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HomeMy WebLinkAboutBLD2006-00442 t .:- II 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#: BLD06-00442 Received Date: 7/31/2006 SITE ADDRESS: 201 NEVER GIVE UP RD Issue Date: 10/6/2006 BRINNON, 98320 APPLICANT: ROGER C HERENDEEN LIFE ESTATE PO BOX 320 BRINNON WA 98320-0320 SUBDIVISION: BRINNON BEACH REC VEHICULAR PA Block: Lot: 7+ PARCEL#: 936100007 Section: .23 Township: 26 N Range: 02 W CONTRACTOR/ CONSOLIDATED BUILDERS INC PHONE: (360)683-9522 DEALER 251 OLD BLYN HWY SEQUIM WA 98382 build4lifenyahoo.com Contractor's License CONSOI"993L1 Expires 6/21/2007 PROJECT DESCRIPTION: NEW MFH WITH 6' PORCH INSPECTED BY L& I MODEL#1210CT MAKE: SKYLINE YEAR: 2006 SIZE: 38 X 27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/6/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. • Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing: 71 1l-7--0 Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 6`ZJ U7 HEALTH DEPARTMENT AND PUB IC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY-SEE REVERSE • II 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#: BLD06-00442 Received Date: 7/31/2006 SITE ADDRESS: 201 NEVER GIVE UP RD Issue Date: 10/6/2006 BRINNON, 98320 APPLICANT: ROGER C HERENDEEN LIFE ESTATE PO BOX 320 BRINNON WA 98320-0320 SUBDIVISION: BRINNON BEACH REC VEHICULAR PA Block: Lot: 7+ PARCEL#: 936100007 Section: 23 Township: 26 N Range: 02 W CONTRACTOR/ CONSOLIDATED BUILDERS INC PHONE: (360)683-9522 DEALER 251 OLD BLYN HWY SEQUIM WA 98382 build4life(yahoo.com Contractor's License CONSOI*993L1 Expires 6/21/2007 PROJECT DESCRIPTION: NEW MFH WITH 6' PORCH INSPECTED BY L & I MODEL it 1210CT MAKE: SKYLINE YEAR: 2006 SIZE: 38 X 27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 10/6/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): /6)-(1 66 Stormwater FINAL Approval: Blocking/Plumbing: &t9e-K-4TI /L-Ake_ i1-�" Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: - 6`2'0 HEALTH DEPARTMENT AND PUB IC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS APPLY- SEE REVERSE • • MLA06-00429 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00442 Received Date: 7/31/2006 SITE ADDRESS: NEVER GIVE UP RD BRINNON, 98320 APPLICANT: ROGER C HERENDEEN PHONE: (360)796-4473 LIFE ESTATE PO BOX 320 BRINNON WA 98320-0320 SUBDIVISION: BRINNON BEACH REC VEHICULAR PA Block: Lot: 7 PARCEL NUMBER: 936100007 Section: 23 Township: 26 N Range: 02 W CONTRACTOR/ CONSOLIDATED BUILDERS INC PHONE: (360)683-9522 DEALER: 251 OLD BLYN HWY SEQUIM WA 98382 vahoo.comcl/i Contractor's License CONSOI"993L1 Expires Ok/Tlicl/WVahoo.com REPRESENTATIVE: CONSILIDATED BUYILDERS INC PHONE: (360) 683-9M2 VELLE TUDOR 251 OLD BLYN HWY PROJECT DESCRIPTION: NEW MFH WITH 6' PORCH INSPECTED BY L& I MODEL# 1210CT TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 52,000.00 YEAR: 2006 LABOR & INDUSTRIES APPROVAL? SIZE: 38 X 27 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: — BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 1 Total: 2 Total: 1 Routing Date: / � 1 Le(1— Type Amount Paid By: Date: Receipt: Approved/Date D Manufactured Homes $163.00 KAS 07/31/06 83958 Potable Water Application $55.00 KAS 07/31/06 83958 OCT L2006 Total: $218.00 Jefferson k:: ,, ,_, raNi111)0 & BIJOE q Oeua;trnent co PERMIT r BCD 71 06 044 2 cp 46ff' ��o' ` '� - 30 ) / �ETFERSON COUNTY OCb r Oo 48'6'.' 13 05 co 40' 32' > w 40 201 Intake, Water, V Septi .' Tank 1 to, 1111— p, ty l � u ca w.kvvra_ 0_ ; ; ,„6 rn \ % --� j (1`• - �1 JACK WESTERMAN I• Jefferson c ty 4 oorn►ous.c ASSESSOR �\ ''0 ltox 12' Port TOW.lowi.d. N'.% 983611 !ref (:360) .18a-9 t 0a MOBILE HOME INFORMATION FORIQI. 3 1 2C7S OWNER'S NAME/MAILING ADDRESS: 'EffERP r'ili ,: NAME: k,,,,s4L Ni . ADDRESS: •O. 80.f. 32-C) ,r (�1+.�0►-4 WA Ck �`LO PHONE NO.(_3�) "R-" cQ - 44'3'3. 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)MORILE HOME DATA: (A) MAKE `1 AO_ (B) MODEL I'-1 Q C'( (C)YEARAa (D) LENGTH (E)WIDTH (F)SERIAL. „ /".i��(04_ 52.t`'i (G) YOUR PURCHASE PRICE (I)o not include sales tax) 1. Lift PURCHASE DATE gitekte 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE ADDRESS IJ(Q • (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 MOBINE HOME P K: NAME OF LAND OWNER: JDgQ.1' t-RQAO LOCATION ADDRESS f`1 )Q.Are Q�v-1- REAL PROPERTY PARCEL #/DESCRIPTION 13(- 1 DO- OQ OLIL .1� Signature of applicant, THANK YOU FOR YOUR HELP! e5b JOIN COSSELL, Property Technician „,.. ________________40. ___ . _ ________,.., , 0,3e-rzc' s t. 9 re;Ylbrlar® tmtled �� -sa - - .s, ,t ,..:, ... \ �' - N.,1.k .,„.. .: .'' 