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HomeMy WebLinkAboutBLD2005-00358 1 10 0 MLA05-00335 Review Type: MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00358 Received Date: 6/3/2005 SITE ADDRESS: 654 WHISPERING CEDARS LN CHIMACUM, 98325 APPLICANT: JOHN C HALL PHONE: (360)732-7122 SHARON W HALL PO BOX 601 CHIMACUM WA 98325 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901351005 Section: 35 Township: 29 N Range: 01 W CONTRACTOR/ WASHINGTON HOME CENTER PHONE: 360-748-6604 DEALER: PO BOX 176 CHEHALIS WA 98532 Contractor's License WASHINC0770A Expires 3/19/2007 INSTALLER: WASHINGTON HOME CENTER WASHINC0770A 3/19/2007 360-748-6604 PO BOX 176 CHEHALIS WA 98532 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW MAN HOME W/ EXISTING 500 GALLON PROPANE TANK TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: ID CHAMPION SETBACK: VALUATION YEAR: 2005 LABOR & INDUSTRIES APPROVAL? SIZE: 66X30 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: 3 Total: 2 Routing Date: / ,/, 05 ,-,, -- Type • Amount Paid By: Date: Receipt: A F P F ' \/E Permit $157.00 BAC 06/01/05 73229 V Potable Water Application $53.00 BAC 06/01/05 73229 JUN 2 1 2005 Total: $210.00 Jeff on u ty Planning & i • • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development • 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD05-00358 Received Date: 6/1/2005 SITE ADDRESS: 654 WHISPERING CEDARS LN Issue Date: 6/21/2005 CHIMACUM, 98325 APPLICANT: JOHN C HALL SHARON W HALL PO BOX 601 CHIMACUM WA 98325 SUBDIVISION: Block: Lot: PARCEL#:• 901351005 Section: 35 Township: 29 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: WASHINGTON HOME CENNIABItSHINC0770A Expires: 3/19/20M PO BOX 176 CHEHALIS WA 98532 PROJECT DESCRIPTION: NEW MAN HOME W/EXISTING 500 GALLON PROPANE TANK MAKE: ID CHAMPION YEAR: 2005 • SIZE: 66X30 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/21/2006. • CALL IN FO12 THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUO S FOOTING, SLAB or PADS USED): .��78.09/!S GGK /z763- Stormwater FINAL Approval: kiit,(o,q-1,4) idazt i//4# Blocking/Plumbing: ,29/ C/NL /Is--.D~os 4e..1< ///G6S Propane Tank/Lines SLIT LAE 2 /7, 4745 ff Zoning Final Approval: / // Septic System Final Approval (If not on sewer): Road Approach Final Approval: - /� Final/Skirting/Vents/Porches/Steps: Lk 4r C/Q 0/44� HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY • SPECIAL CONDITIONS APPLY-SEE REVERSE • • SPECIAL'CONDITIONS CASE # BLD05-00358 1.) The application was reviewed by the Jefferson County Department of Community Development staff on June 15, 2005 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: wetlands (per site plan). 2.) The project components are more than 250' from the mapped/identified wetland. The requirement for a wetland delineation and report is waived based on maintenance of a 225' buffer from the wetland per UDC Table 3-3. 3.) A setback of 225-feet, measured perpendicularly from the wetland edge, shall be permanently maintained as a buffer. No filling, grading, clearing, or other alteration of the wetland or its buffer is allowed. 4.) The project is located in close proximity to an identified wetland and is subject to the delineation provisions of Section 3.6.9 of the Jefferson County Unified Development Code. Based upon the proposed location of the project in relation to the identified wetland, the applicant has agreed to maintain a buffer(setback) that exceeds the standard buffer requirements by fifty (50) percent. The applicant acknowledges the additional setback and agrees to maintain the extra 50 percent buffer, therefore, waiving the wetland delineation requirements of the Unified Development Code. 5.) Buffer perimeters shall be marked with temporary signs at an interval of one per parcel or every one hundred (100) feet, whichever is less. Signs shall contain the following statement: "Wetland & Buffer- Do Not Remove or Alter Existing Vegetation." 6.) A permanent physical separation along the upland boundary of the wetland buffer area shall be installed and permanently maintained. Such separation can include installing logs,trees, a hedgerow, or any other prominent physical marking approved by the UDC Administrator. 