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HomeMy WebLinkAboutBLD2006-00493 • MLA06-00477 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD06-00493 Received Date: 8/23/2006 SITE ADDRESS: 125 E MOORE ST PORT HADLOCK, 98339 APPLICANT: LEALA J ROSE PHONE: PO BOX 360 PORT TOWNSEND WA 98368-0360 SUBDIVISION: IRONDALE Block: 16 Lot: 25-26 PARCEL NUMBER: 961801606 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ GIFFORD CONSTRUCTION COMPANY PHONE: (360)732-4092 DEALER: PO BOX 304 CHIMACUM WA 98325 Contractor's License GIFFOCC044NA Expires 07/26/2008 Contractor's License MODERLL972DO Expires 04/14/2007 INSTALLER: MODERN LIVING LIMITED MODERLL972D0 4/14/2007 (253) 926-0455 AKA FUTURE HOMES FIFE WA 98424 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION: REPLACEMENT MFH MODEL: ANNIVERSARY SERIAL#09L3490XU TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: LIBERTY SETBACK: VALUATION 60,172.00 YEAR: 2006 LABOR & INDUSTRIES APPROVAL? SIZE: 40 X 27 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: Exist: Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: � S lag faces c-A Type Amount Paid By: Date: Receipt: u Approved/Date Permit $163.00 KAS 08/23/06 83990 Total: $163.00 SE? 17 au Jefferson County Planning & Building Department • • 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 #: BLD06-00493 Received Date: 8/23/2006 SITE ADDRESS: 125 E MOORE ST Issue Date: 9/18/2006 PORT HADLOCK, 98339 APPLICANT: LEALA J ROSE PO BOX 360 PORT TOWNSEND WA 98368-0360 SUBDIVISION: IRONDALE Block: 16 Lot: 25-26 PARCEL#: 961801606 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ GIFFORD CONSTRUCTION COMPANY PHONE: (360)732-4092 DEALER PO BOX 304 CHIMACUM WA 98325 Contractor's License GIFFOCC044NA Expires 7/26/2008 INSTALLER: MODERN LIVING LIMITED MODERLL.972D0 Expires: 4/14/200i AKA FUTURE HOMES FIFE WA 98424 PROJECT DESCRIPTION: REPLACEMENT MFH MODEL: ANNIVERSARY SERIAL#09L3490XU MAKE: LIBERTY YEAR: 2006 SIZE: 40 X 27 THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 9/18/2007. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): Stormwater FINAL Approval: Blocking/Plumbing:N ri j-2.1 &? Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: Final/Skirting/Vents/Porches/Steps: 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 • • SPECIAL CONDITIONS CASE # BLD06-00493 1.) The application was reviewed by the Jefferson County Department of Community Development staff on August 29, 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: coastal SIPZ. 2.) 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. 3.) 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. 4.) 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. 5.) VOLUNTARY MEASURES OF COASTAL &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. 6.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 7.) The applicant is proposing to create or add 1218 square feet of impervious surface and 1108 square feet of land disturbing activities. 8.) 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. • 9.) The applicant is proposing to create or add 1218 square feet of impervious surface and 1108 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require 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. 10.) 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. 11.) 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). 