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HomeMy WebLinkAboutBLD2007-00543 • • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 PERMIT #: BLD07-00543 SITE ADDRESS: 1391 IRONDALE RD Issue Date: 11/15/2007 PORT HADLOCK, 98339 Final Date: 2/8/2008 APPLICANT: MARK TOWNER PHONE: 360-774-0374 LISA TOWNER 1391 IRONDALE RD PORT HADLOCK WA 983399529 SUBDIVISION: Block: Lot: TX17 PARCEL NUMBER: 901021005 Section: 2 Township: 29 N Range: 01 W PROJECT DESCRIPTION: REPLACE EXISTING MAN HOME WITH NEW MAN HOME (Serial#: 28896) THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2006 EDITION. �}- OCCUPANCY GROUP: rYAob)l e_ home bu TYPE OF CONSTRUCTION( if CCU I SPRINKLER SYSTEM yes no THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 2/8/2008 I:\F_B LD_Occupa n cy.rpt 10/29/19 • MANUFACI RED/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 #: BLD07-00543 Received Date: 10/15/2007 SITE ADDRESS: 1391 IRONDALE RD Issue Date: 11/15/2007 PORT HADLOCK, 98339 APPLICANT: MARK TOWNER LISA TOWNER 1391 IRONDALE RD PORT HADLOCK WA 983399529 SUBDIVISION: Block: Lot: TX17 PARCEL#: 901021005 Section: 2 Township: 29 N Range: 01 W CONTRACTOR/ L & L CONSTRUCTION PHONE: DEALER PO BOX 785 PORT ORCHARD WA 98366-0785 Contractor's License LLCONI*044NA Expires 8/1/2009 PROJECT DESCRIPTION: REPLACE EXISTING MAN HOME WITH NEW MAN HOME MAKE: KARSTEN YEAR: 2007 SIZE: 56 X 26.8 Directions SR 19 TO IRONDALE RD- 1300 BLOCK OF IRONDALE RD To Site: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 11/15/2008. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TO YOUR PROJECT. Setbacks/Footing (CONTINUOUS FOOTING, SLAB or PADS USED): (a-Aa—CI Tt)) Stormwater FINAL Approval: Blocking/Plumbing: 6._ I '17 Propane Tank/Lines ► VA, Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: XIS IA Final/Skirting/Vents/Porches/Steps: 5(_IlzYtNc: ilEiv S ?ZC"F,''�S f ncfx 04 2/7fr? Lu 1, U` b4 HEALTH DEPARTMENT AND PUBLIC WORKS APPROV L 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 1PU ILDING PERMIT APPLICA•N MLA07-00578 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD07-00543 Received Date: 10/15/2007 SITE ADDRESS: 1391 IRONDALE RD PORT HADLOCK, 98339 OWNER: MARK TOWNER PHONE 360-774-0374 LISA TOWNER 1391 IRONDALE RD PORT HADLOCK WA 983399529 SUBDIVISION: Block: Lot: PARCEL NUMBER: 901021005 Section: 2 Township: 29 N Range: 01 W CONTRACTOR: L & L CONSTRUCTION PHONE PO BOX 785 PORT ORCHARD WA 98366-0785 Contractor's License LLCONI*044NA Expires 8/1/2009 REPRESENTATIVE: PHONE: PROJECT DESCRIPTION REPLACE EXISIING MAN HOME WITH NEW MAN HOME TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION 88,036.00 MAIN: CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: # OF STORIES: CONST TYPE: OTHER: GARAGE: SHORELINE: CONST TYPE: SETBACK: DECK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PUD BEDROOMS: BATHROOMS: Exist: 2 Exist: 2 Prop: ' Prop: Total: Total: 2 Routing Date. `O1 I f S! v i °y Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $163.00 CJZ 10/15/07 93464 APPROVED- Total: $163.00 NOV 15 2007 Jefferson County Planning & Building Department • • SPECIAL CONDITIONS CASE # BLD07-00543 1.) A MINIMUM OF 10' MUST BE MAINTAINED BETWEEN BUILDING FOUNDATION AND EDGE OF DISPOSAL COMPONENT. 2.) ALL COMPONENTS OF THE SEPTIC SYSTEM ARE TO BE COMPLETELY PROTECTED FROM VEHICULAR TRAFFIC OR MECHANICAL DISTURBANCE. 3.) MUST COLLECT AND DIVERT ALL SOURCES OF DRAINAGE AWAY FROM SEPTIC TANK, RESERVE & DRAINFIELD. MUST COMPLY WITH ALL PERMIT CONDITIONS, STATE AND LOCAL CODE. 4.) 10' SEPARATION REQUIRED BETWEEN A WATER LINE AND ALL PORTIONS OF THE ONSITE SEWAGE SYSTEM; EFFLUENT TRANSPORT LINE, TANKS, TREATMENT AND DISPOSAL COMPONENTS 5.) A MINIMUM OF 2' MUST BE MAINTAINED BETWEEN DECK FOOTING AND EDGE OF DISPOSAL COMPONENT. 