7.) The applicant is proposing to create or add 1980 square feet of impervious surface and 198'0 square feet of land disturbing activities. 8.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 9.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act (SEPA) pursuant to WAC 197-11-800(1)(b)(i). 10.) The site plan as submitted with the building permit application on June 1, 2005 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated June 21, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 11.) This approval is for a manufactured home only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 12.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 13.) Not more than two (2) unlicensed or inoperable vehicles shall be stored on any lot less than one-half acre unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Unified Development Code (UDC) Section 6. Outdoor storage of thirteen (13) or more unlicensed or inoperable vehicles is prohibited except in those districts where specified as an automobile wrecking yard.or junk (or salvage) yard and allowed as a Permitted Use in Table 3-1 of the UDC, and such storage shall meet the requirements of UDC Section 4.10. In no case, shall any such unlicensed or inoperable vehiclesbe stored in an Environmentally Sensitive Area (ESA). 14.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 15.) The building height is not to exceed 35 feet. 16.) Minimum setback from any ing'�ss/egress easement shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. If and ESA is present, then the more stricter setback shall apply. 17.) Exterior lighting for residential uses shall not exceed twenty feet (20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 18.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 19.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 20.) An address of 654 Whispering Cedars Lane, Chimacum has been assigned to the parcel. Whispering Cedars Lane is a private road (P180). The parcel does not have direct access off of Whispering Cedars Lane. It is via an ingress/egress easement. Jefferson Title Company faxed documentation regarding proof of legal access. 21.) The parcel has been zoned as RR 1:20 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 22.) A septic permit(SEP99-0116)was finaled on April 12, 2002. A critical area review (CAR98-0143)was finaled on June 16, 1998. A building permit(BLD98-0308) was finaled on July 9, 1999 for a detached garage. w4"5oN cow JEFFERS�COUNTY • W ' DEPARTMENT OF COMMUNITY DEVELOPMENT 1-3 =\ '� 621 Sheridan Street • Port Townsend • Washington 98368 �� 360/379-4450 • 360/379-4451 Fax & '' JUN 1 2005 q`�, ING�0 www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 05-335 Project Description(include separate sheets a necessary): --- - 414 AA)Fi c ui) i) 147 E Tax Parcel — _ Property Number: 1 c 1 3 b I bb 5 Size: /0/A-c.., "/4 22O=") (acres/square feet) Site Address and/or Directions to Property: C'S T 44-4 f. eci., jA,lt cam; , y-', /iv, ._(eikoN j)41 Property Owner(s)of Record: ff/V- G• /-? A) I.. / 1.4_ Telephone: ((i f;tr-' ) '7 )-- •--7i,.-- Fax: _ email: i-A1(I ibt..e:C•iil�j Mailing Address: Fe) Br,L" C C /i e-H iiY/' 2ZA19• A1.4 f 8 5 j Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) U Building ❑ Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑ Address i Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑ Mowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* ❑ Shoreline Management Variance ❑ Temporary Use ❑ Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Wireless Telecommunication* ❑ Jefferson County Shoreline Master Program Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any require later inspe • ns. ss and right of entry to this property shall be requested and shall occur only during regular business hours. t, Signature: ' it C, f 7 Date: (t:-/I /bsj The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any" ividual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if y are VI —co w" the ff son County development code-The Applicant acknowledges that he,she or it holds individual and non-transferabl„r ponsibil'j kor d eying