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HomeMy WebLinkAboutBLD2006-00434 JACK WESTERMAN Ili .1.•fiercoa Coll loartl ASSESSOR 1'0 11ox 12211. i'ort ToSrns.•ud. .1 98168 4:I801 :1115-9105 MOBILE HOME INFORMATION [OHM OWNER'S NAME/MAILING ADDRESS: NAME: ,.'!r �MA f-- I t2F7 - ADDRESS: 4c)3 I {2JA L.00D! 1 T '!, a '3s PHONE NO. '3 60 3 7C( 67 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 CiA5L-0 i3 (II) MODEL (C)YEAR i 67 (D) LENGTH 5�- (E)WIDTH 6/1-4 (F) SERIAL # 55:1 U X (G)YOUR PURCHASE PRICE (Do not include sales tax) _ PURCHASE DATE 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 30 NVl (A) FROM WHOM DID YOU PURCHASE MOBILE 5-#iO I A►� ADDRESS OL / `NGC-c-C (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? No LL Q If Yes, Previous address of mobile. INS - �� SS 4' 5C6 ! C 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 (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space # JJ g (C) IF NOT LOCATED IN MOBILE HO 4 c PARK ,�^ l r ? NAME OF LAND OWNER: c�' n1`' t EE F LOCATION ADDRESS � �I�-'� j.-rE —n 1A �.J (, U(L,LC/JL REAL PROPERTY PARCEL #/DESCR11'TION PC?a (6jO( 03 4 Si! re of applicant THANK YOU FOR YOUR HELP! eX) .s-Q JO COSSELL, Property Technician JACK WESTERMAN IIIO .1t•fierson I'onsgliolartlaitais4. ASSESSOR 1'll llux 1220,logrt %%'.11 911:1611 4360 :185-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING� ADDRESS: NAME: jA V^I E A A ADDRESS: 403 I [- C1 jt f f + L o.'/3 PHONE NO. 6( 3 7q � 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 (1 13 (B) MODEL (C) YEAR (D) LENGTH 52 (E)WIDTH �`-j"C (F)SERIAL # 5C V X (G)YOUR PURCHASE PRICE (Do not include sales tax) PURCHASE DATE 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE-MOBILE SLOW I A Q� ADDRESS G AN - � (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? No v` /n If Yes, Previous address of mobile. NCB- Ar)/)/Z�SS ` 1 )E 1^Q � V- /Z If No, What County was Mobile assessed in last year. 3)WHERE MOBILE HOME IS TO HE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes A. (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE Ro1Qn aA 1 Z_ NAME OF LAND OWNER: c�_JJ LOCATION ADDRESS 4 I 5i4 14604 E /J C�Ci(,L,LE-k)i REAL PROPERTY PARCEL #/DESCRIPTION Pq 2 ,CJc U2.3 a4- Si at re f applicant THANK YOU FOR YOUR HELP! dJODI COSSELL, Property Technician BUILDING PERMIT APPLICATION 137)-- Jefferson County Building•rtment• County Courthouse • Port Townseflash.98368 • 385-1310 N E I. LOCATION: geographic name S W SIDE OF ROAD FEET NE S W FROM INTERSECTION OF \ ROAD AND \ ROAD other specific location or landmark: ll�< <, f\Cp Y )-)cAC, �. 11-,C �� __ �� LEGAL DESCRIPTION: 17 Lot Block Subdivision Tax Number 1/4 Section Section Township Range II. TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY ❑New building El Single Family New County Resident ❑Addition ❑Multi-Family Is this structure to serve the residential number of units or commercial needs of those employed El Alteration P Yed El Hotel,Motel, Dormitory at either the U.S.Navy's Trident or ❑Repair,replacement number of units Indian Island Facilities? ❑Wrecking ®-Mobile Home ❑Moving (relocation) �f"' El Other—Specify ❑YES y�w0 'Foundation only USE OWNERSHIP 'Full-time Residence RPrivate (individual,corporation,nonprofit institution,etc.) — CI Second Home: Recreation Cabin,etc. ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: k ❑Second Home: Future conversion to permanent residence COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food • Cost of improvement $ processilg plant,machine shop,laundry building at hospital,elementary To be installed but not included school,secondary school,college,parochial school,parking garage for in the above cost department store,rental office building,office building at industrial plant. a. Electrical If use of existing building is being changed,enter proposed use. b. Plumbing c. Heating,air conditioning d. Other (elevator,etc.) • TOTAL COST OF IMPROVEMENT $�5., 7x) III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS ❑Masonry (wall bearing) ❑Public or Private •Number of Stories !{ •Total square feet of floor area, Wood Frame �Indivic!ual (se tictank etc.) all floors,based on exterior ❑Structural steel <-jt:5 1 j +'tea: dimensions �L� X Zj 6) ❑Reinforced concrete TYPE OF WATER SUPPLY 1'� •Total land area,sq.ft. ❑Public or private company /f"/X /9' / El Other—Specify NUMBER OF OFF-STREET 1c Individual (zet cistern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE ' CI Gas Outdoors ❑Oil RESIDENTIAL BUILDINGS ONLY `� Electricity Number of bedrooms CI Coal TYPE OF MECHANICAL CI Other—Specify Number of Full bathrooms Partial IV. IDENTIFICATION - Name Mailing Address-- Number,street,city and State ZIP code Tel.No. Owner n v\�\ (otte � n 3—, SC� ) \ `OS CA a ,lC 'e V� +- _ 2. 