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HomeMy WebLinkAboutBLD2006-00233 • • 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#: BLD06-00233 Received Date: 5/4/2006 SITE ADDRESS: 20 KALA POINT DR Issue Date: 6/28/2006 PORT TOWNSEND, 98368 APPLICANT: RICHARD W BEAL 3-9,_"l ((n2 SHARON K BEAL "� PO BOX 958 CHIMACUM WA 98325 SUBDIVISION: IRONDALE Block: 135 Lot: 20-27 PARCEL#: 962113508 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: NEW M/H W/NG 120 GAL PROP TANK (SILVERCREST DISCOVERY) MAKE: CHAMPION YEAR: 2006 SIZE: 68' X 27' THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 6/28/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): 7-1 - '2j Stormwater FINAL Approval: Blocking/Plumbing: ?L'NeK 4'7@=_1)/5t.v�6" DK 1274A4 Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 4.-hZ 1 V 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 • • MLA06-00222 Review Type: MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00233 Received Date: 5/4/2006 SITE ADDRESS: 20 KALA POINT DR PORT TOWNSEND, 98368 APPLICANT: RICHARD W BEAL PHONE: 360-379-9168 SHARON K BEAL PO BOX 958 CHIMACUM WA 98325 SUBDIVISION: IRONDALE Block: 135 Lot: 20-27 PARCEL NUMBER: 962113508 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER: REPRESENTATIVE. JOHN BEAL PHONE: 360-379-9168 NICOLE BEAL PO BOX 958 PROJECT DESCRIPTION: NEW M/H W/A/G 120 GAL PROP TANK (SILVERCREST DISCOVERY) TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW VALUATION MAKE: CHAMPION SETBACK: YEAR: 2006 BANK HEIGHT: LABOR & INDUSTRIES APPROVAL? SIZE: 68' X 27' SEWAGE DISPOSAL: CON WATER SYSTEM: OTHER BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 3 Prop: 2 Total: 3 Total: 2 Routing Date:/ 5 f 0 Type Amount Paid 13v: Date: Receipt: Approved/Date F Manufactured Homes $163.00 LYK 05/04/06 81211 JUN aS 2006 Potable Water Application $55.00 LYK 05/04/06 81211 Total: $218.00 Jefferson County Planning & Building Department JACK WESTERMAN • Jefferson tr�'ourthouse ASSESSOR PO Box I2�0, Port Townsend, WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM__ OWNER'S NAME/MAILING ADDRESS: NAME: 30\ni-) d f►cAncu. C -e0-5., MAY - 4 2006 ADDRESS: P.0 C 'f On%rc\(:cv.vy) 1,7,11 gcs-3 I PHONE NO. - a + 1i2(6 v E;.OPMENT 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 HOME DATA: (A) MAKE C_hA-vv. LS'YL (II) MODEL -1 kVev- CNScaver(9 YEAR QCXoLp (D) LENGTH LC S (E)WIDTH aU' `e) (F) SERIAL # fern d' Y\ (G)YOUR PURCHASE PRICE (Do not include sales tax) v/ C O PURCHASE DATE 47/200e 2) 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)WIIERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes (B)IF LOCATED IN MOBILE HOME PARK: NAME a$ ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: �:D\CV 1 4 ..-Y py-' geoLi LOCATION ADDRESS aC) C\ 2- by To",,nS\C\ U;;1a REAL PROPERTY PARCEL #/DESCRIPTION q l.P aI t 3a,Oa d G to a 1 350 C► s aO *o 3o a.Q Signature of applicant THANK YOU FOR YOUR HELP! 6JO COSSELL, Property Technician • 0 Washington Home Center www.washhome.com Silvercrest Discovery 4684R • . . - . .s,•,- .t.. ..„ . . ,..,.., . : - , ,,,,,,,,- .,.., :, is A A w.. . , 1 ilk: . . ;.:.4 A•• i• ' ' •iF• . . ' • •'' • 4 •••• -'.: , • w• 1. ' :.‘' , 7.." :.&4.1. • ...,riee 4'sr - -,i... --•,ee` ..1.1 ' . . --* . ,- -.. ...# .... , I , • ier . . t 11111 I I:. kg. P . ' ' 1111111111 A 11 It , • • • , Cham.ion \06 Total Living Width: 26'8" 1813 s.f. Depth: 68' n 14orcat on4.) Ocw)Q... Ck-\- --Fad-oy u, XBedrooms,2 Bath Ceminp,...A.4.11- Family Room&Morning Room 4-- Lere, ' S, Silvercrest Discovery 4684R., s.1 i 8 1 y)c., door • 'It 711[T i ,,,.! 1:1;1-7 : I: -4-1104146eano ( .. , :,4 —MORNING ROOM 1D-4 el-11 01/Ji NG Room KITCHEN , -, FAMILY ROOM ie.' :k1',Oil 1%. r in PM? , i If-nit-1o' vt-tr,it-ur f) COrnp4A.,314.1r• 1:1 : , „ roarn ate s" NUN_,igil walidil ... HALL 111-> 1. L "lic.c2reu LovoiLivw-j-i 11114 1 Atli 915S 1 4 4tili 1 .....212 . MTH MASTER BEDROOM UVIMG ROOM 1310R0042 BEDROOM/3 --Ili 13'-irrit-f 11'-ifof-if in-5-Y12-4- If-Cry V.-10- sr itcoinie ( '- laill mg r,,4 .0.---3.1mimai .orff ______. - III 1 Shelton Sales 61 SE Ryan Road Shelton, WA 98584 Phone: 1-800-490-9424 _ OPMENT . • • SPECIAL CONDITIONS CASE # BLD06-00233 1.) The application was reviewed by the Jefferson County Department of Community Development staff on May 17, 2006 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: Special Aquifer Recharge Protection Area (SARPA). 