12.) The site plan as submitted with the manufactured home installation permit application on August 23, 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 29, 2006 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 13.) 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. 14.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 15.) Not more than 2 unlicensed 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 autormobile 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 requriements 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. 16.) Minimum setback from East Moore Street and 6th Avenue rights-of-ways shall be 15 feet per variance granted by the Development Services Manager on March 16, 2006. Minimum north and east setbacks shall be 5 feet. 17.) 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. 18.) 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. 19.) The building height is not to exceed 35 feet. 20.) A minimum of two (2) on-site parking spaces shall be provided for the manufactured home. 21.) The lots have been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 22.) The lots were created through the Irondale#1 Subdivision on June 3, 1909 under AFN 27961. 23.) A Declaration of Restrictive Covenant has been recorded on September 6, 2006 under AFN 515234 for the purpose of consolidating the lots to meet minimum land area requirements for on-site septic and to allow zero lot line setbacks. The Covenant is strictly for building and septic purposes only. 24.) An address of 125 East Moore Street, Port Hadlock has been assigned to the parcel. East Moore Street is a county local access (C677709). 25.) The site is served by PUD#1 water. 26.) A septic permit (SEP93-0302)was finaled on November 29, 1993 and is being reviewed as a redesign that was submitted on August 24, 2006 and approved by Environmental Health on September 13, 2006. A building permit(BLD93-0736) for a manufactured home was finaled on March 30, 1994. A building permit (BLD97-0105) for a roof over porch was finaled on January 28, 1998. • JEFFERSON CO4TY 4„i5°N c°6� DEPARTMENT OF COMMUNITY DEVELOPMENT ti o �I 621 Sheridan Street O� Port Townsend, WA 98368 .F�I'NCs Al Scalf, Director March 20, 2006 Pamela Rose PO Box 360 Port Townsend, WA 98368 Dear Pamela, Your request to reduce the twenty(20) foot street setback from Moore St. and 6th Ave for the property(parcel#961 801 606)located at 125 Moore St. was reviewed by the Development Review Staff and the Development Services Manager on March 16,2006, with a site visit conducted on March 8, 2006. Based the information you provided,the site visit and input from the Public Works Dept your request to reduce the street setbacks referenced above from twenty (20)feet to fifteen (15)feet has been granted. Z! hnson Assistant Planner Development Review Division S4 KCEI\ ED Dept of Community Development ":" ? 3 73QS JEFFERSON COUNTY GCB Building Permits/ Inspections Development Review Division Long Range Planning • . . .. • . . •. ., _ „ . . . . int: e. . s .-. ., . . i... 1 _ jeo , . • . • • ,. . • / •ir * • . .s'.-7:.i:::•:,,;,:.:. _.,,..,1 ( -41acLtrt-rv., --..-LeLxtr.,, Q.), --...- _c:2 .. el"' ':A:,•' ..,:.':,f,.•'.=,. Ell la yt.Q.. ' [!. ( .i ,v11) ... SECOND- . . frc I-L BED'ROOM A. - 2 '-'0; l'r.-q-1 9t.1•x?OW 9cl•x 1 • -:.... i_ - LL L L DINING '\'' 0 f 176; P d 0 4b . "' • .: : :';',.::X) '#....e" / ... ...,, .. . .. A.- • , a „ -... . .. r-...-- '1 :.'11,\I '''.- ;-•-- .„.. . . .. , , .,.... ...•::.:k. .. .. io \d....k CIw ill.,,/,0•' _. -v:d.