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HomeMy WebLinkAboutBLD2005-00575 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#: BLD05-00575 SITE ADDRESS: 61 PLUTE RD Received Date: 9/6/2005 NORDLAND, 98358 Issue Date: 9/9/2005 APPLICANT: STEVEN W MORRIS ANDREA LYNN MORRIS 61 PLUTE RD SUBDIVISION: NORDLAND WA 983589644 Block: Lot: T 19+ PARCEL#: 021282021 Section: 28 Township: 30 N Range: 01 E CONTRACTOR/ BUY RITE HOMES DEALER 3543 W STATE HWY 16 PHONE: (360)479-0795 PORT ORCHARD WA 98366 Contractor's License BUYRIH*0840B Expires 5/20/2006 PROJECT DESCRIPTION: REPLACEMENT OF OLD MFH W/NMFH. NEW FOOTPRINT & LOCATION ALSO /VG 100 GAL PROPANE TANK. MAKE: KARSTEN YEAR: 2005 SIZE: 48 x 26 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 9/9/2006. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing: ,8re� k1 4 1�, J7oW,S ow I(/)/dr,• Propane Tank/Lines c,t-te7Zj0)2.-J`AS-iF 4'7;200K afe- Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: � -1 L 6-2 HEALTH DEPARTMENT AND PUBL 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 111111111111111111111111111111.1.111......--- t1LDING PERMIT MLA05-00539 APPLICATIN LReviewAO5 Type:05I Department of Community Development Jefferson County Port Townsend, WA 98368 621 Sheridan Street PERMIT #: BLD05-00575 g1612005 Received Date: SITE ADDRESS: 61 PLUTE RDNORDLAND, 98358 OWNER: STEVEN W MORRIS PHONE: 360-385-2920 ANDREA LYNN MORRIS 61 PLUTE RD Lot: T 19+ NORDLAND WA 983589644 Block: SUBDIVISION: Section: 28 Township: 30 N Range: 01 E PARCEL NUMBER: 021282021 1 PHONE (360)479-0795 CONTRACTOR: BUY RITE HOMEStCdt .�4.kp 3543 W STATE HWY 16 LJJ PORT ORCHARD WA 98366 Contractor's License BUYRIH*0480B Expires 5/20/2004 PHONE: REPRESENTATIVE: TIOP REPLACEMENT OF OLD MFH WINMFH. NEW OPANE TANK.FOOTPRINT & PROJECT DESCRIP LOCATION ALSO AIG 100 GAL PR MOB SQUARE FOOTAGE: TYPE OF WORK TYPE OF IMP NEW MAIN: 1,280 PRO VALUATION 61,115.00 ADM: HEAT TYPE:EAT TYPE: 2003 HEAT BASE: H OF STORIES: CODE EDITION: R_3 UNHEATED: OCCUPANCY: OTHER: SHORELINE: OCCUPANCY: 5N GARAGE: SETBACK: CONST TYPE: DECK: BANK HEIGHT: CONST TYPE: SEWAGE DISPOSAL: ALT WATER SYSTEM: PWELL BEDS BATHROOMS: Exist: 0 Exist: 0Prop: 2 Prop: 2 Total:2 2 Routing Date: t G Receipt: Approved/Date $157.00 SLE 09/06/05 76653 H Amount Paid Bv: Date: A P P R O V j ED Type Permit $49,00 SLE 09106/05 76653 q 2005 Propane Tanks/Stoves 09/06/05 76653 SEP Application $53.00 SLE Potable Water Total: $259.00 Jefferson County Planning &B Department A1 Al * , QV.c_P C.4& `\ JACK WESTERMAN III ! Jefferson Count-' thouse . ASSESSORlur,I'O Box 1220, how ownscnd.WA 98368 Cp y (3601 385-9105 MOBILE HOME INFORMATION Fir 10 1.4 U w OWNER'S NAME/MAILING ADDRESS: SEP ' 6 20O5 n NAME: 54 E Lsc y i' lt-vs r e cn N\_0 ! : i ADDRESS: (v I �t i.:t f�.. `f:.t•3 �(, cc). � ri �i�� { � 15 _� Ci • PHONE NO. 3c c) :�(. �.__._______..._ _._..�__----._.__ __ ` 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 been moved to this county from another area. 10MOBILE HOME DATA: (A) MAHE > - cccC'V I F" tc ' (B)MODEL I<S `"I SIC 5 a (C)YEAR 2rf1,5 / (D►LENGTH / iS } (E)WIDTH 2 t i8." (F)SERIAL# c't ,`e'r (G)YOUR PURCHASE PRICE(Do not include sales tax) � l l5 . r PURCHASE DATE T eft 4'reef cin-T I I(-rim f 20 PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF 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 (ie.! (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: ` E v E' `i i1 Pc:= A.(". c \ 'S LOCATION ADDRESS IBC= t 1 t k* € �Q.t., ill C' ; c \c%- (A C)) ''3 P 9 3 5 'J REAL PROPERTY PARCEL#/DESCRIPTION c' Z 1 Lb-2. n 2. 5 Zq• T .3c E Z :E,c,cr -5 , 1 ll 1 k Signature oflapplicant THANK YOU FOR YOUR HELP! 055S1-121_�C JO COSSELL, Property Technician • • SPECIAL CONDITIONS CASE # BLD05-00575 1.) The application was reviewed by the Jefferson County Department of Community Development staff on September 8, 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: Eagle; SARPA aquifer recharge area; high risk SIPZ. 2.) 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. 3.