1_A f' M Contractor State License No. 3. __ Architect The owner of this building and the undersigned agree to conform to all applicable laws. Signature of applicant ,Address Application date PLANNING AREA fl / FIRE DISTRICT y SCHOOL DISTRICT WATER DISTRICT APPROVED BY 'K !' -C `'j C �Z 1 ly OLYMPIC HEALTH DISTRICT: . : � • APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER aefs; �` r ' ..ate �,3? CrST /7 7 BUILDING OFFICIAL The Printery —Port Townsend • • RETURN ADDRESS J6mEs A l( Z 4 3 vIc7Zi2-it LL Q() P 7 wAS t1ST.�r�C)FW.95H1^'GTO^' MANUFACTURED HOME 'L ASE CHECK ONE TITLE ELIMINATION i APPLICATION_____c ❑TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty DREMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) N MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 6a 1 1C1 ( ( 5,2x 0-14 5c c►3 uX _ a,LAND LEGAL DESCRIPTION ON PAGE T .73 MANUFACTURED HOME WILL BE AFFIXED ❑ REMOVED elS3 V REAL PROPERTAX P RCE�`NU LOT BLOCK PLAT NAMEOR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION ( � �V` kc*Ea_ El GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS I (...:, 0 0 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTEAE OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE c--C 3 \JtC i 21A1 LC)P T Taok U4A ci NAME OF LEGAL OWNER DOL CUSTOMER CCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WVAM/ARE THE REGISTE D OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title, IF APPLICABLE - "L Z Signature of Additional Registered Owner and Title, IF APPLICABL NOTARY SEAL OR STAMP NOTARIZATION/CERTIFFIIp TION FOR REGISTERED OWNER(S)SIGNATURE State of Wasingtof 'La gip,.. Signed or attested 2 /)c/O L County 1 /� before me on I by j(�-V�LS 6./i 1 ho k41 )' 4ig�n2ture 1\c \ tt,u l ! PRINT NAME OF REGISTERED OWNE NOTARY DR AGENT by PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR r/ ,.(�/C Title AND: Dealer No.OR ! v-" 1 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 w Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. ©; BUILDING PERMIT OFFICE CERTIFICATION `certify that Xhe manufactured home has been affixed to the real property as described. 0 a building permit has been issued for this purpose and the attachment will be inspected upon completion. ME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# ITION DATE ATURE/POS CJ' 1, c C(%UM�+- L VV A -) - 3 — G Co TD-420-729 MANUF HOME APPL(R/2/02)OR(lf)Page 1 of 2 • „,,i • MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 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 D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) Tr I,,,T I `i SEA i Me"1/YC:012910 .Tv pIAr.'P-+E .&0F O Wc ) 0..3 OLipt`=2 or, PU cr51 PAC— I -4 , I1._;J Er g` c t)ri I (,uA5 61U -00 .-r✓6=114- - GuiTP- &LL 11 0GL_4)5 OF T SEc 3 c.ce^�s�f\DJc3IWc:- -, 70T UL by MEz LC i t O i , st-�c:u.›-%cg Ti-C P— Or : t) PUS I..PY4 u�714 -85-r 30 i= ET cr 5A 0 11Z T (7, &Uk:1/4,1 �-n TO .J F r.-1(Z5o('- Cc.,0 rt2 N) puQ- 'Sc-5 i3ie OE6.) O/7F-0 J&), --i t 1 C,( (AK, ,2-G'IZi'1 C- A02-1L te1 (g6( i Vt` M-1) AV I T-012-5 F.I1Z , (''7g63 El 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 0 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 110 TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX IMPORTANT: Once the application has been approved by the County Auditor/Vehicle Licensing Office, take your application form to the County Recording Office. Retain proof of the recording fees paid. If the Recording Office retains your original application form, obtain a certified copy of the recorded form. APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the Manufactured Home Application, paying all required fees. Vehicle licensing subagents charge a service fee. For full instructions on completing this form for Title Elimination, Removal from Real Property or Transfer in Location, see form TD-420-730, Manufactured Home Application Instructions. The Department of Licensing has a policy of providing equal access to its services. If you need special accommodation, please cal(360) 902-3600 or TTY(360) 664-8885. TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2 • • 3S~ go ( c1 Vet)PAv- tA)C:( `i;