HomeMy WebLinkAboutBLD1994-00384 JEFFERSON COUNTY
INSTALLATION APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
206-379-4450
PERMIT # •BLD94-0384 DATE RECEIVED. : 05/13/94
SITE ADDRESS: 18711 HIGHWAY 101
:QUILCENE, WA 98376
APPLICANT. . . :HARRY TRENT PHONE:
MAILING ADDR:PO BOX 5
:QUILCENE WA 98376
PROPERTY OWNER: PHONE:
MAILING ADDR. . :
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CONTRACTOR. . : PHONE:
MAILING ADDR:
CONTR. LIC #: EXPIRATION DATE: / /
PARCEL NO. . . :702114016 ALT: CON: NA _
LEGAL DESC. . :STR 11-27-02 WWM, TAX # WATER: DATE:
LOT , BLOCK , SHORELINES:
BY: DATE:
DESCRIPTION OF IMPROVEMENT: Mobile Home inspection/title elimination
BUILDING TYPE •T E BEDROOMS--- BATHROOMS-- MAIN FL. . . : 0 sf
TYPE OF IMPROVEMENT:NEW EXIST. : 0 EXIST. : 0 ADD'', FL. . : 0 sf
GARAGE/CARPORT PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf
WOODSTOVE TOTAL. : 0 TOTAL. : 0 UNHT BSMT. : 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP. . : CARPORT. . . : 0 sf
TYPE OF CONST WATER SUPPLY. : GARAGE 0 sf
UNITS. : 0 STORIES: 0 HEAT TYPES. : DECKS 0 sf
DIMENSIONS: MOBILE HOME COMMERCIAL: 0 sf
FRAME TYPE: MAKE: YR: INDUSTRIAL: 0 sf
EST COST. $: 0 SIZE: BANK HT. . . : 0 ft
PROJ GRP. . : 5746 SH SETBACK: 0 ft
Owner/agent FEES
Signature: type amount by date recpt
INSP $ 30. 00 AK 05/13/94 92293
Date:
Issued By: :5113
11
Date:
$ 30. 00 TOTAL
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iIICEnSif G MANUFACTURED HOME APPLICATION OFk.O CCrST OF
. T�I�T'ILE OPTIONS. / tpe
I l 1 Original sC mLE ELWNATION ICorrol•t•r but section 3.below) 1994 NAT 7 PM746
r- Transfer TRANSFER N LOCATION(Complete ALL section below)
-I Duplicate ^ REMOVAL FROM REAL PROPERTY IConQlate all but section 4.below) .., T';a FURY
1 —`Reissue _ -' • tl�Ln.v
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_ MANUFACTURED HOME r �C ��"�-
ppppprr__ w tvAMMIte � ` a,orow*T10N MAMMA RAW e•'' _ _ ..i aa
c\Ofr WCD I, of_a 2L�.t6O-a FRONT: REM a r• -----
2— LAND .
•Attach a copy of the legal description of your land. It can be obtained from your Cou yAssesssmoron TAX ot-oNfffiicee.
,•Land to which the manufactured home is being:] AFFIXED 0 REMOVED I7ba �/A Ul
3 • TITLE COMPANY CERTIFICATION
I.certify that the legal description of the land and ownership are true and correct.m !OATS!OATSum mitt COMPANvNGNa wRYar I a sATWd
I NOTE: Application must be finalized.with•Licensing Agent within 10 colander days of the date signed by the Title Company R•pr•s•M.tive.