'I” 1 ( O BEDROOM "d Nai �t C.. , d — it7 Sri• — r �. a ��� T covERE E 9 3 - _.a... ,�ILR 4 Lu N Ulr(De,l rrto-nur --- MASTER �(c ' I BEDROOM i UVING ROOM ----- No.I Itto— try IT rkiC 606 ■n�■u 1210CTI3416(918SQ.FT.)2B DROO •CATHEDRAL THRU-0UT L OPTION PORCH �iNA\�� i• . — 0 - I 00 - 001 — r- . . �1yb•+.fYV'{ ! 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The application was reviewed by the Jefferson County Department of Community Development staff on August 15, 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 and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: spotted owl; landslide 1; SUSC aquifer recharge area, coastal 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.) 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.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 6.) The parcel is located within a coastal SIPZ (seawater intrusion protection zone) according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy (Resolution 44-22, effective September 23, 2002)that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 7.) Critical Aquifer Recharge Areas may require special protection measures to mitigate water quality degradation. The submitted proposal does not require additional aquifer protection measures. However, during construction the project shall follow the Best Management Practices (BMPs) and facility design standards as identified and defined in the Stormwater Management Manual for the Puget Sound Basin. 8.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 9.) VOLUNTARY MEASURES OPOASTAL &AT RISK SIPZ: Water conservation measures: 1. Roof and other intercepted precipitation shall be routed to on-site detention ponds and/or other approved means and allowed to be released to the soil slowly. 2. Water collected from Storm water and roof catchments may be used for watering lawns and gardens. Unless catchment water has been treated to meet drinking water standards, there shall be no cross connections allowed between the potable supply and impounded water. 3. Water withdrawn from wells on each property shall not be used for watering of lawns and/or gardens. 4. Ground water withdrawn from each property shall be restricted to a rate of three (3) gallons per minute. 5. Installation of water conserving fixtures such as low flow toilets, faucets and shower restrictors and other water saving plumbing fixtures. 6. Landscaping plan (xeriscaping, native vegetation with minimal amounts of irrigation). Please NOTE that the above listed measures are not intended to be exhaustive, but rather is intended to be illustrative of the types of water conservation measures. 10.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 11.) The applicant is proposing to create or add 918 square feet of impervious surface and 918 square feet of land disturbing activities. 12.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 13.) 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). 14.) The site plan as submitted with the building permit application on July 31, 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 August 15, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 15.) This approval is for a manufactured home installation with deck 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. 16.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 17.) Not more than 2 unlicensed or inoperable vehicles shall be stored on any lot 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 Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor 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 or Chapter 18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage)yards. In no case, shall any such junk motor vehicles be stored in a critical area. 18.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 19.) Minimum setback from Never Give Up Road right-of-way shall be 20 feet. Minimum side and rear yard set backs shall be 5 feet. 20.) 