6.) The application was reviewed by the Jefferson County Department of Community Development staff on October 30, 2007 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: Shoreline Designation -Conservancy, Shoreline Slope Stability- Stable and Unstable, High Landslide Hazard Area, Susceptible Aquifer Recharge Area (SUSC), Coastal Seawater Intrusion Protection Zone (SIPZ). 7.) 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. 8.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 9.) 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. 10.) 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. 11.) Among the native conifer species which may be used in buffers or for re-vegetation include, but are not limited to: Grand Fir(Aibes grandis), Sitka Spruce (Picea sitchensis), Shore Pine (Pinus contorta), Douglas Fir(Pseudotsuga menziesii), Western Red Cedar (Thuja plicata), and Western Hemlock (Tsuga heterophylla). Among native tree species which may be used includes: Vine Maple (Acer circinatum), Big-Leaf Maple (Acer macrophyllum), Red Alder(Alnus rubra), Pacific Madrone (Arbutus menziesii), Quaking Aspen (Populus tremula), Black Cottonwood (Populus trichocarpa), Bitter Cherry(Prunus emarginata), Oregon White Oak (Quercus garryana), Cascara (Rhamnus purshiana), Pacific Willow(Salix lasiandra), and Scouler's Willow(Salix scouleriana). Among the native shrub species which may be used are: Sevice-Berry(Amalanchier alnifolia), Red Osier Dogwood (Cornus stolonifera) Sala! (Gaultheria shallon), Ocean Spray (Holodiscus discolor), Indian Plum (Oemlaria cerasiformis), Pacific Ninebark (Physocarpus capitus), Red Flowering Currant(Ribes sanguineum), Wild Rose (Rosa nutkana), Swamp Rose (Rosa pisocarpa), Willows (Salix ssp.), Red Elderberry (Sambucus racemosa), Snowberry (Symphoricarpos albus), Evergreen Huckleberry (Vaccinium ovatum), Red Huckleberry (Vaccinium parvifolium). 12.) Marine shorelines and islands susceptible to a condition that is known a•awater 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. 13.) 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. 14.) A vegetative buffer of 30-feet shall be permanently maintained from the top or edge of the Landslide Hazard Area. All buffers shall be measured perpendicularly from the top of the Landslide Hazard Area. 15.) Landslide Hazard Areas and their associated buffers shall remain naturally vegetated. Should buffer disturbance occur during construction, the Unified Development Code (UDC)Administrator shall require replanting with native vegetation. No alterations shall be made to the Landslide Hazard Area or its associated buffer without prior authorization by the UDC Administrator. 16.) Prior to and during approved construction activities, the perimeter of the landslide hazard area buffer shall be marked with a temporary sign. The sign shall be placed in such a manner that it can be directly observed from the construction area. The sign shall contain the following statement: "Landslide Hazard Area and Buffer- Do not Remove or Alter Existing Vegetation." 17.) All construction activities shall not encroach upon the landslide hazard buffer. This includes the storage or preparation of materials. 18.) The applicant shall permanently separate the boundary of the Landslide Hazard Area Buffer from the remainder of the subject property through installing logs, trees, a hedge row, or any other prominent physical marking approved by the UDC Administrator. 19.) 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. 20.) 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. 4 21.) VOLUNTARY MEASURES OF•ASTAL &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. 22.) MANDATORY MEASURES FOR COASTAL SIPZ: 1. For proof of potable water on a building permit application, applicant must utilize DOH-approved public water system if available. 