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HomeMy WebLinkAboutBLD1987-00043 Jefferson County Buiidingf,artment • Cou.,ty dh.r-thouse • Port Towns Wash.98368 • 385-1310 N E I. LOCATION: yeographic name S W SIDE GF ''ai rt ROAD FEET NE S W FROM INTERSECTION OF LAD AND ROAD other specific location or landmark: � O k. \ P �1.s g C t_C�C LEGAL DESCRIPTION: S N\ `-'( q1 �7 L/� /'�/ Lot 'B+rn.k -s cf u visjono \ I O�JJ q l J OOSNumber Township Range II. TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY , New building ❑Single Family ❑New County Resident ❑Addition ❑Multi-Family Is this structure to serve the residential ❑Alteration number of units or commercial needs of those employed El Repair,replacement ❑Hotel,Motel, Dormitory at either the US.Navy's Trident or number of units Indian Island Facilities? ❑Wrecking Home ❑Moving (relocation) ❑Other—Specify ❑YES ❑Foundation only ❑NO OWNERSHIP USE ❑Full-time Residence ❑Private (individual,corporation, nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc. ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: -3 ❑Second Home: Future conversion to permanent residence COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food • Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary To be installed but not included school,secondary school,college,parochial school,parking garage for in the above cost department store,rental office building,office building at industrial plant. a. Electrical If use of existing building is being changed,enter proposed use. b. Plumbing / '� c. Heating,air conditioning /4 c . 7e7 d. Other (elevator,etc.) 7 l L • TOTAL COST OF IMPROVEMENT $ III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS ❑Masonry (wall bearing) ❑ •P •Number of Stories Public or Private El Wood Frame •Total square feet of floor area, "❑,Individual (septic tank,etc.) all floors,based on exterior El Structural steel dimensions TYPE OF WATER SUPPLY Total land area,sq.ft. El Reinforced concrete • �-Other—Specify XPublic or private company pecif NUMBER OF OFF-STREET i❑Individual (well,cistern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE ❑Gas Outdoors ❑Oil RESIDENTIAL BUILDINGS ONLY ❑Electricity Number of bedrooms Coal TYPE OF MECHANICAL ElOther—Specify Number of Full bathrooms Partial IV. IDENTIFICATION- • // Name Mailing Address— Number,street,city and State ZIP code Tel.No. I. L EO N4-11-0 / C I_!C -P° -,x 3 2\ �\��r.o r-c e/z.o 76 Owner SjE-VLok.IS L/6/ c? 2. Contractor State License No. 3. Architect The owner of this building and the undersigned agree to conform to all applicable laws. Signature ci,.f2p.plicant Address Application date r PLANNING AREA ' FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT dlL-/AFV Bp/^^ `�/ll oWT C o-F ri�� �- ,� 1 1 1J rLP e� '%a INA�y C to l JEFF C HEALTH DEP T7vIENT 1 J APPROVED B : PERMIT FEE ISSUE DATE RECEIPT NUMBER se7 q........11.,... .----2 BUILDING OFFICIAL Q/ // Tr,c P1,nte., — Purr Tc...v serid // r/ .t2, /Kee- �-1 caa 1..-%- • • 1 RETURN ADDRESS James L.Anderson Katherin A.Anderson (I7 STATE OFWASHINGTON MANUFACTURED HOME PLEASE CHECK ON licEnsinG APPLICATION ®TITLE ELIMINATION 0 TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty ❑REMOVAL FROM REAL PROPERTY Dof a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) MANUFACTURED HOME TPO/PLATE NUMBER I Y988 EAR I MAKE AR DM LENGTH/WIDTH6 N4 (FEET) 19422EEHI LE IDENTIFICATION NUMBER(VIN) &41597 © LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE ElAFFIXED ElREMOVED REAL PROPERTY TAX PARCEL NUMBER 966900005 LOT I BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE 5 // I QUARTER QUARTER SECTION 0 GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER I NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER James L.Anderson DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTERED OWNER Katherin A.Anderson DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE NAME OF LEGAL OWNER Sound Community Bank DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY 10200 East Marginal Way South STATE ZIP CODE Seattle WA 98168 GRANTEE NAME James L.Anderson and Katherin A.Anderson I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of Jefferson before me on by Signature PRINTED NAME OF REGISTERED OWNER James L.Anderson NOTARY OR AGENT by PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY Title Katherin A.Anderson County/Office No.OR AND: DEALERSHIP POSITION/AGENT/NOTARY Dealerpira on OR MI TITLE COMPANY CERTIFICATION Notary Expiration Date 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 the manufactured home has been affixed to the real property as described. I certify that a building permit has been issued for this purpose and the attachment will be inspected upon completion. N (TYP D OR PRINTED) BLD P I OF ICE HO E /1Alhi,e. nrk. Stt,k'A- � 05,..11 (1-- 5b I __ c�s?-00043 SIGNATURE P S ���II.Y.[SIJ TD-420-7 MANUF E APPL(R)2/02)EXT(W)Page I of27ATE / v`' MS StreamLine Mobile-Manufactured Home Application Rev.8/2/2006 • • MANUFACTURED HOME-FROM SECTION 1 TPO/PLATE NUMBER I YEAR I MAKE I LENGTH/WIDTH(FEET) I VEHICLE IDENTIFICATION NUMBER(VIN) / II 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 REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY Title County/Office No.OR AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date RILAND DESCRIPTION(A legal description of the land can be obtained from the local County Assessor's Office.) Lot 5, ,Lazy C Ranch,County of Jefferson,State of WA. fl 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) I WA DEALER NUMBER I DATE OF SALE PURCHASE PRICE TAX JURISDICTION/TAX RATE DEALER'S AUTHORIZED SIGNATURE $128,000.00 El USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). D 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) I COUNTY OFFICE/VFS OPERATOR NUMBER SIGNATURE I DATE ® TITLE FEES FILING FEE I APPLICATION I MOBILE HOME FEE I ELIMINATION FEE I 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 en StreamLine Mobile-Manufactured Home Application Rev.8/2/2006 A P RovEI P 1 1 japi) rAc o twt INSPECTION REQUEST( PERM I T Olt/NER CONTRACTOR DATE SITE LOCATION f3 711/417' 4k=ej 110 • 1) 1 V p, (Q.-K vA �/ i �1 i �^ 0 e hv-� � Y or. Jaty\. `lZ 01 © v' ,re S eq- ve Ors' ea , �� �� J e v'� G!�I S b t ij.,(3, 'PS --�L. 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