„'•.•_*-Nf ie-., )..'.,,-..,-:...,..:i::,,,,:;•,:!i'-:,!.::.i:7:i;.•;:;i,.,;iW:::,,i,., .:;i•0:-A:4..-:•-S.l.Ez..-R7...-..,.-.. ..,l,:,::,1:,. .?Lk".- .;L•‘r,..''-...f.,:_0i„::1..Ti„,i.i!,,-,.3,r;.,:,44,:7i....1-P,..',l u,:.l 1,r6.K.w.1.,4,.-.-,,,:-', 7 ....,.j,'..V•.'4,11it t•r.,Iak oi,l'.i_%1 ,7-,:\,• .4 ..,3 , .0-?AgpRoom . A ' / • 1 _ •l ; . gd . , . - .RECEIV I - -"-s- ° .. - •. ,:.., •' •.-?-•;.:,,`.` ;r;,,.-- .k....emi... Skae. ' . ___._...,_41: :':::'..• .-.:-Itir Z:*:; ,,,.„,-: •'.•-• . 1' Tr AUG 2 3 2130 Ale) ..- 1 4-1-w 5 o,,,)z °ea . .•.. :::• • _.• .. . LIBERTY . • • .— RSARY DOUBLE WIDE 1 0 EggilSON QG284445 b9L34960XU -Pk BASE PRICE : :•;^ $54'052;06- ,•,: -.. :. i.,„.. . .. ...._ ,• .. , _ . ,_- . • .., -.-. . 1 .....e,-.. •• .••• • • ,. . OPTIONS SHOWN: " ••• EXTERIOR FROST FREE 'FAUCET- 1EA. RAISE WINDOWS 5"''':; • 1648 SKYLIGHT ',..: . OVERHEAD BEDROOM LIGHTS 3 EA CENTER SHELVES BASE CABINETS OVERHEAD UTILITY SHELVES CERAMIC TILE BACKSPLASH: KIT. CERAMIC TILE BACKSPLASH BATHS PLUMB AND WIRE FOR DISHWASHER _ .-d• ,. WHITE TRIM ' frlft. 7- INSULATED STEEL FRONT DOOR V, • . . ,,/- .• . .. 1,...9--- , . i ...• . .. ,. . •_. ...... ...• ., .. . . ' PRICE AS SHOWN, •.. . c - • • pfp /fo . , ,_. . ..: ,.,,,,,...„.. . ., : .,• ..... • , . ..........,„........„..........:., ,.. . ... . ......,: ....„, ..,:-.f-igt•...4.;:0 7:12= --- • -' . ..: -- • _. . 7 . .. ''...::' ........ ... - .. .. . : • . r „.. , >r .- .._ ., . : • ,.„. ....,,,,,,.. ,. „,:„:., • , . _„,:, . . • . . . ... .__. . _____................ ... . , JACK WESTERMAN Io .Jefferson C tr Courlhouye ASSESSOR PO lIox 12 rrrETTJAI5113611 1360):185-9 H,� MOBILE HOME INFORMATION FORM AUG 2 3 2116 OWNER'S NAME/MAILING ADDRESS: NAME: � 3 1 I F % :,��ci -Rue _ ll JEFFERSON COUNTYDCD ADDRESS: i 25 1 . v11 c)cre_ • / ( "1. ,✓f e,.L 1k:4icJC PHONE NO. 3c,1 - 5 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 r� (B) MODEL hl/i,,/ L'e r .,- r (C) YEAR �LIL:(y (D) LENGTH eA; (E) WIDTH (1,C 3479 C1X(,L J (F)SERIAL # (G) YOUR PURCHASE PRICE (Do not include sales tax) /���.?, PURCHASE D + '"7t C/ DATE 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)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 # (C) IF NOT LOCATED IN MOBILE 4tomE PARK 1-1 NAME OF LAND OWNER: t LOCATION ADDRESS p /. r,n �l1,lz � REAL PROPERTY PARCEL #/DESCRIPTION el / On 7 �� ✓C THANK YOU FOR YOUR HELP! Signature of applicant SSQQ Q, 4JO COSSELL, Property Technician r Ni ��� oN c�� JEFFERSC�OUNTY III` DEPARTMENT OF COMMUNITY DEVELOPMENT al `4 621 Sheridan Street • Port Townsend • Washington 98368 360/379-4450 • 360/379-4451 Fax qS, NG�O www.co.jefferson.wa.us/commdevelopment Master Permit Application MLA: 0(p- LI1-7 Project Description (include separate sheets as necessary): • / Ove_ci.• j Cixbr) _ I i. ,.-.t c ."-r a f/e,-37x , r; cIN.,-L1frY1;.:).t h,yu-1.;CAI -..1 r- �- Property Tax Parcel Number: f` ?Nr l c& Size: ; .,.- X I/ (acres/square feet) Site Address and/or Directions to Property: tee- .Yi 'S I� J� . - Property Owner(s)of Record: L /i- ' Y l.GS,.e_, Telephone: (C - ? Fax: -- email: 6-) ' , .04.� fllailing Address: f 7( 1-6-t�"rl -t, r41 j� 3r;-, Applicant/Agent(if different from owner): 14..,,,, if R.ic t� Telephone: Acc, -,�c.,l -Lc,j j Fax: email: Mailing Address: I � - LE-. /I ie'L e_l j-i /9;-L /�c'?(// k I-;-,r tr."..).j j What kind of Permit?(Check each box that applies) N.