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HomeMy WebLinkAboutBLD2008-00148 MANUFAC!URED/MOBILE HOME INSTALLATION PER MIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD08-00148 Received Date: 4/14/2008 SITE ADDRESS: 31 S 7TH Issue Date: 5/16/2008 PORT TOWNSEND, 98368 APPLICANT: DAVID M HENSEL 31 S 7TH ST PORT TOWNSEND WA 983689785 SUBDIVISION: GISE'S ADDITION Block: 13 Lot: 7-8 PARCEL#: 953101304 Section: 16 Township: 30 N Range: 01 W CONTRACTOR/ OWNER/BUILDER PHONE: DEALER PROJECT DESCRIPTION: M/H TO REPLACE EXISTING FIRE DAMAGED HOME (SER# 17705777) MAKE: SILVERCREST YEAR: 1990 SIZE: 48 X 26 Directions SEE DIRECTIONS& MAP IN FILE To Site: THIS PERMIT IS VALID FOR ONE YEAR. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 5/16/2009. CALL IN FOR THE REQUIRED INSPECTIONS THAT APPLY TQYOUR PROJECT. - Setbacks/Footing (CONTINUOUS FOOTING,( B9 PADS USED):cn/ Stormwater FINAL Approval: S s'.Q_. C n c\7‘'--lti'\ I'0 1. Blocking/Plumbing: w,.i8 .- _ Propane Tank/Lines Zoning Final Approval: Septic System Final Approval (If not on sewer): Road Approach Final Approval: r� Final/Skirting/Vents/Porches/Steps: e_Q. C,o h1)v\- h h\� 0 a. P2�'cv rrre.�`l�� ) HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED P OR 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 E LDING PERMITAPPLICATI�1 MRL y Review 181 Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD08-00148 Received Date: 4/14/2008 SITE ADDRESS: 31 S 7TH PORT TOWNSEND, 98368 OWNER: DAVID M HENSEL PHONE: 31 S 7TH ST PORT TOWNSEND WA 983689785 GISE'S ADDITION SUBDIVISION: Block: 13 Lot: 7-8 PARCEL NUMBER: 953101304 Section: 16 Township: 30 N Range: 01 W CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTIOF M/H TO REPLACE EXISTING FIRE DAMAGED HOME (SER# 17705777) TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,248 CODE EDITION: 2006 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: i4-rA Type unt Paid^ Sv: Date: Receipt: Approved/Date Manufactured Homes $168.00 LYK 04/11/08 97139 APPROVED Potable Water Application $59.00 LYK 04/11/08 97139 Total: $227.00 MAY 1 (p 2008 Jefferson County Planning & Building Department • • SPECIAL CONDITIONS CASE # BLD08-00148 1.) SPLASHBLOCK DESIGN CRITERIA A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE, STEEP SLOPES, STREAM, WETLAND, LAKE OR OTHER IMPERVIOUS SURFACE. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASH BLOCK. A SPLASHBLOCK OR A PAD OF CRUSHED ROCK(2 FEET WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHAGE POINT. FOR SITE WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFIELD AREAS. 2.) PRIOR TO FINAL BUILDING APPROVAL USR08-32 MUST BE FINALED, THE St n. c) DV `n 6-it DECOMMISSIONING WELL LOG SUBMITTED AND FOUND ADEQUATE PER DOE Ftn Pc)i"+ WELL CONSTRUCTION REGULATIONS. St rn 0% 3.) The application was reviewed by the Jefferson County Department of Community Development staff on May 8, 2008 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: SUSC aquifer recharge area; unstable slope stability. 4.) 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. 5.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 6.) 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. 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.) The applicant is proposing to create or add 1400 square feet of impervious surface and 2688 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. 9.) 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. 10.) 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). 11.) The revised site plan dated May 9, 2008 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 May 9, 2008 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 12.) This approval is for demolitio•fire damaged home and a replacement oh 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. 13.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 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.