Loading...
HomeMy WebLinkAboutBLD1988-00066 B _DING PERMIT APPLICATION ga Jefferson County Buildi „ DepartmeoteP . O . Box 12204Art Townsend. WA 98368 LOCATION � SPECIFIC LOCATION' SITE ADDRESS ►"'( -n (/h(F A ) eJci_ i�°pj i� , POSTAL DISTRICT /SUBDIVISION 7 LEGAL DESCRIPTION LOT Ke BLOCK + f/ DIVISION TAX NUMBER PARCEL NU 7 S 7ry r 0 9/ey OL1N 1 / 4 SECTION SECTION TOWNSHIP aS ORTH RANGEWM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE (�� M❑ SINGLE FAMILY EW BUILDING MAIN FLOOR 1 N( OB 1 LE HOME �❑ /�.DD I T I ON 2ND FLOOR MODULAR HOME ❑ ALTERATION BASEMENT ` DETACHED ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE S-7 ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI -FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILqtL(.0(e �S ❑ COMMERCIAL❑ INDUSTRIALSIZE tt $35 ❑ HOTEL/MOTEL/DORMITORYYEARt QJq� $ 16NUMBER OF UNITS MAKEt j i `� cl� $8 ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUP $ $ SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR ❑ TRUCTURAL STEEL 0 GAS 0 COAL ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEA TH D PA- MENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS,'%] �/���IP� 1 ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS I ND I V I DUAL ( SEPT I C 47 7, NUMBER OF PROPOSED BATHROOM c . APPROVED DATE 0 I ND 1 V I DUAL WELL NUMBER OF EXISTING BATHROOM PUD i TYPE OF WATER SUPPLY r UBLIC ( NAME OF WATER SUPPLY) APPRO� D31 PY `P ATE DR I V ATE ( NAME OF WATER SUPPLY) 4 PLANNING DEPT . WITHIN SHORELINE JURISDICTION O YES NAME OF ADJACENT WATER BODY O NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO IDENTIFICATION NAME MAILINGC ADDRESS SZZ ZIP TEL NOm OWNER Leck)0(�� �1,�.//`' V 9W. -75 Piv co�c CONT C "`1' ` Pi,z): ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS: •f IGNATURE OF APPLICANT APP IC T N DATE RECEIPT NUMBER CHECK NUMBER OR CASH . _ 97/-3� I5 3s) I (P7 A ROVED BY2A' LO!- '� 7i `. St ,.. �i� A P P V BASE FEE INSPECTION r 5. ,D L BLDG SURCHARGE _ PLAN CHECK • ENERGY SURCHARGE 4(v0l0 TOTA 4FF,'�i::•.rjoJ4l'Y PE V;i4 di'x ,-PT 0 iV ) 911 NUMBER REFUND DATE DAT I SU D I. BUILDING OFFICIAL fo / in 7 ks i , RETURN ADDRESS L7MATI'QjFWASHINGTON MANUFACTURED HOME paitar_'t f -i-xyt'hV1 lll u�a�� ��Jf EJTITLE ELIMINATION APPLICATION �rcEns�nc 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) 0 MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) &81920 1988 LIB 70 X 28 09L2284DXU © LAND LEGAL DESCRIPTION ON PAGE 3 REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE MI AFFIXED ID REMOVED 994 200 020 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 66 SEVENTH AVENUE ACRE TRACTS © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS JEFFhRSON 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER WILLIE P.MEARS NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER MARION DINAH MEARS ADDRESS CITY STATE ZIP CODE 3875 VISTA CAMPANA SOUTH#11 OCEANSIDE CA 92057 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER WASHINGTON MUTUAL BANK NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 3060- 139TH AVE SE FLOOR 2 BELLEVUE, WA 98005 GRANTEE NAME `.BCT 6" I DO SOLEMNL A ST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLES 1D 1I I;FORMATION IS ACCURATE: iiii 0 Registered Owner and Title, IF APPLICABLE , J P' Signature '�'�( yr.a Registered Owner and Title,IF APPLICABLE O-44,611 40,4,4.1h lii _- NOTA24.355a. MP N4of ARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE CZ (p 8 0 State of n $ a E6 0 Signed or attested _�'tO before me on O'v 6 <*�``, by W/LLIE 0', Cleg-S :•,'c�ees,> '� Signatur ,l ., F PRINT NAME OF REGISTERED OWNER NOTARY AGENT ` .i- ; by 1� o 0I ON u 5 ��Nr1 �? d..9.1.387-` ? PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY i/V°T/}2 y ,a 41,C C County/Office No.OR 7`2 t,/ U j 1 Title AND: Dealer No.OR} DEALERSHIP POSITION/AGENT/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. a BUILDING PERMIT OFFICE CERTIFICATION i_ I certify that: ID the manufactured home has been affixed to the real property as described. 0 a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(TYPED OIT"PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# 1\'44-hlt— "ra , 1C lark ®)&ICI J445c) . ipmit, i JS13N URE.POSh 150:2;000: tTD-420-29 MAN UFH MEAPPL(R/2 )0R(W)Page 1 oft MANUFACTURED HOME - FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) &81920 1988 LIB 70 X 28 09L2284DXU D SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELI J, NATION OF T LE I 'EMO L FROM REAL PROPERTY. Signature of Legal Owner and Title,IF APPLICAB /I L' ` �.. /t 4 f?Iort/4, E L 'Leo Signature of Additional Legal Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION FOR LEGAL OWNER(S)SIGNATURE -► — . ',/6tate of Washington Signed or attested R. Z. ROBERR ` County of I before me on C.1 0 5/0 )TARY PUBLIC °l ill rF OFWASHING1GNI" PRNTN MEOF1GALOWNER toiY PILLttt 14 I natUr2NO AR7iat RAGENT^ ) IiSSION EXPIRES'' t -1 R 29 2007 ey o� 1 v 7 PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY / County/Office No.OR 1 I Title --- AND: Dealer No.OR/t7 %70/ DEALERSHIP POSITION/AGENTOTARY Notary Expiration Date D LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office TT 86&86A SEVENTH AVE AC TTS; AS FULLY DESCRIBED ON EXHIBIT"A" ATTACHED HERETO AND MADE A PART HEREOF 0 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). 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) 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, Manufactured 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 . % t o,o p , i 0)9-`46 \ 130' w Ai 6 V. d 1 i i \ - 1 1 70' l . \ \ ?Y 5. )ey x3 $EQ12� .;�� A2e:�q 4,r F` Sc4Lc.,' L =3c, 1 �Ax N '. Y•,Aq ---'�� ' T. 1 _ Q4't _ g 4..4.?y - -20`- ` ©9 sr :,''' '''''' %4 r l / y. c5,,, ,e, C E q / / •3 k: z...,, ... 1 „,...,._, l` y ,.. .,,,, , .. , : 1 _._ N .. , „,„. `r . 1 .1- ---------,....,..„,..< p Sri' L.. r- 8 (. - � - \ i:i ri r i.. It 1 V . • 1. oi 'Ll V l..Ei)t1'�►TY N'. ' i eiar FNOALDIN4 A , - :,,g,= '11 1Y 'A FR�vvl : M da... �y'(y'�'j .i� y - s, s, set ((I. »� �s I AV Rt<'�t "T ,- • i 4'; 4:. . Ya, 17.1 N L a r 8 8 f :r d r 7 z /_ I ,. ` D '_2. ,t -"' ---- �8•a9 . 46 * fi. C .... ... N 87 38 09 W. $,,..1 .p.�. t : � ''' ' 1". , �y r..i.. r ...v „ ;: ©O APPROVED JEFFERSON COUNTY PLANNING&SLOG D€PT 1 ll \n \IAAtntt, *-"341 oat „AA",104-80- 44- 1:-"tkAAlc 11 ��$ c