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 ❑Garage Attached/Detached 0 Special Use(Essential Public Facilities)** 'Manufactured Home ❑ Boundary Line Adjustment ❑ Modular ❑ Short Plat** ❑ Commercial* ❑ Binding Site Plan** ❑ Change of Use ❑ Long Plat** ❑Address l i Road Approach 0 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* 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: D ESIGNATION OF AGENT -Ji-t I hereby designate _ a GYy-rn ( act as my agent in matters relating to this application for permit(s). 41. OWNER SIGNATURE, ` -- d � f��c' .eJ 7t.� Date: ` --L - t (l 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. ii Signature: < ii ' a. -A--, c-%. 5 —'`� —( (1. t�- Date: 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: ,, <<Gc-�. /1` ,/4- - t Date: - - `)-,-;( 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 CONgTRACT/OR OR MANUFACTURED HOME INSTALLER: PHONE: FAXX:: /'. ,1`I J'=4 // ` ) !_=,_ 1 ( -t (/'7')• c/�.3 t _ c,. hi-1�%�'� /!7L'!_!ir'r/i /��/.ii5• /.�...'t)t+'� ��l / yl�' MAILING ADDRESS: L'.Z( /`1' -7`�l L 1. ` J €fO 7.).' _ )-1 P r-ti"i 1 7 L.,"t4 . 9 L?3/2 G61÷TIERefeofe6 LICENSE ,/ WAINS NUMBER: n r)e i t 1`// ! "/.r L C' .Cir i. V/Y-6'7 NUMBER ti 5 i'/ Afte HTEG' GiNEER: ",fr� `` PHONE ( .���.,/ ) 1` ' FAX: ( ) ! 1trc c. e- nlame-(1it�C'r'r1 C i , i`.- r s :r(:. I4 )CCC_'vi':.A.;ti _�� �2.EkiC / MAILING ADDRESS: L:E vC e_ 4 9/ — 72 ti l c Z Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ,' New 11 Wood Existing: ;c.. ❑ Sewer ❑ Addition ❑ Steel Proposed: Bank Height: ❑ Community System ElAlteration/Remodel ❑ Concrete Total: Individual System ❑ Repair 0 Masonry V 1 OSEP Permit# O Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: f i Private well I I Two Party Type of Heat: Proposed: N. Public Total: )\ 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 C1 Above ground Tank Size of Propane Tank: I 1 Heat Stove i 1 Cook Stove ❑ Woodstove [1 Fireplace Insert ❑ Hot Water Tank ❑ Pellet Stove I I 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: 2nd Floor Heated Consistency Review: Other Heated ``��;� R v � Base fee: �3 � REf`� I \• 1 ) Mezzanine Additional Section: Heated Basement A!I^ n x r r' Plan Check fee: Unheated Basement nn��{{ p�{{�1jfi {� State Surcharge fee: Other Unheated j 1 r eflt J i11 f f KA Pot Water Review fee: Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: ` LS (rl/ � Other TOTAL: $ 3 7/ 0 0 Receipt Number: $ q b Cash/Check Number: LI I ESTIMATED COST(REQUIRED) Date: C 0 �D� •Fair market value of all labor and materials foundation to finish o Initials: dic.CIJ) G:\PermitCenter\FORMS\DRD FORMS\Master Permit Application 12-30-05.doc ot RETURN ADDRESS 61/7 k---- alp . 11/do . iq clA) `NO pd 3 • WASHINOTON STATE DEPARTMENT OF • Manufactured Home as CH CK ON I C LICENSING Application TION ❑TRANSFERTITLE INALOCATION 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 1..1 1 i L�N�aTHNVI DTyjFFFJ) VEHICLIDENTIFICATION NUM�R ) © LAND t/n/ 4 'hi !UU X t7CLLEEGGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE Ga'AFFIXED ❑ REMOVED 961 801 606 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 25&26 16 Irondale#1 © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 1- NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER William N.Rose NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Pamela N.Rose ADDRESS CITY STATE ZIP CODE 125 E.Moore Street Port Hadlock WA 98339 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Golf Savings Bank NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE P.O.Box 5010 Lynnwood WA 98046 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED QWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: j Signature of Registered Owner and Title, IF APPLICABLE J 4N //4, '-. Sign�att c fnp I�Registered Owner and Title, IF APPLICABLE c i.,: <, ' .