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.) 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. 4.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 5.) 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. 6.) The applicant is proposing to create or add 1,813 square feet of impervious surface and 1,813 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. 7.) 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. 8.) 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. 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 revised site plan as submitted on June 5, 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 June 27, 2006 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 sh I • than one-half acre unless totally screened from view of neighboring dwellings on any and less 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.) 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. 15.) Setback from Kala Point Rd. right-of-way is no less than 20 ft., setback from Prospect Rd. right-of-way 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. 16.) 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. 17.) 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. 18.) The building height is not to exceed 35 feet. 19.) A minimum of two (2) on-site parking spaces is required for the single-family residence. 20.) These are a legal non-conforming parcels designated as Rural Residential 1:5 under the Jefferson County Comprehensive Plan Land Use Map effective August 28, 1998. 21.) A septic permit(SEP04-00149) was approved July 8, 2004 for a capacity of 360 gallons per day. This permit was finalled April 5, 2005. 22.) Kala Point Dr. (C679109) is a county local access road. A road approach (RAP04-00105) was approved on May 20, 2004 and finalled on July 16, 2004. An address of 20 Kala Point Dr. has been assigned to the parcel. 23.) This parcel was created through Irondale#6 under AFN 30490, recorded 6/28/1910, Volume 2, page 139 with the Jefferson County Auditor's office. 24.) A Declaration of Restrictive Covenant was recorded June 5, 2006 under AFN 511913 with the Jefferson County Auditor binding lots 20-30 of Block 135, Irondale No. 6 for the purpose of meeting bulk and dimensional requirements and minimum land area. 25.) This project was sent to the Department of Public Works on June 9, 2006 to review the 15 ft. setback from the ditch along Propspect Avenue. On June 13, 2006 Public Works commented as follows, "Structure would be 40 ft. from right-of-way and 15 ft. from the top of bank. Prospect Avenue is adequate for anticipated buildout traffic. If improvements were made, they would be on the south. Public Works does not object." 4,4�� C1N c��� JEFFER�J COUNTY • W g� A DEPARTMENT OF COMMUNITY DEVELOPMENT ~' " ` '" 621 Sheridan Street • Port Townsend •Washington 98368 &G , , 360/379-4450 • 360/379-4451 Fax uuAAY - 4 2006 ; �sHINOr'o www.co.jefferson.wa.us/commdevelopmeYif' Master Permit Application MC ao -aaa. Project Description(include separate sheets as necessary): ClC•v-IU. «C.-\ \sr EC\ 1-kc) ----)Q._ ‘4 C�ckv-r,.c; c_ Property Tax Parcel Number: (i t:; 1 l.3 SCj 4 CI Lc a I 3CSC)Ci Size: (acres/square feet) Site Address and/or Directions to Property: 3.0 kc\� C)i. . . t7C,v--4 \0 ,�‘.-.)Sc_'vtiC Property Owner(s)of Record: e i(IN-NC•r(-\ \), A Shia.v (:),-1 V. ' t'c' Telephone: -10} -q 1 is eL) Fax: email: Mailing Address: P.c., c&,X cAce, c. ,\'1 Vk\C,CVOA-NA �;1A CIci:,--). Ac� Applicant/Agent(if different from owner): .�c.)\\x-' -' \Ncirec>\i. .c:`\ Telephone: 3. i cl-(711(..r�) Fax: email: Mailing Address:V.0 FSC>X k(: (;V1 t titi)C.ti C l 14 v I cx ,A, What kind of Permit?(Check each box that applies) k4 Building ❑Variance(Minor, Major or Reasonable Economic Use) Cl Demolition Permit ❑ Conditional Use[C(a),C(d),or C)** [7 Single Family ❑ Discretionary"D"or Unnamed Use Classification 0 Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** .14 Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address i1 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: N. DESIGNATION OF AGENT I hereby designate �(l�l, 111C\'\CkS: A to act as my agent in matters relating to this app ication for permit(s). OWNER SIGNATURE r 6.414_. 