NA 1 4 SULDllvd PERMIT OFFICE CERTIFICATION
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I certify that the manufactured home has been affixed to the real property as described,or the noo.wNse
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following buildi G permit has b I I issued for this purpose and wil}be inspected upon completion.
a1bNA rut / -„Y'.; y . I alma re eT awumo«a Murtat t`Ts ,/./---
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111 ;/OWNER INFORMATION
{ cou+Tr• ere wax MurAe[R OF Nuasu a f 1 Maass provide the Department of Licensing IDOI)
1 NUNG PEE
5 ■ ,: REGISTERED OWNERS 1 LEGAL OWN EAS`J Client-NUMB:R'for each owner: I
1 NAME OF FIRST REGISTERED�� OWNER,. APPLICATION
�1)-r t H IN IR Qv c 1 1 1 1 l 1 1 1 1 l I I
i •
ER
NAME OF SECOND SEOISTED OWNER t 'TISGCFTiWIE/FD
311 I 1 I l I 1 I ion
,,,,,s, s Of Rev mgi0T D Ev t,pt This'NUMBER`may be found on 1
CityI 1�IUO/" your Washington Driven License/ ELIMINAT'cN
lI X STATE Decoct I.D.Card-OR-If the owner lea l__
Z...'J j 0 —0-�\\`�^� 1,\A dim* business,provide the Unified {�M
1 NAME Of FMST LEGAL OWNER_. • W business Id•ntlfirlU81)number. •
I I I I I I l l l l l 1
y
MARINO01M634' $Ua.AOEMT KISI i MNO ADDRESS Of FIRST LEGAL
1 More than two registered or I
CITY STATE DfcooE ora legal owner?..• TOTAL FEES&TAX
_ Please use attachment forma
•MONATURA of LIAM OWNER WOW-AM CONSENT fOR - (DATE ITD-420.732) [. • t
• n $
ELIMWATION OF
TLE:X -
►IRICNA3E►NCE
Anyone who knowingly makes rr false natr.r 4 of a manna)fact w e•hy DEALER'S REPORT OF SALE
of•felony.and upon conootan may be p.Nvah.d by•nr of up t.15.000
$
and/or 10 yowl,impnaomrnt IRCW 48.12.2 TO sou UANLY ATTEST I certify Om this Information Is TM JUNSpCttONRAa RATE PENALTY Of PERJURY IJIW IM.'E ARE THE REGISTERED Comic*. Th•vehicle le clear of
OWNERS OF THISN AND TH • NATION IS ACCURATE: encumbrances•aeept as shown.
1‘,.....1.1‘,.....1.011...oysr�a(!MO, mwf
/I'�J ek4 DEAIEA NAYE WOW,Mli
X WA WINO. DEALER'S AUMORILED SIONATURE
• .. X__-__ --mss} X y l'
NOTT''A'F�_rYonnyutwceAurr(t(•1 wsot1 3..ww.,s...I�.�rpa....M.TN. Re`s'+"• USE TAX EXEMPT s.I.rNw..nw
X l_" \V,.,.Illt �V _Ow•.• t"�E 1\ /e �A .� __COVMY R..wvMi.n I01K1.nMYYM nwMWR.I•M...11 _
6 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL:(Not for use by Sub-Agents)
I certify that the above application appears to have been completed correctly,and the applicant
I
I has sufficient documentation to proceed with the recording_of this form.
9ONwr JE M— S oHnt•Afa OFfT OR MUMMIES DATE
_
tXALF: (\.•• (\ _____ 5 13 s1�
RECORDING OFFICE
} 7 This form has been recorded in the county records.
1 MCOMINONIWER • (OUN TY VOLUME/PAGE DAT .
e 'Lr3 c -
MANUF NOMI A%ilMle 1 ��.►►ryII
TD�2P/2 7 /h
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LIlNnI1 Or N' SNMGTOM
/ICEnSInG MANUFACTURED MOVE APP A11 ADDITIONAL ATTACNAI(T I"
LEGAL DESCRIPTION OF LAND
Use this form when a legal description from the county is not legible,and/or a statutory warranty deed is not available,to
provide the legal description of the land. This form must be recorded with the Manufactured Home Application and a certified
copy presented to a vehicle licensing agency as part of the supporting documentation for a Manufactured Home application.
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Check type of application: es Title Elimination •
• ❑Removal From Real Property
I El Transfer In Location
Land: Property Tax Parcel Number 702 114 016 & 702 114 024
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Legal Desaiphon:
SECTION 11, TONNSHIP 27, RANGE 2W
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num.,11 AM ATTACKIENiAaily,p 1 A I
yo; 505 rir271