( - /7e, 4 -. \ Msj�� "'�o""�/ I NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE Q�S,.••'""••.MG�f► � I State of Washington . ._ Signed or attested �. V O Tq �� County of 1' } L before me on N t �'15..2009 by IL. , //f�'<<a j �i /S�'S ..- Signature (_,%'u i-4 4.L 1--- - ._ �„, •• p : PRINT NAME OF REGISTERED OWNER F, NOTARY OR AGENT i y '. L8Lto ;• 'Z' _I •'••. .••' ���� by IL t)I _L �L_' (.. _ Li!l i'� kc':.-S/2z„_..ss _ •,,�% 0'�wAsN��a`0 PRINT NAME OF REGISTERED OWNER PRINTED NAME OFCo NOTARY ce No.OR DEAL RSHIP /i��if1111111111\\\� Title !� C" AND: DealerNo.OR�.,.�✓5;�/z'r E POSITIO 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 Icertify that: A 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) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT 0 SI NA RE/ p-IVrf�.1 ram i 4 `...� D.l\- `J'a,O DATE TD-420-72 6)W IP�a(ggef 1 of 2 �/ , 1 / ! _MANUFACTURED HOME-FROM SECTION 1 TPO/PLATE NUMBER YEAR AKE LE GTH/WIDTH(FEE ) VEHICLE IDENTIFICATION" � NUMBER(VIN) Lj 7 ?ebei4ij LE x �9 6-' 5-78 Lf / ti 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 , c I/ Signature of Additional Legal Owner and Title, IF APPLICABLE d �� ,VI t "�e__, NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR LEGAL WNER(S)SIGNATUR n- "'..tn."'g' ` ,%7 �. Aj''f.., ate of Washington V /horL��t g F�(lt�1'^f fw ( f.( I 9 Signed or attested NO FA p� BLiq DGNi D S. PEARSON C. t/P 17 �� before m STATF !..°f ' ';".7H~IING1l fib - ( � Signature /^�,p�9pq y tt�It-1 -, 4,PRI NAM FL AL OWNER NOT YQRP N COMM)a i x! d,`. f f' kl " """'""'In' • • '3 PRINT NAME OF LEGAL OWNEq PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR 51-I I DEALERSHIP POSITION/AGE /NOTARY Notary Expiration Date D LAND DESCRIPTION (A legal description of the land : •- obtained from the local County Assessor's Office) LOTS 25 AND 26,BLOCK 16,IRONDALE NO. 1,AS PER PLAT RECORDED IN VOLUME 2 OF PLATS, PAGE 125,RECORDS OF JEFFERSON COUNTY,WASHINGTON. SITUATE IN THE COUNTY OF JEFFERSON,STATE OF WASHINGTON. 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 NAME(TYPED OR PRINTED) , ,... � WA DEALER NUMB R DATE F SAL PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S ORIZEDSIGNATURE 7,r.•� 874/' ram.. K U �-- USE TAX EXEMPT Sale to a Certified Tribal member on the reservation 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 8 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 (R/6/06)IN Page 2 of 2 I --.....„,.........- 1 ,, , .... 73 0 ,_ . ,..-, _ A %act 1 \ • •- m .fr / ITS r-- 7'- '*- 0003 ...... I?\.,1 r . C:= CY, = • -e ...... L.T\ I -.... / , M I— -P• CCP •••1—C1 (C) IG \\ .., 4 t F:= 04 Z 3 \ 5 04' s. - - - - - -\ • \ - siS.‘ \ \ Stilb 77:t 4111111MIN,\., Vik -0 ' M T e. -r --- m 't 4 0 , N.',C' • ,,.,,,,4." M I„:„,. *\ cn . ' -.-, '(.s. cn . r - ,,, • . (,) • 7d , %,, 0 !,- J -0 t..- , -,... -,, , •-;„. 0 t.... .k., x-, RI . , . . -:- 4 4t. • t 1 • „ :--,-- _, • ,,,,,,,r '•\.,,, - —..--ola6 ..... . est, , , •' , III 1 I I ., 0 , X -. N • 4, j-7(0 0 0 671 7 ...........!•••••••••••••••••••••=1.•••••••••••1=01 1 7t, i.1 Cq ! . 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