2. If public water is unavailable, a qualifying alternative system may be used as proof of potable water or an individual well may be used as proof of potable water subject to the following requirement: a. Chloride concentration of a laboratory-certified well water sample submitted with building permit application. 3. If public water is unavailable, a qualifying alternative system may be used as proof of potable water. 23.) 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. 24.) Stormwater shall be retained and infiltrated on site. The owner shall control all sedimentation and erosion on the property. 25.) The applicant is proposing to create or add 150 square feet of impervious surface and 1,590 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. 26.) 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. 27.) 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). 28.) The site plan as submitted with the building permit application on October 15, 2007 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 October 30, 2007 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 29.) 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. 30.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 31.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 32.) Not more than 2 unlicensed vets shall be stored on any lot unless totall•eened 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. 33.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 34.) The building height is not to exceed 35 feet. 35.) Pre-existing legal lots of record less than one acre in size in rural residential districts are subject to the stormwater requirements in Chapter 18.30 JCC 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. 36.) THE MOBILE HOME WILL BE REMOVED PRIOR TO FINAL INSPECTION. 37.) 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. 38.) Setback from Irondale Rd. right-of-way is no less than 30 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. 39.) A Restrictive Covenant for Irondale/Hadlock Sanitary Sewer System No Protest Agreement was recorded November 13, 2007 under AFN 529176 with the Jefferson County Auditor. 40.) Irondale Rd. (C933507) is a major collector road. A road approach is existing and an address of 1391 Irondale Rd. has been assigned to the parcel. II . 0N S ,t r 6, JEFFERSON COUNTY . \k,, DEPARTMENT OF COMMUNITY DEVELOPMENT -' ''z "''4 621 Sheridan Street• Port Townsend • Washington 98368 rat• * 360/379-4450• 360/379-4451 Fax OCT 1 5 2007 _ . �, ,IlINCi.0 www.co.jefferson.wa.us/commdevelopment J Master Permit Application MLA: ( . Project Description(include separate sheets as necessary): RePL erc -_)(s-r M O BILE N -Ae. 1,01,1H Nam) flA r u.,yQ J fLED f-]-D MMC Tax Parcel 90102 Property , Number: Size: •,5O acre . (acres/square feet) Site Address and/or Directions to Property: SR K't Tim Itati•%A-L.0 KOALA -loam 'tki "nil., 130o ri ocic t= - oNDArt-c 42c is_. Property Owner(s)of Record: MARK AND LISA TOWNER Telephone:360-774-0374 Fax: 360-765-0780 email: Imtowner@hotmail.com Mailing Address: 1391 Irondale Road,Port Hadlock,WA 98339 Applicant/Agent(if different from owner): same Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies OBuilding 0 Variance(Minor,Major or Reasonable Economic Use) ❑ Demolition Permit El Conditional Use[C(a), C(d),or C]** ❑Single Family ❑Garage Attached/Detached 0 Discretionary"D"or Unnamed Use Classification I Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* ❑ Boundary Line Adjustment ❑ Change of Use ❑ Short Plat** ❑ Address El Road Approach 0 Binding Site Plan** ❑Home Business 0 Cottagelndustry 0 Long Plat** ❑Propane ❑ Planned Rural Residential Development(PRRD)/Amendments** ❑Sign ❑ Plat Vacation/Alteration** ❑Allowed"Yes"Use Consistency Analysis ❑Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management El 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 ❑Tree Vegetaion Request *May require a Pre—Application Conference **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE 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. Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the ap ication that he or shej%-CAJ .L,j' ants prior notice. Signature: ( ,Q, ,,{_,A- Date: t V /J � /07 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-transfe ._,e responsibility for a enng to and complying with the ESA. The Applicant has read this disclaimer and si ns and dates it below. Signature: 4/4 I 4A, Jol. a/ Date: l0/'4- a7 C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master Permit Application 12-19-2006.doc • • BUILDER STATEMENT The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: L&L Construction ( 360)479-8312 ( ) MAILING ADDRESS: P.O.Box 785,Port Orchard,WA 98366 EMAIL: P44,13e)(48&,-1244LUctaaKIr3A0ree9e6 DKr CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER WAINS#2060 ARCHITECT/ENGINEER: PHONE ( ) Fax:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: :1 New Li Wood Existing: ❑ Sewer i Addition ❑ Steel Proposed: Bank u Community System I I Alteration/Remodel ❑ Concrete Total: 2 Height:_ it Individual System I I Repair CI Masonry 7L5(r SEP Permit# CX3— ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Type of Heat: Proposed: 2 1 yZPublic c—I cAY-1 a Total: 30' a 't'XC Vzir CtOtrr trZa fc, If this is a Commercial Project you must answer the following: t# Number of Parking Spaces: Current: Proposed: umber of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: ❑Underground Tank °Above ground Tank Size of Propane Tank: ❑Heat Stove 0 Cook Stove ❑Woodstove ❑ Fireplace Insert ❑Hot Water Tank 0 Pellet Stove 0 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: 2fla Floor Heated Consistency Review: Co 8 Other Heated Base fee: r_ Mezzanine Additional Section: Nnv Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Al ^s Other Unheated Pot Water Review fee: /- C Xing Garage/Carport SUBTOTAL Decks 911/Rd Approach fee: Other iCX(511 1 TOTAL: $ Receipt Number: Ck 3'4c0�. Cash/heck Number: ", ESTIMATED COST(REQUIRED) Date: 0-7 'Fair market value of all labor and materials foundation to finish 1 ! (� (5� Initials:' OCT i 5 260ef C:\Documents and Settings\caral\Local Settings\Temporary Internet Files\OLK86\Master$e ni Application 12-19-2OO6 kc-r Y JACK WVESTERMAN. Jefferson Ott, Courthouse ASSESSOR PO Ilox 1220, Port Toro-nsend, WA 91;3643 4360):31;5-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: i11 R V 4 L)Spa N ADDRESS: 1 3c1 1 f.�,'k c.l e R cc 1=i-;' 14 1( j:,a 9 c PHONE NO. 344C._ 77.. -CF3-7 y 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. I)MOBILE HOME DATA: (A) MAKE 6c4 rsu n (B) MODEL 5VeCi, (C) YEAR tC 7 (D) LENGTH ScL% (E) WIDTH` (F)SERIAL # TB V- (- SS i(p (G) YOUR PURCHASE PRICE (Do not include sales tax) SS,O3(a PURCHASE 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 ACID (B)IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILX HOME PARK: NAME OF LAND OWNER: L K.k fDl.`° ,(- LOCATION ADDRESS 139 Toyiciate &id Part l + 9832) REAL PROPERTY PARCEL #/DESCRIPTION R41 oat ons- nn E ( LI 7 11 to 1 �f Signat re of applicant THANK YOU FOR YOUR HELP! OCT 57 �, I 0_,,tsl-e 46Z COSSELL, Property Technician rY� c r�r • a x , H.41141:-. 