affixed:
SS773 . -2so2
Legal Description L21 6 &rr-i M0Ar
Owners' Names LIST& \h4/ es Signatures'
'SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED TO THE REAL PROPERTY LISTED ABOVE.
Building Permit Office Certification:
I certify tl at the manufactured home has been affixed to the real property as described above and/or building permit
numb^r CAy—$5-53 has been issued for the purpose of affixing the manufactured home to the land and will be
inspected upon completion.
NAME
SPOKANE OOUN3Y P
CLOG. PEIIMI7 OFFICE
DATE
PHONE NUMBER
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application appears to have been completed correctly, and that the applicant has sufficieht
documentation to proceed with the recording of this form.
NAME
SIGNATURE
OFFICE/CAAP OPtRA FOR NUMBER
DATE
Recording Office:
1 certify that this form has been recorded in the county records.
NAME
SIGNATURE COUNTY DATE RECORDING NUMBER
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.
TITLE RIM WI1/901 Noe 2 of 2