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 17.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 18.) Minimum setback from South 7th Street right-of-way shall be 10 feet-15 feet. Minimum setback from Stevens Street right-of-way shall be 15 feet. Minimum north and east setbacks shall be 5 feet. 19.) 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. 20.) 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. 21.) The building height is not to exceed 35 feet. 22.) An address of 31 South 7th Street, Port Townsend has been assignd to the parcel. South 7th Street is a county local access (C690019). 23.) The lots were created through the Gise's Addition Subdivion on August 16, 1889 no AFN available. 24.) The parcel is served by an individual on-site well. 25.) A demolition permit(BLD08-00149) for the fire damaged manufactured home was issued on May 19, 2006. A septic permit(SEP97-0235)was approved on December 23, 2978 and a redsign for designation of reserve submitted on April 16, 2008. A well review (USR08-0032) for decommissioning of well was approved on April 28, 2008. A building permit(BLD93-0085) for a steel shop was approved on March 11, 1993 and cancelled on April 6, 1993. According to Assessor records, a residence was constructed on the site in 1929 and remodeled in 1988. 26.) The Administrator reduced the setback on South 7th Street to 10-15 feet and 15 feet on Stevens Street on May 9, 2008. JACK WESTERMAN • Jefferson Cat Courthouse ASSESSOR Po Box 12211, Port Townsend,WA 98368 (360)385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME4v e'b SO& ADDRESS: 3/ o, „s 0w`t2) cost f SI PHONE NO. U6 30/ 'o/ 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 m to 1.4 on the tax rolls in Jefferson County or if it has been moved to th ;.\. rom Wilier area. I►MOBILE HOME DATA: (A) MAKE , CVu►2Cf $Q' (B) MODEL OEEORRSON CUO 1V. (D) LENGTH `t 8 (E) WIDTR yZ6 / (F) SERIAL # /7 74,S7 7 7 (G) YOUR PURCHASE PRICE(Do not include sales tax) C, 1`r PURCHASE DATE3b-44. I 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IFF NEW MOVE TO QUESTION 3) / (A) FROM WHOM DID YOU PURCHASE MOBILE (:0(-1-3eN) A: n/1d S Gk~ 10dv i rj ADDRESS /' 417 Uth- ✓ Avg PV ac.Si0 414 9k-376 (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? Yes o If Yes, Previous address of mobile. � — If No, What County was Mobile assessed in last year. '(S 1 P 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes (No • (II) IF LOCATED IN MOBILE HOME PARK: NAME &ADDRESS OF PARK Lot/Space# (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: O P:0 iTh Pt / 1.)S Z LOCATION ADDRESS 3 ( S. Pe)2T (p c,, i,L: k 4 V 62 REAL PROPERTY PARCEL #/DESCRIPTION `ic 3 - /01- JO II 3 V Signature of applicant THANK YOU FOR YOUR HELP! SS ) JO COSSELL, Property Technician ��..¢soN CO,� JEFFERSON WJNTY . DEPARTMENT OF COMMUNITY DEVELOPMENT `'' ' `' 621 Sheridan Street • Port Townsend •Washington 98368 j • 11 360/379-4450 • 360/379-4451 Fax + '„r.-, q p www.co.jefferson.wa.us/commdeveloar>1�n 1. S1INOZ Master Permit Application _ .,r MLA: r ) 1 S 1 Project Description (include separate sheets as necessary): %NS*iALL41T1Jw Oc- /14F--14 Affilin Pl1!'r+ r1,p Tax Parcel -- Property Number: /,� _ (Ci t' 3G Y 3 0 3 _ Size: ,J vClLi (acres/square feet) Site Address and/or Directions to Property: l _ Property Owner(s)of Record: Lb,Av; it/t. f �'N5 CT' �, Telephone: ,>(2() ,SU! `lrj l.4- Fax: email:'-r-,ec/o 1' c;,,,vc ) Y cc': Mailing Address: ,3/ S. ' , rc'�t+T(4.vSc,v i , jb� S Applicant/Agent(if different from owner): S sj,-t Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑Building 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Demolition Permit 0 Conditional Use[C(a),C(d),or C]** ❑ Single Family 0 Garage Attached I Detached 0 Discretionary"D"or Unnamed Use Classification p-Manufactured Home 0 Modular 0 Special Use(Essential Public Facilities)** ❑ Commercial* 0 BoLndary Line Adjustment ❑ Change of Use ❑Short