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 4.) Critical Aquifer Recharge Areas are defined as Seawater Intrusion Areas, and Special Aquifer Recharge Protection Areas and the following land uses located within Susceptible Aquifer Recharge Areas (1)All Industrial Land Uses (2)All Commercial Uses (3)All Rural Residential Land Uses requiring a Discretionary Use or Conditional Use Permit(4)All Rural Residential Land Uses with nonconforming uses that would otherwise require a Discretionary Use or Conditional Use Permit (5) Unsewered Planned Rural Residential Developments (6) Unsewered residential development with gross densities greater than one unit per acre. All of the above listed uses shall be subject to the applicable requirements and standards of the Jefferson County Unified Development Code. 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 High Risk SIPZ (seawater intrusion protection zone) according to the County GIS map. There are 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 High Risk SIPZ is defined as: areas within 1,000 feet of a groundwater source with a history of chloride analyses above 200 milligrams per liter(mg/L). 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.) MANDATORY MEASURES O IGH 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 HIGH RISK 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 requirements: a. Variance from Chapter 173 WAC standards granted by Ecology per WAC 173-160-106 for a new groundwater well within 100 feet of a sea-salt water intrusion area per WAC 173-160-171 (i.e., within 100 feet of a groundwater source showing chloride concentrations above 200mg/L or within 100 feet of the marine shoreline); or for an existing or proposed groundwater well not subject to an Ecology variance, applicant must provide evidence through a hydrogeologic assessment (relevant components of an Aquifer Recharge Area Report per UDC 3.6.10.e) of a reasonable probability that the subject aquifer will not be degraded by the proposed use of well. b. Installation of a flow meter. c. On-going well monitoring for chloride concentration. d. Submittal of flow and chloride data to the County per monitoring program. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 11.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 12.) The applicant is proposing to replace an existing manufactured with a newer manufactured home within the same footprint. 13.) 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. 14.) 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). 15.) The site plan as submitted with the manufactured installation permit application on September 6, 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 8, 2005 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 16.) This approval is for a manufactured home replacement 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. 17.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. • 18.) Not more than two (2) unlicensed or inoperable vehicles shall be stored o than one-half acre unless totallyscreenedn arty lot less 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). 19.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 20.) The building height is not to exceed 35 feet. 21.) 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. 22.) 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. 23.) Minimum setback from Plute Road right-of-way shall be 20 feet. Minimum side and rear yard setbacks shall be 5 feet. 24.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 25.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 26.) An address of 61 Plute Road, Nordland has been assigned to the parcel. Plute Road is a private road (P132). 27.) The proposal is not subject to the SIPZ requirements for High Risk as this is a replacement manufactured home and potable water has been previously proven. 28.) The proposal was not sent to WDFW for Eagle hit as this is a replacement of an existing manufactured home in the same footprint. 29.) A septic permit(SEP71-0063 was finaled on Auguat 23, 1971 and is now filed with SEP05-0250. 30.) There is a pending complaint case (COM05-0013) regarding accumulation of junk vehicles and other debris. Due to the potential fire hazard of the existing older home and the fact that there has already been a fire at the home, the county is eager to issue this permit for replacement of the home so that there is no further risk of fire and harm to the occupants. The issuance of this permit(BLD05-0575) does not rectify the existing complaint and that the complaint will be dealt with on a seperate basis by code enforcement personnel. o • ,���'`'S jN c06 JEFFERSON�NTY E�.,., ((-. � ��``�—�- �____,� 4410 DEPARTMENT OF COMMUNITffLaOF1018NT L'-7 ��'` lik 621 Sheridan Street • Port TOWllse id •Washington 98368 I 360/379-4450 • 360/379-4451 �a� ��tt pIp 4 O'. www.co.Jefferson.wa.us/commdevelopm814tP — 6 � f!. - 1 14r7NG j i Master Permit Application MLA: C``.