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HomeMy WebLinkAboutBLD2006-00168 • • 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 #: BLD06-00168 Received Date: 4/6/2006 SITE ADDRESS: 294 GREEN MOUNTAIN LN Issue Date: 5/1/2006 BRINNON, 98320 APPLICANT: JEFFREY TRUPPNER CHERISHA TRUPPNER PO BOX 237 HOODSPORT WA 98548-0237 SUBDIVISION: GREEN MTN SHORT PLAT Block: Lot: 1+ PARCEL#: 602352028 Section: 35 Township: 26 N Range: 02 W CONTRACTOR/ WASHINGTON HOME CENTER INC: PHONE: (360) 427-6667 DEALER PO BOX 176 CHEHALIS WA 98532 0) Contractor's License WASHIHC0770A 6Exp es8493 3//9/2007 PROJECT DESCRIPTION: NEW MFH (MODEL - DISCOVERY 4603K) MAKE: SILVERCREST YEAR: 2006 SIZE: 60 X 26'8" THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 5/1/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): —l2_--0 L. Stormwater FINAL Approval: Blocking/Plumbing: -- )—C){:* Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: —2—Oto HEALTH DEPARTMENT AND PUBL C 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 96ILDING PERMIT APPLICATI R MRL Review Ty 161 ype: l Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00168 Received Date: 4/6/2006 SITE ADDRESS: GREEN MOUNTAIN LN BRINNON, 98320 OWNER: JEFFREY TRUPPNER PHONE: (360) 877-6374 CHERISHA TRUPPNER PO BOX 237 HOODSPORT WA 98548-0237 GREEN MTN SHORT PLAT SUBDIVISION: Block: Lot: 1+ PARCEL NUMBER: 602352028 Section: 35 Township: 26 N Range: 02 W CONTRACTOR: WASHINGTON HOME CENTER INC PHONE: (360) 427-6667 PO BOX 176 CHEHALIS WA 98532 Contractor's License WASHIHC0770A Expires 03/19/2007 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION NEW MFH (MODEL - DISCOVERY 4603K) TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW MAIN: VALUATION 67,035.00 ADD'L: HEAT TYPE EEE CODE EDITION. 2003 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 2WELL BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: AKfrotvitatevE Manufactured Homes $163.00 KAS 04/06/06 80896 Potable Water Application $55.00 KAS 04/06/06 80896 MAY I 2006 Total: $218.00 Jefferson County Planning & Building Department Coin, JACK WESTERMAN I• Jefferson (Sty Courthouse ASSESSOR PO flex 1220, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: •T FP/LLry S 7'tJW 4 720,,n'l-rit ADDRESS: /7.O , ?So)? 23 7 IlovizI'o,zj C!'•k FAria PHONE NO.(360) P7? -1o37y 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. 1)MOBILE DOME DATA: (A) MAKE S1LVc,2C,Jec T (B) MODEL Z/SCcegily y 1((C) YEAR 2-°0(o (D) LENGTH (0/ (E)WIDTH of If// (F) SERIIAL # Nia4.9 (G)YOUR PURCHASE PRICE (Do not include sales tax ._Q703w4URCHASE DATF3//SAb 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) MEW (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 Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARIS: NAME OF LAND OWNER: .3l:f-FA. y S 04?2VS/Mt .J /20/01"A/17Z. LOCATION ADDRESS Catch! 1fl6Ai ,e.A/ 5/9 / a/e-/, /oIy (��¢ REAL PROPERTY PARCEL #/DESCRIPTION 602 3S—Z. 02.2 aLE C E \L I) Si nature of licant THANK YOU FOR YOUR HELP! APR - 6 2006 ss-e Q JODI COSSELL, Property Technician echnician JEFfEHSON GHO Eli a cn w to — • • Cl) a) cd o C4r O m '9O = - a xt: 0) fl H c0i s pc �` o n '4' i s 5 0 m 0 0 0 26'-8" r' I o� a) cn n, pp''C' O _ 00 p 477 '19W1Y �.f y it .. m s23 a Q- 1...-..., INIIIIMIIIMME' N 1r■■■■■ 11 C f) A -O 0) d N C 1cz, c �T z v i , T',.-s,„ r.......ft 1 4„ Nig Q _ � f IiállIiIII i CO ty I CD ��.``- IN- 12 l IC mum TT I cn N mom `V i . Elms ,,, ___ . ,,---- _____, 0 ____ II!!!!!ip 111- NMI Iiiiiii ti ■■■ i m 1msssE■ n ■E■ cr:, ll o II I11 or A 1 - t ' ■■ - ini; (/) 1 ■■ ■III 1 N ' IIE .., .+ice .. - et -, le'D iq I 1 .-r RECEIVE I) 11 IDd J C:;; CZ APR - 6 2006 W JEFFERSON COUNTY HO . 1 c. w0-3 N C O 'C O C7 D) ft 'T • • SPECIAL CONDITIONS CASE # BLD06-00168 1.) The application was reviewed by the Jefferson County Department of Community Development staff on (date) for the potential presence of Environmentally Sensitive Areas April 18, 2006 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: Type 5 Streams, Level I Landslide Hazard Areas and Susceptible Aquifer Recharge Areas. 