aia d complying with the ESA. The Applicant has read thisdisclaimer and signs and dates it below. Signature: ' L' tkek Date: l C:\Documents and ttings\mochil\Desktop\Master Permit Application 7-8-04.doc • I OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: /0 f- AM C? r C .NW G615C-S0 X vt1 A_-r3> ( ) ( ) MAILING ADDRESS: Pt+bert i Z( L 6-,L C,! ;C tL?A qQ C J EMAIL: CONTRACTOR'S LICENSE l r WAINS NUMBER: NUMBER `j0/1 S I4-c ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ,E' New U'Wood Existing: NM ❑ Sewer • ❑ Addition ❑ Steel Proposed: Ban ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: v Height: :J' Individual Syste .- ❑ Repair ❑ Masonry SEP Permit* qt./-0;it, CIDemolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: 'L Private well ❑ Two Party Type of Heat: Proposed: ❑ Public l-G� Total: / Name of System: 7'Z® If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or A liance Installation permit,mark all items below that apply: i Underground Tank Above gro d Tank Size of Propane Tank: Sere) yam- . 'j'r i Heat Stove Cook ove Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove i Other Is this applianc nq installed in a Manufactured/Mobile Home? es / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size, distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage ! For Office Use Only Current _ Propose. Amount Main Floor Consistency Review: 2""Fl..r Base fee: 51 3f0 Floor Additional Section: I Mezzanine: Plan Check fee: Heated Basement State-Stprefrargelee�fo pa.•.t, i t met) '1:1 Unheated Basement Pot Water Review fee: 81 Other Unheated 911/Rd Approach fee: Ext,Slr‘r\co — Garage/Carport ` jl TOTAL: $ ono Decks Receipt Number: 1 2� Other Cash/Check Number: 3 333 ESTIMA D COST(REQUIRED) Date: . //- .Fair ma et value of all labor and materials foundation to finish W///05 Initials: JUN 1 2005 C:\Documents and Settings\mochil\Desktop\Master Permit Application 7-8-04.doc JACK WESTERMAN III • Jefferson County ftrlhousc ASSESSOR PO BON 1220. PerTownsend, W.% 98368 • (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: I NAME: o4-:ii C.L -LL. i k ADDRESS: 4,S( Wi*i3 — i'J(1 C D -eS 2i ) .k ?SAC /V) Lt/. �6,,5�? PHONE NO. 36 c, 73 a 71 a-a The purpose of this questionnaire is to obt reformation regarding either the (wt current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. Po 6 c. , V SZANLA L)°) °a t-\ 1Ar.,iv"`g i i'Et L SH-Wit..re h.0 e t l A 1►MOBILE HOME DATA: 1 -$ov- c 4y --4 CJA-c S„,t‘,'VIA ,ram7i9'%� M,j {+) U-� 1,f/S S)1 rn- (A) MAKE alli- (B l( (B► MODEL '" L-J 4 ' (C)YEAR 2-6'e'-5 (D) LENGTH a C'' (El WIDTH 3 r 1�'V/-VZ r3e,E'at (F) SERIAL# 6r>1i T (G)YOUR PURCHASE PRICE (Do not include sales*ex) 0 ( 4'4 S PURCHASE DATE.)UN 3 2) PREVIOUS OWNER/LOCATION OF MOBILE OM'E: OF NEW MOVE TO QUESTION 3)�-- (A► FROM WHOM DID YOU PURCHASE MOBILE ADDRESS (B)WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes No (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK /Cl// Lot/Space # (C► IF NOT LOCATED IN MOBILE HOME °" ,/ j NAME OF LAND OWNER: _)6 N-} of 3 upfT LOCATION ADDRESS 6 54 W/-:i5.-Aite/,3 c � J c_#4-04P6:0,k l(,/ REAL PROPERTY PARCEL #/DESCRIPTION ct a 1 3 5 l O©S c / Signs re of applicant THANK YOU FOR YOUR HELP! t5ia/3 eib SS-e X cL { _ t r— JODI COSSELL. Property Technician � G ����� ��av� �!� U 141 I L- ` LDc, PA AT IS i 13 f4AN b A. tom,c 5-33, - R c: RETURN ADDRESS FAF ST HOEiiAL SO13S &LOAN P. O. Box 351 105 West 8th Street Port Angeles, WA 98362 tqlSTA i"!:OF%,Y15 H!\'C:1"Oi\' MANUFACTURED HOME -PLEEA5EGHECKDN ®TITLE ELIMINATION lICEnSInG APPLICATION ETRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty OREMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) © MANUFACTURED HOME • TPO/PLATE NUMBER YEAR MAKE ID LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) P,r)(C)C cv n C-O OX- '4'' 1 i-O(p W3 -c)t-4c 3 /eD © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE aAFFIXED REAL PROPERTY TAX PARCEL NUMBER �f REMOVED 901 351 005 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 35-29-1 W SE SE NE © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 16 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER JOHN C HALL NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER SHARON WENCKUS HALL ADDRESS CITY STATE ZIP CODE P 0 BOX 601 CHIMACUM WA 98325 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER FIRST FEDERAL SAVINGS AND LOAN ASSOCIATION NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE P 0 BOX 351 PORT ANGELES WA 98362 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I I WE AM/ARE THE REGIS ERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: 7 Signature of Registered Owner and Title,IF APPLICABLE ( ,., /—',,, / /. Signature of Additional Registered Owner and Title,IF APPLICABLE ' r it ?A. \- ;r t,1-� • I, \,;WMa ' r,;, NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE �.' c.. '••.<4 ;:•• State of Washington )("(7:, Signed or attested z..).'*r 0T AR y • County of � f e•f—5e)A-- before me on /�-01.. •:� :�r\N. _ by_ ny L . /`1C J"etGldeit Signature C" GCS' .0e,r‘<..-.--"' ► N• p \C) :F)` PRINT ME OF REGISTERED OWNER U B` NOTE AGENT i17>,••• • , \ by ".. •' `\' ��. PRINT NAME OF REGISTERED OWNER -,G, op \NI p., \\\�� PRINTED NAME OF NOTARY County/Office No.OR //I///1II10° Title..__—. AND: Dealer No.OR____ DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date • TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY I PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION I certify that: t the manufactured home has been affixed to the real property as described. a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAM PED OR PRINT ED G PERMIT OFFIC EJPHONE# 0 1 Kt:,PERMIT# SIGA RE/PO ITION l ' f s D TE 4 ~ � 0l. Llliv` ji\ ,S\,Y/Q.-t j � ) 4 *� ITD20-72NUFH L(R/2 Page 1 of 2 MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 6 SIGNATURE OF LEGAL OWNER X SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE i, `` • i. /• -! i Signature of Adgingthu Owner and Title, IF APPLICABLE NOTAR � �� \\\RYA.Q4 L,„l,, NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE • .. S e of Washington + Signed or attested /SOTA/q _I County of ( ���� �` before me on '� cn i Exp.02-16-07 3 • A(/ Cj jI INTNAME�F LEGAL t Signature'"� • B L l + � NOTARY OR AGENT /op WAS" ```.' PRINT NAME OF LEGAL OWNER PRINTED NAME OFCo NOTARY No.OR 'NUM M Title (`�� P 1 ' AND: Dealer No.OR ?) j/c- /(1,/ DEALERSHIP POSITION/AGEt4T/NOTARY Notary Expiration Date D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4 OF THE NORTHEAST 1/4 OF SECTION 35,TOWNSHIP 29 NORTH,RANGE 1 WEST,W.M. TOGETHER WITH AN EASEMENT FOR INGRESS AND EGRESS AS GRANTED BY INSTRUMENTS RECORDED OCTOBER 10, 1973 AND JULY 5,2005 UNDER AUDITOR'S FILE NOS. 220249 AND 500292, AND RESERVED IN INSTRUMENTS RECORDED JULY 16, 1984 UNDER AUDITOR'S FILE NO. 290398 AND JUNE 18, 1997 UNDER AUDITOR'S FILE NO.401360. SITUATE IN THE COUNTY OF JEFFERSON, STATE OF WASHINGTON. 8 DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT.THE VEHICLE IS CLEAR OF ENCUMBRANCES EXCEPT AS SHOWN. ANY REQUIRED SALES TAX HAS BEEN COLLECTED. DEALER NAMEg (TYPED OR PRINTED) � WA DEALER NUMBER DATE OF SALE C(J(( L:ft/ Ahs17C `Cllftr / �)4,7 J�2/2l//(> PURCHASE PRICE / TAX JURISDICTION/TAX RATE DEALER'S UTHORIZED SIGNATURE / ❑USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). 9 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) I 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 10 TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing 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. Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination, Removal from Real Property or Transfer in Location, see form TD-420-730, Manufactured Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please cal(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2 . . _ ._. -•.,-,- _ _ _ .. .) 1 .- 8 IMNaw-- [° [0 ' 0 w 0 . — ii ............_—r I. E.7 CD 0) cil 0.0 ..._,0 171 'el c— ,,-c-) ;:-• )''- 1 c z I'l-i IV -'0 --6 0 ..--•"" 0 ....6 'r ' (..— d 7 Iy4 C D tz . • Z ril Q --n rn - - - I -‘-k- 3 ° - • - V') . • 667± (f) ' c 0 rri 1. : . 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JOHN AND SHARON HALL SITE PLAN C k. i. KNA.C.ADAA., to A- q23p-s" . .,.., i . 3---+ PARCEL NO. 901—351—005 ,1 ' c:A • (.3 tC..) 7 32.-7 1,a.)., . _ . ... ,, .......,... • • •• ....... .