57 /�� � oc‘,62 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 required later inspections.Access and right of entry to this property shall be requested and shall occur only during regular business hours. - Signature: "1'��'�-t7�C C,r`Q c Date: .a- 1 -O�' 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 pr 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 c agency rhVApplicant 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: `irtA C-,1,(L 1; Date: CS-.. 1 -0(L) 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:`-ill� .l -C- '"Lc S I c-, -- " `< A )!r Date: - ` - Cj GENERAL CONTRACTOR OR MANUFACTURED HOME TALLER: / PHONE: FAX: - cwt1 �P lit 1 �ie� 6,0( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: A Shoreline: Type of Sewage Disposal: ❑ New 0 Wood Existing: ❑ Sewer Addition ❑ Steel Proposed: Bank Height: 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: o2 /Individual Systeryir ❑ Repair ❑ Masonry SEP Permit# 0 77 ❑ Demolition ❑ Other: Bedrooms: 2 Water Supply: Existing: .J Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: . r (Public Total: Na a of System: I 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: Li Underground Tank 'ti!f Above ground Tank Size of Propane Tank: 0 Heat StoveCook Stove 11 Woodstove ❑ Fireplace Insert 0 Hot Water Tank ❑ Pellet Stove 0 Other Is this applia ce being installed in a Manufactured/Mobile Home? ,?es-1 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 Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: (Q 5 2r-Floor Heated Consistency Review: G 3 Other Heated .Base-fee:. " - 1 - Mezzanine �r0 rn^r5 6.—•t Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: --- Other Unheated Pot Water Review fee: 9 0 Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other r - Receipteiypt�Number: 53 I at MAY "l4asfl9Ffeck Number: a� ESTIMAT T(REQUIRED) Date: 5 d f �/_ .Fair market value of all labor and materials foundation to finish I JP?,1 NT T K� Initial,s:L` ,,,. G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc RETURN ADDRESS CHICAGO TITLE 3030 HOYT AVENUE EVERETT, WA. 98201 Manufactured Home "L S CH CK ON JJ WASHIN6TON STATE DEPARTMENT OF ❑TITLE ELIMINATION a• LICENSING Application ❑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) 0 MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) *448915 2007 CHAMP 26 X68 11800PH031659AB © LAND LEGAL DESCRIPTION ON PAGE I REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE 0 AFFIXED 0 REMOVED 962113508 LOT 20-27 am PLAT NAME OR SECTION/TOWNSHIP/RANGE OUARTER/OUARTER SECTION 11 IRONDALE DIVISION K © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER JOHN BEAL NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER NICHOLE BEAL ADDRESS CITY STATE ZIP CODE 20 KALA POINT DRIVE PORT TOWNSEND, WA. 98368 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER GLOBAL ADVISORY GROUP, DBA MORTGAGE ADVISORY GROUP, LLC NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 2902 COLBY AVENUE EVERETT, WA. 98201 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- C .�+.„ / \3 b Signature of Additional Registered Owner and Title,IF APPLICABLE``'(L1..(.�1pLQ. II)• c L---C NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE r e of Washington Signed or attested ( J A N I E M. T U R N EIR > County of k\t��P before me on ',. 7-3- a NOTARY PUBLI �� g YY��� ; 1 STATE OF WASHINGTu y i� H w b�N L si natur G�Y.,s y FRINT NAME OF REGISTERED OWNER NO Y OR AGENT COMMISSION EXPIRE byf��,,E.��, ;- d ;f,� ��U fr,T� a-t - JUNE 9, 20 12 I I,PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY COUnty/Off County/Office No.OR ��It e w1G� G--�� AND: Dealer No.OR�0��-\3-, I DEALERSHIP POSITION/AGENT/NOTARY Notary 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. 0 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. NAME(TYPED OR PRINTED) ?LOG PERMIT OFFICEPHONE# BLDG PERMIT N >1nQ Sv1<I) (4- 3(00) 37 4q- 4U $5U706-"DO.D33 SI N TUR !PO TION I mgOl/ I` TD-420- 9(R/B✓08) Page 1 of 2 'Q M t� �'2.(..�� 1 �� - LI , --. -- , LOOM fr--—-T. =--- ? .. , . ,,,,,:.',,..J , . . �1 ~- w. ., t. y .Y �_ti t "� Cal C7 - . CO d CAI P �I� 1 , , ...,.. 1. * . I ... 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