Plat** ❑ Address ❑ Road Approach 0 Binding Site Plan** 0 Home Business 0 Cottagelndustry 0 Long Plat** ❑ Propane 0 Planned Rural Residential Development(PRRD)/Amendments** ❑ Sign 0 Plat Vacation/Alteration** ❑Allowed "Yes"Use Consistency Analysis 0 Shoreline Master Program Exemption/Permit Revisions** ❑Stormwater Management 0 Shoreline Management Substantial Development** ❑ Site Plan Approval Advance Determination (SPAAD)* 0 Shoreline Management Variance 0 Temporary Use 0 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 0 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: 7 D SIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNA(l'URE _ Date: — _7:re 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 aainst Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and-right df entry to Jeff son County and its employees, representatives or agents for the sole purpose of application review and any required later inspections. StO'ffs acc ,4 and right of entry will be assumed unless the applicant informs the County in writing at the time of the application that he o s watp prior noti t Signature: G' �"4 y — Date: / S`_ �J'. 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. An individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in cgrfipliance ith the Je erson County development code. The Applicant acknowledges that he,she or it holds individual and non-transferable( respo sibil�itypt f tiering , and complying with the ESA. Tte Applicant has read this disclaimer and signs(and dates it below. Signature: l�\., _ .. ' e//: 7 Date: �� ,r U C1 G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc • BUILDER STATEMENT II 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 Ge eira/Contractor for the proposed project. ii Signature:'4., �4''7 am,, Date: `/0)- G S GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: Fax: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX: ( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: iii.. New 1, Wood Existing: l I Sewer ❑ Addition ❑ Steel Proposed: a Bank LI Community System O Alteration/Remodel ❑ Concrete Total: Height: t-Individual System ❑ Repair ❑ Masonry -444 SEP Permit# V..., Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: , Private well 0 Two Party Type of Heat: Proposed: d, ❑ Public 1,,.cc� 48,a_ Name 2 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: i Underground Tank i Above ground Tank Size of Propane Tank: i Heat Stove I Cook Stove i Woodstove i Fireplace Insert i Hot Water Tank i Pellet Stove 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: l,?L(h' (� KA- ici -1 2nd Floor Heated Consistency Review: (C' bi--PO Other Heated Base fee: I 1, S tt' Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: �� t^- Garage/Carport SUBTOTAL c- Decks 911/Rd Approach fee: Other TOTAL: $ 34,05 Crl; Receipt Number: Ct--1 t 3c) Cash/Check Number: _j 1UD ESTIMATED COST(REQUIRED) Date: •Fair market value of all labor and materials foundation to finish -1- . Initials: ('O �9 Jt) G:\PermitCenter\###FORMS###\DRD FORMS\Master Permit Application 12-19-2006.doc 1' 65 O°/fig //S ail..408 -�-a°l8/ . ,o1v CbferA -BIAJEFFERSON C '� �if ; COUNTY w, DEPARTMENT OF COMMUNITY DEVELOPMENT APR 2 5 200� 621 Sheridan Street • Port Townsend• Washington 98368 2° 360/379-4450 . 360/379-4451 Fax Jr C CC p f+o �� http://www.co.jefferson.wa.us/commdevelopment/ L ift i1JEOM Stormwater Calculation Worksheet I muot L. _ / f , .,p �f -7 PROJECT/APPLICANT NAME: s 1 a / /'( !�V'`-�+\-i j a DETERMINING STORMWATER MANAGEMENT REQUIREMENTS:This stormwater calculation worksheet should be completed first to classify the proposal as"small,""medium,"or large." The size determines whether a Stormwater Site Plan is required in conjunction with a stand-alone Stormwater management permit application, building permit application, or other land use approval application that involves stormwater review. The basic information will also be helpful for completing a Stormwater Site Plan,if required. 