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. 21.) 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. 22.) The building height is not to exceed 35 feet. 23.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. • 24.) The parcel has been designate s RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 25.) The lot was created through the Brinnon Beach Recreational Vehicular Park BSP on July 6, 1987 under AFN 20894. The BSP was amended on December 1, 1991 under AFN 345921 and a second amendment was filed on November 6, 1998 under AFN 416087 26.) A septic permit(SEP97-0219)was finaled on August 21, 2000. A boundary line adjustment(EXM97-0025)was finaled on May 13, 1997. A plat alteration (SUB98-0001) to consolidate Lots 7 & 8 was finaled on November 6, 1998. 27.) The site is served by Brinnon Beach water system (ID#25326C). 28.) An address of 201 Never Give Up Road, Brinnon has been assigned to the parcel. Never Give Up Road is a private road (P393). 29.) The county GIS maps identify the subject parcel and surrounding parcels as being within a landslide hazard area 1. (These lots were platted in 1987 and amended in 1991 and 1998). The topography does slope down to the east, however on this parcel it is a gradual slope. Staff has previously been to this site and there is no sign of erosion or drainage issues/concerns. There is no top or toe of a slope on the parcel or in the immediate vicinicy, therefore a 30-foot vegetative buffer is not required. CA IN 00 JEFFERS�COUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT 621 Sheridan Street • Port Townsend • Washington 98368 i 360/379-4450 • 360/379-4451 Fax p� www.co.jefferson.wa.us/commdevelopment N� Master Permit Application MLA: O Co -`4ZQ 'eclt J s8iption (include separate sheets as,neceslary): , �1. (lac( �' �y'2 R�C fv i= { ' : ;y :-� y�.lSKC fit.• L 1,-- Property Tax Parcel Number: Lp" Qa� - Size: - .,.t.a. ,. /"j3-1. Cf. (acres/square feet) Site Address and/or Directions to Property: i\ri.,.Y2--ifs C'. ; ,r " . { i kik(n/j WA- Property Owner(s)of Record: ...t int: Gt. .F'ill , Telephone: .a;3 L() — =f y(.E tit-}`i l..F . Fax: email: Mailing Address:.-D • f5o 2-r) i Li kkik-t L&.k -t Applicant/Agent(if different from owner):��or-1 Sc,li(Ia.kA reel tc Idr, s *. ', r vi e,(.t -ari (.—L_. Telephone: > C(`,-lr c --` V3 Z Fax: .3tc : t.j SI` 2L/7 but . .rc C.6st. Mailing Address: i ( Li ' Joj 6 H7L'y C((t� : $ 4 !Oh irk �n %__ What kind of Permit?(Check each box that applies) Li Building ❑ Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit ❑ Conditional Use[C(a),C(d),or C]** ❑ Single Family ❑ Discretionary"D"or Unnamed Use Classification ❑ Garage Attached/Detached ❑ Special Use(Essential Public Facilities)** evlanufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address ❑ Road Approach ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑ Propane ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis 0 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: t DESIGNATION OF AGENT I hereby designate - C �t .. -, L_ to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE �II � 1p Date: /l g1 D� . Fr By signing this applicati•n fo ,the owner a'ent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or it's knowledge. A 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 nul .nd 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 provi access and right of entry to Jefferson County and its employees, representatives or agents for the sole purpose of application review and any re uired ater inspe ti ns Access and right of entry to this property shall be requested and shall occur only during regular business hours. Signature: // Date: (/ t /' i- The action or ac ons pplicant wi undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species a d could le d to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species "or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issue- •t violate the ESA. 