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.) Geologically Hazardous Areas in Jefferson County are characterized by slope, soil type, geologic material, and groundwater that may combine to create problems with slope stability, erosion, and water quality during and after construction or during natural events such as earthquakes or severe rainstorms. 5.) A Type 5 Stream (Fish and Wildlife Habitat Area) has been identified on the subject property. The stream will require a setback of 50-feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM). Fish and Wildlife Habitat Areas shall also have Buffers and Building Setbacks established. 6.) Buffers are areas that shall be maintained in their natural condition, however, minor pruning or alteration of vegetation may be permitted as long as the function and character of the buffer are not diminished. 7.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea Sitchensis), Shore Pine (Pinus Contorta), Douglas Fir(Pseudotsuga Menziesii), Western Red Cedar (Thuja Plicata), and Western Hemlock (Tsuga Heterophylla). Among native tree species which may be used includes: Vine Maple (Acer Circinatum), Big-Leaf Maple (Acer Macrophyllum), Red Alder(Alnus Rubra), Pacific Madrone (Arbutus Menziesii), Quaking Aspen (Populus Tremula), Black Cottonwood (Populus Trichocarpa), Bitter Cherry(Prunus Emarginata), Oregon White Oak (Quercus Garryana), Cascara (Rhamnus Purshiana), Pacific Willow(Saliz Lasiandra), and Scouler's Willow (Saliz Scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier Alnifolia), Red Osier Dogwood (Cornus Stolonifera) Salal (Gaultheria Shallon), Ocean Spray (Holodiscus Discolor), Indian Plum (Oemlaria Cerasiformis), Pacific Ninebark (Physocarpus Capitus), Red Flowering Currant (Ribes Sanguineum), Wild Rose (Rosa Nutkana), Swamp Rose(Rosa Pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus Racemosa), Snowberry (Symphoricarpos Albus), Evergreen Huckleberry (Vaccinium Ovatum), Red Huckleberry (Vaccinium Parvifolium). 8.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 9.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 10.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 11.) All construction activities shall not encroach upon the buffer. This includes the storage or preparation of materials. • . 12.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 13.) 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. 14.) The identified Fish and Wildlife Habitat Area (Type 5 Stream), shall maintain a vegetative buffer setback of 50 feet. The setback shall be measured horizontally from the Ordinary High Water Mark (OHWM) to the proposed manufactured home. 15.) An additional setback of five (5) feet is required from the edge of the buffer area to the proposed manufactured home. 16.) A permanent physical separation along the boundary of the 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. 17.) 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 be in place prior to and during construction activities. The signs shall contain the following statement: "Buffer- Do Not Remove or Alter Existing Vegetation." 18.) The applicant is proposing to create or add 1608 square feet of impervious surface and 4400 square feet of land disturbing activities. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal shall adhere to Best Management Practices (BMPs). 19.) 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. 20.) 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. 21.) 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). 22.) The revised site plan as submitted on May 1, 2006 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 May 1, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 23.) 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. 24.