1 __LI , m 6'-8" 2 i` r __ 14x39V1 r T --= L,2 o r Lit o I' o 0 1-/- —_ L� 7 CT CD 1 � = g L--T Immimg ls, m r1 Z' -0 v Refer I 0 a-Tr, 6- V x c"-n = �, Co (9 = if --` • <' o '- V1 r_._ rn � V gal x i ai� W ...8' c - i co CP c ____I Raised Bar cp LID o co o C O CD O rnC...1 O OcD_ v rnrnrnof fl—/20J ao c� w�; GO • ......, 7J 0 x �' = W O O O O (Jr? 3 W , fU o- ' \ c° D L / —{ 78x58H I r ! RETURN ADDRESS Mark and Lisa Towner 1391 Irondale Road Port Hadlock,WA 98339 LlI STATE Ort`SH(NGTON MANUFACTURED HOME PLEASE CHECK ON 4licEnsinc APPLICATION El TITLE ELIMINATION ❑TRANSFER IN LOCATION O REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(F.EET) VEHICLE IDENTIFICATION NUMBER(VIN) 2007 Karsten 56/28 © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE ❑AFFIXEDREAL PROPERTY TAX PARCEL NUMBER 0 REMOVED 901 021 005 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION // S2 T29 R1 W © 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 Mark Towner NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Lisa M.Towner ADDRESS CITY STATE ZIP CODE 1391 Irondale Rd Port Hadlock WA 98339 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Eagle Home Mortgage,LLC NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 10510 NE Northup Way#210 Kirkland WA 98033 GRANTEE NAME Mark Towner and Lisa M. Towner . I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGIS D OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: , L'- -- Signature of Registered Owner and Title,IF APPLICABLE ..-- Signa`uoMMIMI Registered Owner and Title,IF APPLICABLE r.=V, —aCrx_AA, r- ,. _ \l ��jt1�Fj�4let�' ' NOTARIZATION/CERTIFICATION FOR REGISTE' :D OWNER(S)SIGNATU �VP • �t /� State of Washington Signer ors"(•sted 1)LL// (7 ' ti? 01A8). ,t A R Y County of Jefferson b fdre eon (1 I l) / 'c ,,�. Mark Towner it 0 l f'! ( Li 06112512v11 $ y PRINTED NAME OF REGISTERED OWNER Signatu OTA OR A NT 7)//__. �G o �� AV 8� by Lisa M.Towner Ai'(a�f(A N Y��1 C/" '1� •' 15 `4 \,\.� PRINTED NAME OF RE E�RE(DD�OWNER P' TED AME OF NOTARY O g �� NN�,}� v County/Office No.OR / 7 / 'OF WAS Title ("' AND: Dealer No.OR I / 11111111 DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date D 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 First American Title Of Jefferson County (360)385-1322 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: • 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. NA E(TYPED OR PRINTED) BLDG PE IT OFFICE/PHONE# BLDG PERMIT# A�}A l t, TZ, S(,IC7:it n 6 3 7q- 5�) 13Loo'7-DD5' 43 S[ N URE/pOS1 ✓/ '' J ^�� 5/alobTD-420- 29 M(NUFE AP L(R/2/02)E ( )Page 1 of 2of �C MANUFACTURED HOME—FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 2007 Karsten 56/28 6 SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELIMI. , 10 OF TITLE/REMOVAL FROM REAL PROPERTY. Signature of Legal Owner and Title,IF APPLICABLE r!. gc f Signature of Additional Legal Owner and Title,IF APPLICABLE 0 ARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE S��til'',...^ 7;.:ale,..0AR:Ww.cas::::inn:oonm,'' SignedorattestedJ ONTGOMERY S.SMITH �� IL1r�C� beforemeon �-/ ��' NOTARYPUBLIC �1 � �STATE OF WASHINGTON I � ne Signatu E OF REGISTE OWN �� NOTARY OR G T�7 COMMISSIONEXPIRESf ��_J'YY � � () JUNE 19, 2011 �y � ,q�t,,, S, ( ,6jks-• `���.N.Ps- 1't"••,-,_ �"`'�_^�^�-.,v PRINTED NAME OF REGISTERED OWNER PRINTED M OF NOTA tY 1 p Cou ty/Office No.OR ,n Title V) — f/T�r AND: Dealer No.OR kV-47-1V )1 DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 7 LAND DESCRIPTION(A legal description of the land can be obtained from the local County Assessor's Office.) Ptn GLI S2 T29N R1W Full legal description attached as exhibit"A" 8 DEALER'S REPORT OF SALE I CERTIFY THAT THIS INFORMATION IS CORRECT,THE VEHICLES 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 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 call(360)902-3600 or TTY(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)EXT(W)Page 2 of 2 P g SaktE - c,...., , • 1, ....',, 1 1 I Di 7 1 poen.. Totzt..3 sew 0 i.. pliAir .210.1•04.rne•were.M10...MRIVNIV "t1.0...i.,:;,.......S241.4. 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