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HomeMy WebLinkAboutBLD2005-00401 '► • • MLA05-00363 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD05-00401 Received Date: 6/15/2005 SITE ADDRESS: BEATTIE AVE PORT TOWNSEND, 98368 APPLICANT: VICTOR LAVERGNE PHONE: 360344-4069 22511 253RD AVE SE MAPLE VALLEY WA 98038 SUBDIVISION: IRONDALE Block: 104 Lot: 11-15 PARCEL NUMBER: 962110403 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ PREFERRED HOME SERVICES PHONE: 360 808-1830 DEALER: 61 HOUSE RD SEQUIM WA 98382 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: NEW Man Hm TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 57,000.00 YEAR: 2005 LABOR & INDUSTRIES APPROVAL? SIZE: 44 x 28 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: • 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date: ( 1 �� Ppa Type Amount Paid By: Date: Receipt: , pproved/Date Manufactured Homes $157.00 RAC 06/13/05 73271 1 L� i� Permit $49.00 RAC 06/13/05 73271 OCT 2 7 2005 Potable Water Application $53.00 RAC 06/13/05 73271 effer n n Planning Total: $259.00 & A 0 • 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#: BLD05-00401 Received Date: 6/15/2005 SITE ADDRESS: 182 BEATTIE AVE Issue Date: 10/27/2005 PORT TOWNSEND, 98368 APPLICANT: RONALD JAHODA ANITA JAHODA 74 HILTON PORT TOWNSEND WA 98368 SUBDIVISION: IRONDALE Block: 104 Lot: 11-15 PARCEL#: 962110403 Section: 34 Township: 30 N Range: 01 W CONTRACTOR/ PREFERRED HOME SERVICES PHONE: 360 808-1830 DEALER 61 HOUSE RD SEQUIM WA 98382 PROJECT DESCRIPTION: New Manufactured Home MAKE: SKYLINE YEAR: 2005 SIZE: 44 x 28 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/27/2006. CALL IN FOR THE REQUIRED INSPECTIONS THAT APP • OUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTINc SLA: .r PADS USED): e,--F246. //-S7 Stormwater FINAL Approval: Blocking/Plumbing: - - Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 3 Ae"c94o HEALTH DEPARTMENT AND PUB IC 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 # BLD05-00401 1.) The road approach permit (RAP05-00127) must be inspected and finalled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact the Department of Public Works at 360-385-9160 for the final road approach inspection. 2.) The application was reviewed by the Jefferson County Department of Community Development staff on August 12, 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, the following ESAs were confirmed to be present on the subject property: Airport Noise, Susceptable Aquifer Recharge Area (SUSC), Coastal Seawater Instrusion Protection Zone (SIPZ). 3.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 4.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 5.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. • 9.) VOLUNTARY MEASURES COASTAL&AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 10.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 11.) The applicant is proposing to create or add 1,425 square feet of impervious surface and 4,100 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington 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. 12.) 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. 13.) The project shall comply with Construction Stormwater Pollution Prevention (SWPP) Elements#1 through #12 of the Department of Ecology's Stormwater Management Manual for Western Washington 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. 14.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 15.) 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). 16.) The revised site plan as submitted on September 8, 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 September 20, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 17.) 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. 18.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 4 19.) 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). 20.) Pre-existing legal lots of record less than one acre in size in Rural Residential districts are subject to the stormwater requirements in UDC Section 6.7 and must meet the"Area of Impervious Surface Coverage" to the maximum extent practicable as determined by the Administrator." Lot coverage is defined as amount of impervious surface, which includes rooftops, driveways, concrete, etc. 21.) The building height is not to exceed 35 feet. 22.) 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. 23.) 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. 24.) Setback from Beattie Ave. right-of-way is no less than 20 ft., setback from Meader Ave. right-of-way(unopened platted right-of-way to the south) is no less than 20 ft.side and rear setbacks are no less than 5 ft. If an environmentally sensitive area (ESA) is present, then the more restrictive setback shall apply. 