1. `1 PARCEL SIZELfI.E.,SITE) Size of parcel - 3 7 acres An acre contains;/13,560 square feet. Multiply the acreage by this figure. Size of parcel in square feet i c (,1 sq/ft Land-disturbing activity is any activity that results in movement of earth, or a change in the existing soil cover(both vegetative and non-vegetative) and/or the existing soil topography. Land disturbing activities include, but are not limited to clearing, grading, filling, excavation,and compaction associated with stabilization of structures and road construction. Native vegetation is vegetation comprised on plant species,other than noxious weeds,that are indigenous to the coastal region of the Pacific Northwest and which reasonably could have been expected to naturally occur on the site. Examples include species such as Douglas fir,western hemlock,western red cedar,alder,big-leaf maple,and vine maple;shrubs such as willow,elderberry,salmonberry, and salal;herbaceous plants such as sword fern,foam flower,and fireweed. LAND DISTURBING ACTIVITY,CONVERSION OF NATIVE VEGETATION,AND VOLUME OF CUT/FILL Calculate the total area to be cleared,graded,filled, Answer the following two questions related to exQcaava ted,and/or compacted for proposed development conversion of native vegetation: project.. Include in this calculation the area to be cleared for: C Does the project convert V4 acres or more of Construction site for structures 5 sq/ft native vegetation to lawn or landscaped areas? Drainfield,septic tank,etc. sq/ft Circle: Yes (tl o, Well,utilities,etc. sq/ft Does the project convert 2 Y2 acres or more of Driveway,parking,etc. (C 0 t j sq/ftnative vegetation to pasture? Circle: Yes No) Lawn,landsc aping,etc. sq/ft f , Other compacted surface,etc. sq/ft Indicate Total Volumes of Proposed: Total Land Disturbance i s D sq/ft Cut (I0 Fill 1 I 0 (cu/yd) [over] stormwater talc worksheet—REV.trVIDOh'1 • • Impervious surface is a hard surface that either prevents or retards the entry of water into the soil mantle as under natural conditions prior to development. A hard surface area which causes water to run off the surface in greater quantities or at an increased rate of flow from the flow present under natural conditions prior to development. Common impervious surfaces include, but are not limited to roof tops,walkways, patios, driveways, parking lots or storage areas, concrete or asphalt paving, gravel roads, packed earthen materials, and oiled,macadam or other surfaces which similarly impede the natural infiltration of stormwater. STORMWATER CALULATIONS—IMPERVIOUS SURFACE NEW EXISTING .._ U(' c7''r G +�� (� '(,` '" r P Structures(all roof area) ! '--' sq/ft Structures(all roof area) G sq/ft Sidewalks sq/ft Sidewalks sq/ft `Patios sq/ft Patios SS sq/ft Solid Decks sq/ft Solid Decks _sq/ft (without infiltration below) (without infiltration below) Driveway sq/ft Driveway G 0 0 sq/ft Other sq/ft Other sq/ft Total New /YO V sq/ft Total Existing f r sq/ft TOTAL NEW+TOTAL EXISTING* sq/ft 'This amount will be used to check total lot coverage. The following questions will help determine whether the proposed project is considered development or redevelopment. DEVELOPMENT v.REDEVELOPMENT Divide the total existing impervious surface above by the size of the parcel and convert to a percentage: / % Does the site have 35%or more of existing impervious surface? Circle: Yes (111...°).