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2003, 07-28 Certificate of ExemptionCiirIFTIFICATE OF EXEMPTICNO City of Spokane Valley Division of Planning 11707 E Sprague, Suite 106 Spokane Valley, WA. 99206 Existing "parent" tax parcel number(s) '' ,5 7, '/, (9 7 2 /'/61 Site address or frontage road name j=-.M49211,?4gorirle_i7 Q Action: C dQi^(' Public road Priivate road ❑ Private driveway❑ Auditors ditors recording #: Legal description - Section C$ Township ` ' Range F r (A fill cC Al /-o 1- ��' - )e*c /.2/ Pt l-= Xr, S3 I- yP it 1- rr),'J . r©>7` W /a / K'74. eic,515 7 / /.3 P74. Of L /a "/3 / � (97'.5 7`r / / 2 / � ' )a %i^ /. continued on back Total existing acreage ,/- Current zoning New property size a , /7 Comprehensive Plan category E r (work) Name of applicant C- �'/yL Phone Number (home) /2-F-37 Mailing ddress ly 41.-7-,t,,-- .72-f/ City _ State 'rq Zip ?%L/l I certify that I as owner or authorized agent have examined this document and state that the information contained in it and submitted by me or my agent to compile said document is true and correct, and authorize the City of Spokane Valley to proceed with processing. In addition, I have read and understand the provisions contained herein and agree to comply with them. I understand that the issuance of this exemption is not intended to verify that adequate provisions have been made for drainage ways, potable water supplies, roads and sanitary wastes. Any subsequent approval based on this exemption shall not be construed to give authority to violate or cancel the provisions of any state or local law. Applicant Date 7-2- E-- d3 Staff Use Only This Certificate of Exemption issued pursuant to section i„?,/e)p,jd < /e;6,of the Subdivision Ordinance for the City of Spokane Valley and RCW 58.17. The Certificate of Exemption is intended to indicate if the property as described is exempt from the State and Local Subdivision laws which regulate the sale, lease or transfer of ownership of property and is subject to the following conditions and/or findings: 1. NOTICE TO PURCHASER - This piece of property may not have appropriate provisions for potable water supplies (drinking water), sanitary wastes (septic tank or sewer), drainage ways, streets or road, alleys or other public ways. City of Spokane Valley is not responsible for making provisions for the above -stated items. If this property is served by a private road, City of Spokane Valley is not responsible for improving or maintaining said private road. 2. For property created via this exemption, the applicant shall file a Segregation Application with the County Assessor prior to the issuance of a building permit. 3. This Certificate of Exemption is for and shall run with the land, and shall be applicable to the applicant, owner, heirs, successors,or assigns. 4. The use of this property must conform to the Zoning Code 5. The following conditions shall also apply continued on back The required information has been submitted to the City Engineer. By Date Department of Public Works APPROVED 0 DENIED Receipt #: (0376 By 46,f-i,?2,4ate n of tanning CERTIFICATE MUST BE GIVEN TO EXISTING OR NEW PROPERTY OWNER THIS CERTIFICATE IS NEEDED FOR ALL BUILDING PERMITS SALE / DEVELOPMENT SEGREGATION This application for segregation must be completed in entirety and signed. To expedite processing please include all recorded documents and/or maps necessary to show ownership changes, mailing addresses, and any other pertinent details. ACO NUMBER Name: Address: City. State: �� Phone: �Z s7/-7 2 rk: APPLIICAANNT: Name: Address: City: Zip: / 2 / OWNER IF NOT APPLICANT: State: Zip: Phone: Work: /tisOwner * Lessee APPLICANT IS: S� v �C coy the Purchaser of Other * TAXPAYER A Name: Address: City: State: Zip: Phone: Work: Name: Address: City: State: " p00"EN Asses Zip: sot mane �pY ttiv cep coo °"s ECEIVED Address: City: State: Phone: AUG 1 9 2003 ZjpFPOKADEPAFt Ttt FNT nF Y CDMMUNITY DEVELOPMENT WOM PARCEL NUMBERS ,5 2 /,e9/�27 4 5- 7 '/, )//) TAX STATUS: c All taxes must be current at application , and must be kept current until request is finished. Building locations indicated on map. Segregation Merge BLA-MLLA ( l TCA Survey Map Notes (See back) CITY or Co. PLANNING Approved Denied yy2 ,'(16th evils Official Name (Print) Phone fficial Signature Date ACKNOWLEDGEMENT: (PLEASE READ BEFORE SIGNING) This segregation is for the division of property: same owner; sale or lease; or transfer of ownership by recorded deed or contract. A division of land for the purpose of transfer must be performed in accordance with applicable State and Local Laws. Local City or County Planning Departments grant final permissions for divisions of land. Taxes are current at this time , and will be kept current until request is processed. PRINT NAME 7-36-� SIGNATURE DATE ASSESSOR OFFICE 1116 W. Broadway, OCH-1 Spokane, WA. 99260 Received by/td"