25.) This is a legal non-conforming parcel designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 26.) A septic permit (SEP05-00296)was approved October 26, 2005 for a capacity of 360 gallons per day. 27.) Beattie Ave. (C678309) is a county local access road. A road approach (RAP05-00127) was approved on June 6, 2005 and an address of 182 Beattie Ave. has been assigned to the parcel. 28.) A minimum of two (2) on-site parking spaces is required for the single-family residence. 29.) This parcel was created through Irondale Div. 4 under AFN 30605, recorded July 14, 1910, Volume 2, page 141 with the Jefferson County Auditor's office. 30.) A Declaration of Restrictive Covenant was recorded September 9, 2005 under AFN 502854 with the Jefferson County Auditor binding lots 11 thru 15 of Block 104, Irondale No. 4 for the purpose of meeting bulk and dimensional requirements and minimum land area. 31.) The subject property is located in the proximity of the Jefferson County International Airport(JCIA). The JCIA is a public, general aviation airport with a hard surfaced 3,000-foot, 12,500-pound weight bearing capacity runway. JCIA experiences frequent landings and take-offs. Structures located in the proximity to the airport will, to varying degrees, be subject to noise and vibration from aircraft during take-off, landing and approach activities. 32.) The assessor's records indicate a cabin on the property. Building department staff conducted a site visit on September 30, 2005. The building is a 2-story building with gas pipe and chimney, no kitchen facilities and no plumbing. JCC 18.10.040 defines dwelling unit as "one or more rooms or structures designed for occupancy by an individual or family for living and sleeping purposes, containing kitchen facilities and rooms with internal accessibility, for use solely by the dwelling's occupants." Development Review staff concluded the existing building is not a dwelling unit or residence. JACK WESTERMAN Iiii Jefferson C 1'ourthon . ASSESSOR :: i PO Ito* I MP f vr .�A fort To m444-nd, t '"- F 4360) :un-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: JtiO�� �� a NAME: /`t O/✓4t4) /41-He g4 , ADDRESS: * 7 if Ai//_ roA( 'J P//2-1- 70 1.A//VJ EA' 0 PHONE NO. 3 V Y- — gO ec.,cJ The purpose of this questionnaire is to obtain information regarding either the 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 be, ,,, ed to this county from another area. CQ '' 1)MOBILE HOME DATA: h r (A) MAKE � G-/./L✓�-� (B)MODEL k�SIAie, �� a j`'' /�A��- (C)YEAR � l (D) LENGTH L 7 (E)WIDTHf_ p��4 nl y�r� (F)SERIAL # 4G)YOUR PURCHASE PRICE (Do not include sales tax)C- DC� _ PURCHASE DATE TUz--'4200 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (I " OVE TO QUESTION \ (A) FROM WHOM DID YOU PURCHASE MOBILE ��L. /t 6$I -7SS 5' ADDRESS O��/S �/ �/ (B)WAS MOBILE HOME ASSESSED WN JEFFERSO1COUNTY LAST YEAR?Yes No If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. /bl/4 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 Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: V 1Lt-7)72 /-/4vt- y/V6 LOCATION ADDRESS /L > gE7 717 T i.J 8--t , REAL PROPERTY PARCEL #/DESCRIPTION ? '�//a 116 3 G-6 T.S /7 7 AK)/S /46, 1 fT .67 4 Signature of applicant THANK YOU FOR YOUR HELP! 4JOD� COSSELL. Property Technician �g50N co JEFFERSOR UNTY A DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend •Washington 98368 ' A . 360/379-4450 . 360/379-4451 Fax J U C 1 3 2005 1`SHING9 www.co.jefferson.wa.us/commdevelopment f Master Permit Application MLA: Project Description 5ipcludle separate sheets as necessary): 114 AA )/crG"r1/i2-e-,4 4 omee- .fief vp y S'-e v77C #- 611.c'l ye- Tax Parcel .76 !10 tid 3 L o r.c Property /00 X/Z.S " Number: (� J J/-(S Size: I3F�rT7'ik A✓� /L, s'on S' ..1.74. (acres/square feet) Site Address and/or Directions to Property: � Property Owner(s)of Record: V[CTp� L V / Lys-/f 2S`'3rd f f S& M p pte Vc /(G c' Telephone: 72S �3 2 5r-03 2- Mailing Fax: email: Address: ApplicantlAgent(if different from owner): <`o�/QLB 0� A'NiT4 J,' H d O,q Telephone: Q 3,-/v 10 YO 6 q Fax: Mailing Address: 71 f '- t.U -r /r4 VE p, Ti. email: What kind of Permit?