'ny individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s) even if you are in'o •liance with the 'Je erson County development code.The Applicant acknowledges that he,she or it holds individual and non- transferable resp,,ns'•ility fir adher'/• to and complying with the ESA. The Applicant has read this disclaimer and igns and dates it below. Signature: /� /. / I Date: !0 1 1 ZI C;((a _ 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 responsibilit of the Gte eral Contractor for the proposed project. Signature: ' W Y 1� Date: L/i E/W . GENERAL ON OR OR M N FACTURED HOME INSTALLER: PHONE: FAX: i' ' 01 &:eJ .► \ Li- k-tk- . (�.tt�) (�g 3—�152, . c :if c )8(�1-$ 4Z, MAILING ADDRESS: ) 6)-1 d gl IL( } EMAIL: ��u i'l d 4 Li-,.E� ,Aa��. COV$ -. CONTRACTOR'S LICENSE U WAINS "1J NUMBER: /1 , y iroL 9 CtCv5 `-7 NUMBER ARCHITECT/ENGINEER: PHONE (314 )c 9622 FAX: (AC ) 1- 324Z MAILING ADDRESS: -4-tot Did �06 s(}p�1 u_t . EMAIL t �‘A, L; c �46,kr,?v• C Project Type: Frame Type:j Bathrooms: Shoreline: Type`of Sewage Disposal: le- New C Wood Existing: ❑ Sewer ❑ Addition ❑ Steel Proposed: I Bank Height: ❑ Community System ❑ Alteration/Remodel ❑ Concrete Total: ❑ Individual Sysm ❑ Repair ❑ Masonry t" SEP Permit# �c�� ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: p" Private well f I Two Party Type of Heat: Proposed:Total: ��/14 CI Public Name of System: r31_, lv - c If this is a Comm rcial 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: I 1 Underground Tank ❑ Above ground Tank Size of Propane Tank: f l Heat Stove I I Cook Stove L1 Woodstove I i Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove 17 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. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: (1 b Floor Heated Consistency Review: Other Heated Base fee: 1 3 Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated r C Pot Water Review fee: l O Garage/Carport �`�� SUBTOTAL /4 Decks 911/Rd Approach fee: l -J G a Other TOTAL: $ ( a :7 Receipt Number: $3 -l5e Cash/Check Number: tat _ ESTIMATED COST(REQUIRED) Date: I t"Y� .Fair market value of all labor and materials foundation to finish 31 Initials: G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc • • • RETURN ADDRESS 4 Pr Po A fb l'i IR )� �r ,(„ ,NAI;FIINGTON MANUFACTURED HOME PLEASE CHECK ONE ��1,.licEnsinG U,», APPLICATION TITLE ELIMINATION 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 TP /PLATE NUMBER YEAR MAKE LELTcH/WIDTHLT) VEHICLE TIFICATION NUMB(i VIN) u liet/7 c)%k:1 ` -V x 09 )O U i1-13 © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE g AFFIXED ❑ REMOVED REAL PROPF�i3 TAX PARCEL N�MBER / ` G �j V� 1(i D �)cv� LOTn BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION gPr'nnG,n 5`Al-.h 12c( 1)(h Rrrr� 0 GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER ( �1 NUMBER OF REGISTERED OWNERS NUMBER OF LE AL OWNERS l f ', - NAME OF REGI ERED OWNER DOL CUSTOMER ACCOUNT NUMBER �)/1CC Cc'`�� NAME OF ADDI ONAL REGISTERLD OWNER DOL CUSTOMER ACCOUNT NUMBER f r( n(�' �i Sct_d1 L ADDRESS r CITY STATE ZIP CODE y NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT 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/WE AM/ARE THE RE ISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title, IF APPLICABLE �/ .L ` - /r.L..-c, .rZ! Signature of Additional Registered Owner and Title, IF APPLICABLE_Lie 4/7 ( p NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington . -f rc'r> � Signed or attested 2/ )el County of before me on U. by i re kb'J C Tr nC Signature 011 AGEN.4 Civ P//J����ssffllN//T NAM 6rJRlJEn/GISTERED OWNER AR O AGEN kiA by PRIN~ AM OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR )(,Di-`) 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. © BUILDING PERMIT OFFICE CERTIFICATION I certify that: g the manufactured home has described. a building permit has been issuedbeen foraffixed this purpose tothereal and theproperty attachment will be inspected upon completion. NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# SIGN RE�/PO ITIO ,�� ., D TE 1 Crit\ r•;� .t � .4.'•D Ll.r.kif`1.t C,t .�� (C )r�l 1(.r1 TD-420-729 MANUF HOME APPL(R/2/02) R(W)Page 1 of 2 • MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) X 6 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) 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 OFFICE/VFS 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 TTY(360) 664-8885. TD-420-729 MANUF HOME APPL(R/2/02)OR(W)Page 2 of 2