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 25.) 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). 26.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 27.) Minimum setback from Green Mountain Ln right-of-way is 20 ft. Minimum side and rear setbacks are 5 ft. HOWEVER, the proposed manufactured home shall be setback entirely off the designated BPA Easement. 28.) The building height is not to exceed 35 feet. 29.) This parcel has been designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 30.) A septic permit(SEP05-00432) was approved on March 7, 2006 for a system of 360 gallons per day. 31.) Green Mountain Ln is a private road (P63). The road approach is existing and an address of 294 Green Mountain Ln has been assigned to the parcel. 32.) This parcel was created through the Green Mountain Short Plat under AFN 471468, filed of record June 24, 2006 in Volume 4 of Short Plat, page 194-195 with Jefferson County Auditor's office. 33.) A minimum of two (2) on-site parking spaces are required for the single family residence. �;;ON f,, • •�w 0�,. JEFFER� COUNTY a �} DEPARTMENT OF COMMUNITY DE:VELORMEIt�T, �a `'d 621 Sheridan Street • Port Townsend •Wastingti3t1-9 � �� 360/379-4450 • 360/379-4451 Fax q�,�p� www.co.jefferson.wa.us/commdevelopment Master Permit Application ( [ [Q (� (�j, TMLA: C/c - / I Project Description(include separate sheets as necessary): JEI i EIISON CH\1 Y H(j /rl. vcoscj V/2c-n i ,t- r 2 r)su -.2-?OA, ( J) Property Tax Parcel Number: (o 02_ 35.2 028 Size: 5, 21eq8 et-coo s (acres/square feet) Site Address and/or Directions to Property: rntN ,LA/ OFF [',yL flj. ) Ri 21Ail ✓ LJq 9Y32O Property Owner(s of Record: -FFR ° G-1ER-1S H>�► TR1)iop,Js�/l Telephone(3toO) fl —(o379 Fax: email: CRP4-SHCF0 P J'4NOt),C Mailing Address:-p•d, 60X 237 Hoe DSPo2Ti 1A)' 9g9918 Applicant/Agent(if different from owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies) Ptuilding 0 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 ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** 0/Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑ Address 0 Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** 0 Allowed"Yes"Use Consistency Analysis ❑ Shoreline Master Program Exemption/Permit Revisions** ❑ Stormwater Management 0 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 /J 0 / to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 4 i4 t�j%1r</3,40t. Date: 3/1 5/Okj 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 omissio n of a material fact ct 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. /f �gQ� Signature: /iJ Date: 442/06/ 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 resppnjility or adhering to and complying with the ESA. The Applicant has read this disclaimer and signs nd dates it below. Signature: Date: //S'�j(Jil G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • • 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: Cc-4So if-s (3bo )7y8 —,6 6 Y9 ( ) MAILING ADDRESS: $LP. c'i 2Y/M, -541iz.J-&-v all EMAIL: CONTRACTOR'S LICENSE WAINS , NUMBER: G(J�'16:1://ler� �I.3-`D NUMBEr I(a( ARCHITECT/ENGINEER: -5l44 xlnr , PHONE (31d0 )/L7_k,6/] FAX: ( )j,. $lk/p3 MAILING ADDRESS: Sir- 4,i X.e / A ..5�� ! EMAIL Pr,olject Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: fr/New Er Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: Z Bank Height: ❑ Community System i 1 Alteration/Remodel ❑ Concrete Total: Individual System Cl Repair ❑ Masonry V/i# SEP Permit# b5-/3 Z ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ywo Party Type of Heat: Proposed: 1 LI Public 1s2-/=c'XVE Total: 3 Name of System: 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 Appliance Installation permit,mark all items below that apply: Underground Tank ❑ Above ground Tank Size of Propane Tank: ❑ Heat Stove ❑ Cook Stove f I Woodstove LI Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove ❑ Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / 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. ,, ,,, xi s ,,iz=, rriltrfa!,,..Pitts*.:*::. ei, , ,Square Footage Current Proposed For Office Use Only.: h, . ..,.., . `*, Main Floor Heated EH BIId App ReviewI : ) I 2r4 Floor Heated Considt dy Review! \Y- I Other Heated Base fee: Mezzanine Additional Section: ?)A Heated Basement Plan CdiFfeCit Cps\F ]C Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: (Zi I Garage/Carport SUBTOTAL 1` CD Decks /Rd Approach fee: Other TOTAL: $ Lod co Receipt Number: ` C'S( (A Cash/Check Number: (x ESTIMATED COST(REQUIRED) Date: L� rn •Fair market value of all labor and materials foundation to finish Initials: (IV G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc RETURN ADDRESS F IRST AMERICAN TITLE COMPANY 2037 EAST SIMS WAY PORT TOWNSEND, WA 98368 El GTAT1"C)FWrASHINGTO1 MANUFACTURED HOME 'L AS CH CKONE � ETITLE ELIMINATION APPLICATION IkEnsinG TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty REMOVAL 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) 118314374 2006 SILVERCRE 060 X 027 ® LAND LEGAL DESCRIPTION ON PAGE 2 MANUFACTURED HOME WILL BE L AFFIXED J 602 352 REMOVED REAL 0TY TAX PARCEL NUMBER 028 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION lot 1 Green Mtn S.P. 0 GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER t NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS i NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER JEFFERYRUPPNER NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER CHERISHA/TRUPPNER ADDRESS S.L CITY STATE ZIP CODE 50N.TYEE PLACE /P.0 .BOX HOODSP' WA 98548 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER WELLS FARGO BANK N.A. NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 1000 BLUE GENTIAN RD EAGAN MN 55121 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 G,C / Signature of Additional Registered Owner and Title, IF APPLICABLE d-4N'Irtef/ NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington . Signed or attested , County of ( t- - before - - 0- • _a« by *-CF-re J. Ll- 1C Q. ����� i `� {�� Signature �ll�'.. . PRINT NAME OOREGISTERED OWNER • ARY 0-AeP'NT y by C-+►\e-f is&'iTfuQP `- e"C i Gaf1i176-/ J PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR �-ae/lj 2' iy DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Da 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 gI certify that: the manufactured home has been affixed to the real property as described. a buildingISAY permit has been issued for this purpose and the attachment will be inspected upon completion. LDG PERMIT NAME T h PRINTED) ---k i 4 II' B( D�QFFI Lq- Li ✓D BL' I.V40-oo ilk SI URE/••.ITIO 3 TE I1 /liTD-420-72 MANUFHO EAPPL2)OR(W)Pagelof2 MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 118314374 2006 SILVERCRE 060 X 027 D SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title, IF APPLICABLE Signature of Additional Legal Owner and Title, IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF LEGAL OWNER NOTARY OR AGENT by PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date DLAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office LOT 1 GREEN MOUNTAIN SHORT PLAT,AS PER PLAT RECORDED IN VOLUME 4 OF SHORT PLATS ,PAGES 194 AND 195,RECORDS OF JEFFERSON COUNTY,WASHINGTON SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON 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 NAME(TYPED OR PRINTED) WA DEALER NUMBER DATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S AUTHORIZED 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 TT)/(360) 664-8885. TD-420-729 MANUF HOME APPL(R/2102)OR(W)Page 2 of 2 w w m S y r- ooCop Qo o 41 C XD 1 a NC► � N co N G Cuer, A a l X 77 V V m� n= D w 0) "Q a- - ° — 0) - a al0. CTt ems -°0 �' 0 n NCA)) C ` o w @ CQ N3"0 ... 1 m 2) 3 K. "s OQ -em . � 3y # omo. l oaav i g Q o• m ! ao 03030 . °o,, 309'4) From comer to I `� N. 4 N�,,� 0 N o 0 _ v property line marker. 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