(Check each box that applies) wilding ❑Variance(Minor, Major or Reasonable Economic Use) 0 Demolition Permit ❑ Conditional Use C a , C(d), C ** ❑ Single Family ( ) C( ), 0❑Garage Attached/Detached ❑ Discretionary"D"or Unnamed Use Classification GaragectAttaured heHo / ❑ Special Use(Essential Public Facilities)** ❑ Modular ❑ Boundary Line Adjustment ❑Commercial* 0 Short Plat** ❑Change of Use ❑ Binding Site Plan** ❑ Long Plat** ❑Address C 1 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"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 requiredir/ later inspecionnss,.Access and right of entry to this property shall be requested and shall occur only during regular business hourSignature: 1214i , / tic / eki Signature: "mil J f7 �1 / / Date: ,-/2.f—/v r 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 individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-tran erable r�bili for h rin to and complying with the ESA. The Applicant has read this disclai er and igns and dates it below. Signature: J Date: s 2„ 0 r \ \PermitCenter FORMS\DRD FORMS\Master Permit Application 7-8-04.doc 3 • OWNER BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that y 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: / ���� ( ) 6/0(/b EI H.6/✓/ S (360) 6//V MAILING ADDRESS: 16/5-8l H w4 /v/ J n eCJ�!r'� EMAIL: (Ale y0khArf7d)+42eS_Cat" CONTRACTORS LICENSE p per$get R F 131Z / WAINS ui K, y t fj NUMBER: (.�EZ�R� `- Pt><eCf�dL�� NUMBER N ARCHITECT/ENGINEER: HOPr ter5PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: 0C Wood Existing: �' ❑ Sewer o Addition ,❑L Steel Proposed: Bank ❑ Community System ❑ Alteratiration/Remodel ❑ Concrete Total: Z Height: 'Individual System SEP Permit# [I Repair ❑ Masonry Bedrooms: Water Supply: Li Demolition ❑ Other: Existing: .3 Setback: ❑ Private well ❑ Two Party Proposed: (Public Type of Heat: Total: - Name of System: �encf�.�r"i CthoL rro1Daft Qi i—f If this is a Commercial Proiect you must answer the following: Number of ADA Parking Spaces: Number of Parking Spaces: Current: Proposed: Number of occupants(includes owners,tenants,employees,etc) Current ProposedWill you have Food Service? Yes / No IBC Occupancy: IBC Type of construction: If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑ Underground Tank XlAbove ground Tank Size of Propane Tank: Zed ( i Heat Stove 'Cook Stove ❑ Woodstove II Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other s this appliance being installed in a Manufactured/Mobile Home? es / No When applying for a permit to install a propane tank you must also su mit 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. - I ISquare Footage For Office Use Only Amount Current Proposed Main Floor Consistency Review: 41(.o0 2Nu Floor ` Base fee: i 5 l (O 3ro Floor i Additional Section: ,+� ,�,�\ �' Pee Pile- `t -W Mezzanine: j JUN 3 ZOO Il Plan Check fee: , � '. : , 1 Heated Basement L___--- State Surcharge fee: �- ,`._1'1.I; t,' I {.;. :I�7 Pot Water Review fee: W Unheated Basement _ - 231. Other Unheated 911/Rd roach fge: 1Z� �'* Garage/Carport TOTAL $ +2.CIO Decks Receipt Number: ) 1 I Other Cash/Check Number: \VALI ESTIMATED COST(REQUIRED) Data' .Fair market value of all labor and materials foundation to finish Initials: k� G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • • RETURN ADDRESS L/JSTATo.�mrCP'Fn/�rw^.SH,NGTON' MANUFACTURED HOME 'L AS CH CKONE ITLE 1��, lICEnSInG APPLICATION RAN ELIMINATION TRANSFER 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) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 2005 Skyline 44 X 28 © LAND LEGAL DESCRIPTION ON PAGE r�-�.�� R �R91ERTYTA PyRCEL)MBER MANUFACTURED HOME WILL BE AFFIXED Ej REMOVED �L 1111 VV [C��1rCEL LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 11,12,13,14&15 104 Irondale,Division No.4 © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 1600 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Ronald Jahoda NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Anita Jahoda ADDRESS CITY STATE ZIP CODE 74 Hilton Port Townsend WA 98368 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER First Federal Savings&Loan Association NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE P.O.Box 351 Port Angeles WA 98362 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: /j Signature of Registered Owner and Title, IF APPLICABLE L�i�� % y0 Signature of Additional Registered Owner and Title,IF APPLICABLE—..._/ 4 `�'�a�z'( / `�� ri N01l.1povs A2`bA y P \E•J• R �ttt NOTARIZATION/CERTIFICATION FOR REGISTERED rWNER(S)SIGNA URE T=,LPG ...• ••FAQ t►tr I State of Washington \• \ 'signed or: est- C' .•.S\ N F Ai iftI County of,..�1 ��� 1 1 befor: e.n ` s\ QTARy 9m: �. J �i p i •� CA: Eby I�Gr jCi l�L C%�, Sicmatur� •J w li PRINT NAME OF REGISTE iED NER ;N• _ ,�_ !► . ' >� �% PUBt\0 �� ,'by � -� . -+ . - C ( — .. r Qi ci /rr '•. 3_ 09,.: O�� PRINT NAME OF RE STE D NER PRINTED AME OF NOTARY L9 County/Office No.OR I r I;(�� W c,,AO I Title � �"1 AND: Dealer No.OR_ t 1 1jOF A ` I DEALER HIP POSITION/AGENT/ TARY Notaryp %%%„���v Expiration Date 4 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/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: �$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. 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