�) j:. Project Description(include separate sheets as necessary): I t,p[r E" -5.c ,, ;t \-,c 0,\tz v , E, ‘ ( Ls_ , i\c,,,-,«c c c_ ,e r V c c\e- CiS\L 11`1`.)A--t~_\lk tl.€ LI3 .5 e.. 0 y-; c_. ')y 5 k'_.tti Tax Parcel Property Number: 0 2.1 2 S Z 021 Size: 2 , tCc-e square feet) - Site Address and/or Directions to Property: 4: ( Pt.t_4-e ,'cf, t,r--J 1 c.rn dI t.t_)A <t$ 5)g Property Owner(s)of Record: *E .: C. 'A A r1 r1 C E C� NA c_l Vic- ; % '`-- Telephone: 7 ; `a' -}` Fax: email: I\c..' •••.elf: C'- :c:, iti5/).ct'/I Mailing Address: /,,.i 1)i , k.1..fJ !\l'e, '\r`., ,-,' t r.r,�: _-•' A `f is- 5 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) 0 Building ❑ Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a), C(d),or C)** ❑ Single Family 0 Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** AManufactured Home ❑ Boundary Line Adjustment ❑ Modular 0 Short Plat** ❑ Commercial* 0 Binding Site Plan''* O Change of Use 0 Long Plat** 0 Address ❑ Road Approach 0 Planned Rural Residential Development(PRRD)/Amendments** '1tLPropane 0 Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions*" 0 Stomiwater Management ❑ Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Variance 0 Temporary Use 0 Comprehensive Plan/UDC/Land Use District Map Amendment 0 Wireless Telecommunication* 0 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 Ws 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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. t_v,flevi upt:A..� Signature: ,,...4�.� ,e. .'mac r -- C \,~\,' . ) Date: `i •- t _ f"'J 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-transferable responsibility for adhering to and complying with the ESA. The Applicant has read this disclaimer and signs and dates it below. Signature: l e ,(. Y % t.ttl.,i_.. _. Date: t ! • g - C`' c G:\PemutCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc • 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 rmnsibility of the General Contractor for the proposed project. Signature:... / --u - � b/ln;-'l_iL 7 gate: 'i / •_L;`) -,,r, ,..e-. c(l:-.r \- l r . ,i' GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: l L'L L. l�jt� �e'i-cle �. (-i IcC) 051 -C 7 7 7 (31-.c) �S' 1 - C. 7$c:. MAILING ADDRESS: ? 5 `i L/t`'.3 1--1.,,-1 ic I ' i<i,,t, ryl WA EMa.IL: 5 eci�..:, t.1 1( '_‘2 _t .i t- t v-fi 1 t <f'r�i CONTRACTOR'S LICENSE WAINS. NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: �!7 Shoreline: Type of Sewage Disposal: )2' New N" Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: 7-. Bank ❑ Community System O Alteration/Remodel 0 Concrete Total: 2- Height: IS, Individual System CI Repair CI Masonry SEP Permit# C`j-, Dc ') ❑ Demolition ❑ Other: Bedrooms: ,p1 Water Supply: Existing: - Setback: $ Private well ❑ Two Party yp Te of Hea Proposed: 2. ❑ Public s ;�� E. Total: 2- Name of System: If this is a Commercial Protect 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 Appliance Installation permit,mark all items below that apply: ❑ Underground Tank 0 Above ground Tank Size of Propane Tank: ).(rO " '.-,-1 ❑ Heat Stove ,L9. Cook Stove 0 Woodstove ❑ Fireplace Insert V, Hot Water Tank p Pellet Stove 0 Other Is this appliance being installed in a Manufactured I Mobile Home? Yes /(N� '44C:n to 1t^.c..fti r t i" h a.(c4..�<j • rt Ail)'i;c'IN I `> 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, --., E:including the reserve area. - < 1 1 c),Yri- Square Footage For Office Use Only Current Proposed Amount Main Floor • Consistency Review: l i (1) '- 214"Floor _ Base fee: l 3"0 Floor I1R _{; ' L --- r Mezzanine: I f � I I heck fee: ,J SEP - i; us _ f Heated Basement f `S el Surcharge fee: Unheated Basement Pot Water Review fee: C,"r r 1 %./-- Other Unheated 911/Rd Approach fee: f Garage/Carport 3 : -. _3 .,.. ,„.. 3.- TOTAL: $ 3 1, " , Decks j x '' Receipt Number. '7 (r Other Cash/Check Number IU O ESTIMATED COST(REQUIRED) Dater t 1 i •Fair market value of all labor and materials foundation to finish i0 J i 2.5, cc c, t rc, Initials: (\ G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 7-8-04.doc RETURN ADDRESS 'c \ 4vv\e.C.Z.V -1.