‘ FURTHER INSTRUCTIONS: If the answer is yes, the proposal is considered redevelopment and the attached Figure 2 should be used to determine the applicable Minimum Requirements. If the answer is no, the proposal is considered new development and the attached Figure 1 should be used. At this juncture,the applicant should refer to the applicable Flow Chart to determine the Minimum Requirements for stormwater management. DCD staff will help verify the classification of the project and the application requirements. For proponents of "small" projects who must comply only with Minimum Requirement #2—Construction Stormwater Pollution Prevention—an additional submittal is not required. The proponent is responsible for employing the 12 Elements to control erosion and prevent sediment and other pollutants from leaving the site during the construction phase of the project. Pick up the Construction Stormwater Pollution Prevention (SWPP) Best Management Practices (BMPs) Packet. Proponents of "medium"projects—those that must meet only Minimum Requirements #1 through #5—and for large" projects—those that must meet all 10 Minimum Requirements—are required to submit a Stormwater Site Plan. DCD has prepared a submittal template of a Stormwater Site Plan, principally for rural residential projects. Complete the template in the Stormwater Site Plan Instructions and Submittal Template or prepare a Stormwater Site Plan using the step-by-step guidance in the Stormwater Management Manual. APPLICANT SIGNATURE By signing the Stormwater Calculation Worksheet, I as the applicant/owner attest that the information provided herein is true and correct to the best of my knowledge. I also certify that this application is being made with the full knowledge and consent of all owners of the affected property. r (LANDOWNER bR AUTHOi DD REPRESENTATIVE SIGNATURE) (DATE) kr '.I arc u. .}r�r t• 't�` ';rl �- � �;� o iR stormwater calc worksheet—REV.10/1/2003 2 RETURN ADDRESS D ) ; (,) Of fief)SQ.I Pdt)- T A t - ' MANUFACTURED HOME ��� �yxN■�xy'�'�`'�� STATE OF WASHINGTO7V ■ L7,�_,�."`.n APPLICATION TITLE ELIMINATION IICEflSIflG 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 TPO(PL1T'NUMBER YEAR_0 MAKE ) Lt LENGTH WIDT T) VEHICLE IDENTIFICATION OS NUMBER(�) © LAND 7 J C (!� S J�([o(' X LEGAL DESCRIPTI7ON7ONN PAGE MANUFACTURED HOME WILL BE XAFFIXED 0 REMOVED REALt S -��\CDAX;A3(.(NUMBER LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE �� QUARTER/QUARTERUA SECTION .74 4r 8 13 6-lS S /� hli (Tt vN SE 1/4-I 0 GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER 'NUMBER OF REGISTERED l/)OWNERS NUMBER OF LEGAL OWNERS ga ! NAME OF EG[4 �REDO�N IR ����l el DOL CUSTOMER ACCOUNT NUMBER 4 se Al NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 5. , 711A 5J 1)04- ' ), S-e A LA--Vii /it 3 0k 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 TH G TERED NER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title, IF APPLICABL Signature of Additional Registered Owner and Title, IF APPLICABLE— NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington i Signed or attested ) ) County of C- 2,0 before me on ✓ �( by D t ,Li I tivie I Signatur r PRINT NAME OF REGISTERED OWNER ARY OR AGENT by PRINT NAME OF REGISTF D OWNER PRINTED NAME OF NOTARY County/Office No.OR p�1 )�) Title /u{r� AND: Dealer No.OR� �(/ v/ DEALERSHIP POSITION/AGEN�/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 %the manufactured home has been affixed to the real properly as described. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAM (TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# � AtQ, 6--�,a k�)r C500) 59q —�}4SC) �3UD6 -ao 1�8 SI N RE/POSIT!IN� Atial p^I'Y' J 4 ao/o TD- 20-7 MANUF HOME APPL(R/2/02) (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 oLAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) ( 5E t\( , 7 ( 0,1 (c l� L09- `> 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 OFFICENFS 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, Mahufactured 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 P:11111111171111111111111111.1111EFria) i ' cr CD ( 7 1 Q f I CD Q 5 to rT � T T 3 ' n c., L-11 , 1 41 co ( o I ___ '1 r/ � o 1 1 CI at- = I I G CMG O O e 1 ET c J . 0 . - L l I .. J eL 0 Ilf 1 rv • • III I II g.- v I` tLZ T V y O in M 1—. q4'h 2 (i\\ ., ...„ ,:. c, ., . , ,, m 0. _C\'---.s...' 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