HomeMy WebLinkAboutBLD1987-00399 • N E
I. LOCATION: R' 4 o aP hic name S W SIDE Orr ' OAD ' FEET
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NE
S W FROM INTERSECTION OF ROAD AN(3't «fit/ lib pl ROAD
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other specific location or landmark:
LEGAL ESCRIPTION: \ c l T
Pa r Lot •
Subdivision
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946/0 CIS Tax Number Y.Section Se •iontownship Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
$7 New building Q Single Family ❑New County Resident
❑Addition Q Multi-Family Is this structure to serve the residential
number of units Q Alteration or commercial needs of those employed
Q Hotel,Motel, Dormitory at either the US.Navy's Trident or
Q Repair,replacement number of units Indian Island Facilities?
•
Q Wrecking Mobile Home
Q Moving(relocation) ❑Other—Specify, CI YES ONO
� d Q Foundation only � 1('4-
USE
C OWNERSHIP ❑Full-time Residence
Q Private(individual,corporation,
` ❑Second Home:Recreation Cabin,etc. t
nonprofit institution,etc.)
CI Public ❑Second Home:Future conversion to Public (Federal,State or local gov't-) UBC OCCUPANCY GROUP: - permanent residence E
F
' COST (Omit cents) r
proposed use of buildings,a g.,food Nonresidential— Describe in detail
• 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-
S� _ k > 6
b. Plumbing (. ),
,..)00
c)--- . c. Heating,air conditioning S)pc `--- I l '
d. Other(elevator,etc) -.
•
• TOTAL COST OF IMPROVEMENT $
.f
''''•', III.SELECTED CHARACTERISTICS OF BUILDING - •
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS f 'F
\� Masonry(wall bearing) Q Public or Private •Number of Stories
•Total square feet of floor area,
❑Wood Frame ['Individual (septic tank,etc.) all floors,based on exterior
dimensions
CI Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft.
Q Reinforced concrete
&Public or private company
Other—S ify NUMBER OF OFF-STREET
1Yailji f C( �/ CI Individual (well,cistern) PARKING SPACES
't , J� Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Gas Outdoors ...
❑Oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedroomsJEL I -
❑Coal • TYPE OF MECHANICAL Full
Number of lK
El Other—Specify bathrooms ''
Partial
; _
IV. IDENTIFICATION- -
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
t - f
Owner -
2.
Contractor State License No.
3
Architect t' -
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applican Address 'cation date
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7)C 9,, . SE- dr)AEC-4 A u.2i, .e.-/A7l,c'.7 --- .
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT E-
APPROVED BY ` ` D Q („� (C/ L/—so _� ,;
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JEFFER COUNTY t T7� DEPARTMENTIC J
APPROVE Y: PERMIT FEE ISSUE DATE FZECEIPT NUMBER - t
SrV1,�l/1
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( ram �7 ,. 751( :
BUILDINGO1Ii•IC 2 ( O • a" 4._ ... _3 '7
unto Hoyt, a-U: y�/ '5:7422ntrry• - Port Toa»send
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Manufactured Home:
Year I/87 Make Mae Late Width F' Length 641
Vehicle Identification Number C.0 6 V33 A C B
Registered Owners:
Namesr _
Legal Owners:
Names S )Cc,fV(��� R i 1C [. BLS t _ V1_ e$ Signatures' t -C, ucy, 13IU. Vc1N Ul<ll,'C't
'SIGNATURES OF OWNERS INDICATE TERMINATION OF INTEREST IN THE MANUFACTURED I TOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND
INDICATE INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITII THE LAND HE/SHE/THEY OWN AND TO WHICH IT IS/IS
BEING AFFIXED.
•
Land to Which Manufactured Home is Being Affixed: 12_0 (MpIC., D .
K.
Property Tax Parcel Number cl 'f D 'CD C' 5
Legal Description S (3) r3t1N , I; , u) 11) (5, Li, • ,
4��,S()I oNOwners' Names b_v(' Signatures' kt L CIL
a E'er c�
'SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED TO THE REAL PROPERTY LISTED ABOVE.
Building Permit Office Certification: [ (
APt‘eskasiorigeVat;Drid/orI certify that the manufactured home has been affixed to the real building permit
number Gt)1/4 h s been issued for the purpose of affixing the manufactured home to the land and will be
inspe upon com leti . OCT 2 ► 1992
NAME SG N E BLDG. ER IT OFFICE Jefferson Ce;Jiii;bme1111111G PHONE NUMBER
1 11 iIin i' .i!I1R111t1711t .G
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application appears to have been completed correctly, and that the applicant has sufficient
documentation to proceed with the recording of this form.
NAME SIGNATURE OFFICE/CAAP OPERATOR NUMBER DATE
Recording Office:
I certify that this form has been recorded in the county records.
NAME SIGNATURE COUNTY DATE RECORDING NUMBER
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishable in accordance with RCW 9A.20.021.
TD-420-730 MFG HOME TITLE ELIM IN/1/90)Page 2 of 2
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