‘�-1e C '10(-V 0..A.Iv \ytr\.k LAD A .q 536e) Lrp f )F`WASHIVCIC'N MANUFACTURED HOME,,.., ir7g 'FYxe'74q t•]aii Amh.,�I n-P TITLE ELIMINATION liCEnsinG APPLICATION OTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty rOFIEMOVAL 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 I MAKE LENGTHNVIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 2005 Situ•Vi.co 48 X 26.(t Tic C5 T a R- y d,5- a .3 90/ ® LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE II AFFIXED U 021282 82 REMOVEDREAL 0TY TAX PARCEL NUMBER 021 LOT I BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 2 28/30N/R 1 E ® GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE 1 COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 1600 2 111 1 NAME OF REGISTERED OWNER STEVEN WADE MORRIS DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTERED OWNER ANDREA LYNN MORRIS DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 61 PLUTE ROAD NORDLAND WA 98358 NAME OF LEGAL OWNER FIRST FEDERAL SAVINGS&LOAN DOL CUSTOMER ACCOUNT NUMBER 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: " �� Signature of Registered Owner and Title, IF APPLICABLE��. �ti �4e� `�' �-G!/r t,Signature of Pi1ili/tional Registered Owner and Title, IF APPLICABLE ,.,� C�c.._ T L'—`Thj \. ,\,`�Th N`\�1,0* �hA,t,�P'j I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE 4:.`��� .. ,. I State of Washington Signed or attested • PRY . •' County of 'e-vte.J`�au < Z•• t .Z'�I �6'efoCe me on �G"��_,� W• O y¢ ��' �K1 arre by C i )C.� L C ��GC(� ) Signature J J Lo- a • • .• PRINT NAME OF REGISTERED OWNER NOT O AGEI put, ,�v /// q p. ♦ PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Oftice No.OR iiii; ///°jf!!!!!``,♦ I Title f �Z\\ V V 4,)\f �` AND: Dealer No.OR DEALERSHIP POSITIONp GENT/NOTARY Notary Expiration Date 4 TITLE COMPANY CERTIFICATION Co IS i I certify that the legal description of the land and ownership is true and correct per the real property records. NAMWYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER r e_Q.. . 8_✓Y\e" . -it A �ec -T%H I3a SIGN TUR POSITION t� \ C i i ' + ,( DATE Fina Ize this plication with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILD PERMIT OFFICE CERTIFICATION I certify that: 'the manufactured home has been affixed to the real property as described. El a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(TYPED OR PRINTED) BLD PERMIT OFFICE/PHONE# BLDG PERMIT N q h,.�. A,o nz-5 u kiA,r �- 3(0 o).31 I - L) O 65 --005'75 SIG URE/P.SITI tit DATE I/14U lui,),) rzn,,,,,,,t ,..)1,,L_ , ,ci I I)7 TD-420-72 MANUF HOME APPL(R/2/02)OR(W)Page 1 of 2 MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 2005 48 X 28 D SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITL /REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title; IF APPLICABLE �lj LL�/ Oltillltl///// Signature I 1 stg w and Title,IF APPLICABLE NOT.. O 9 N I'e NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE , ,NR)' Stat f Washington Signed or attested d.07 Z Countyof ('T AT.T eM — �` OZ 1 y. Cbefore me on 5/2/05 N • P U 61' INT FEDERAL SAVINGS & LOAN ASSl�ignature S)-)Ar T NAME OF LEGAL OWNER OA rrG - ' �O OF v4.- AN,,,;``PTTNAHOPPPR-LOAN CLOSRR MART SHIELDS' R AGENT �///111111t1111�f1�r A LEGAL OWNER PRINTED NAME OF NOTARY I Title NOTARY CountyDeal r No.OR AND: Dealer No.OR 02/16/07 DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office Parcels 1,2 and 3,Portion of Government Lot 2,Section 28,Township 30 North,Range 1 East,W.M.,as fully described on page 3 attached hereto and made a part hereof. a 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 NA E(TYPED OR PAINTED) ,1 ii WA DEALER NUMBER DATE OF SALE 0 \/ — &t- Ht)ki -s 11 4(0 2k /I MO S PURCHASE PRICE I TAX JURISDICTION?AX RATE I DEAL 'S AUTHO ED SIGNAT RE `� 1 d47h 0 Z i 0500 t.?'2 D ❑USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). 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) I COUNTY OFFICENFS OPERATOR NUMBER SIGNATURE I DATE 10 TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE I USE TAX 9.00 111 SUBAGENT FEES 15.00 25.00 TOTAL FEES&TAX MPORTANT: Once the application has been approved by the County Auditor/Vehicle 49.00 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-420-723 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2 I 09/13/2005 09:54 5037696022 KARSTEN HOMES • PAGE 04/04 k `-- r.=-• u\N. \../ I T2 CillIEMIO 1 P inailq a•-, !gg . i --- 41 11[1111FIEr ii . - f i I._--LILA. 26'4" I 46ei1H 14°xF3itIV ,- 1 ben 0 1 f-- I I 1 VI IIN--Igi . 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