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HomeMy WebLinkAboutBLD1989-00124r , 1 BIDDING ERIIIT KPPLICATION 411 Jefferson County Building Department^,P .O . Box 1220sPort Townsend. WA 98368 t ... • . , LOCATION : SPECIFIC LOCATION SITE ADDRESS CRC Itt --AT ial.L,747,7 POSTALIDISTRICT LEGAL DESCRIPTION LOT J BLOCK DIVISION TAX NUMBER C-a PARCEL NUtp 1 / 4 SECTION PLANNING AREA SECTION „ --.) TOWNSHIP o NORTH RANGE WM BUILDING INFORMATION --- • _____ BUILDING TYPE TYPE OF IN1a0VEMENT SQUARE FOOTAGE Li SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR OK,MOMILE HOME 0 ADDITION 2ND FLOOR O MODULAR HOME 0 ALTERATION BASEMENT O DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE O WOODSTOVE U WRECKING/DEMOLITION COMMERCIAL O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL * --- NUMBER OF UNITS MOBILE FOMES O COMMERCIAL 0 SIZE. O INDUSTRIAL "411°.--- O HOTEL/MOTEL/DORMITORY YEAR.ALL41,10 M 1 _ _17 . $ 16 AKE V a $S NUMBER OF UNITS — O OTHER - SPECIFY 0 @ $8 ' ESTIMATED COST OF - IMPROVEMENTS 1:: AL FAIR MARKET VALUE UBC OCCUPANCY GROUP $ — -1- ---- SELECTED CHARAC1ERISTICS OF BUILDING _ -- - - ---PRINCIPLE TYPE OF FRAME ---- P INCIPLE TYPE OF HEATING FUEL O WOOD FRAME • ECTRICITY 0 COLLECTIVE SOLAR ,.MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR O STRUCTURAL STEEL 0 GAS 0 COAL O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY -- ---- O MASONRY ( WALL BEARING ) DIMENSIONS I 0 OTHER - --- NUMBER OF STORIES TOTAL LAND AREA . DEPARTMENTAL REVIEW ------- —-- , HE LTH D pAETmEHT ! TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDRCX;;77.4 , 1,-, 27 0 UBL IC OR PR I VAT z r.7.3mBE:R OF EXISTING BEDROOMS ! (G / (...0' „ 00i1, I ND IV I ID tj P . ( SEPT! r.-. ) TIONMER OF pROPOS ED BATHM)Omiza APR VED DATE 0 INDIVIDUAL " EL L j rlormErz OF EX I ST 3 r3c," BATHROCN -- PUD TYPE OF WATER SUPPLY 0 -WBLIC ( tIlW!7: OF WATER SUPPLY) A '/UaOralre4 'APPROVED DATE DATE ipp,' flIVATE ( NAME or WATER SUPpLY PLANNIN DEPT . WITHIN SHORELINE JURISDICTION 1, n 0 YES NAPE OF ADJACENT WATER BODY ----- . — , 0 NO ,b , APPROVED DATE BANK HEIGHT SETBACK . _ ------ . PUB ' I WOR S DEPT ROAD RIGHT-OF -WAY WIDTH - NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD ----- APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES n NO — — --- -- IDENTIFICATION — --- , --.--------- NAME MAILING ADDRESS ZIP TEL NO OWNER et ci 5-- s /0, 7-&zsLsa.5 - , 7.9 7s i Z. CONT. --- -s17, 3 =T=5717131 ----1 ARCH _ ...,,_ _ — , — ...! THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS: "'" "'m * -,..,,,,..• ^.^.** S f TUNE OF Al' A LICATION DAI L 'LIC IT - . ' RECEIPT NUMUER CHECK NUMBER OR CASH 1.21 /7 g7 . ..15-). / APPROV D y ' PERMIT FEES A P P 7:SkCD BASE FEE I NSPECT ION OCT --- ,52. Ex LDG SURCHARGE PLAN CHECK 111989-------- -- _ .... ENERGY SURCHARGE JEFFERSON COUNTY TOTAL PLANNING&BLDG DEPT ' -- 9 1 1 NUMBER REPur-i T-E- - 7TE 47Bir - BUILDING OFFICIAL 4...*H i\AWA— ibl :ht ... . RETURN ADDRESS American General Finance 2310 Mildred St W Suite 116 Tacoma,WA 98460 El SW,m t f 511NGON MANUFACTURED HOME PLEASE CHECK ONL licEnsinc APPLICATION D TITLE ELIMINATION TRANSFER IN LOCATION ❑REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) %002282 1989 DARTM 2846 110025 © LAND LEGAL DESCRIPTION ON PAGE 2 MANUFACTURED HOME WILL BE ElAFFIXED ElREMOVED REAL PROPERTY TAX PARCEL NUMBER 993 200 001 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION 1 Seamount Estates#2// © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 I NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Harold E.Shearer NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Laura M. Shearer ADDRESS CITY STATE ZIP CODE 20 King Dr Brinnon WA 98320 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER American General Finance NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 2310 Mildred St W Suite 116 Tacoma WA 98460 GRANTEE NAME Harold E. Shearer and Laura M.Shearer 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 1. 2, �'�Q e pp �.'L� Signature of Additional Registered Owner and Title,IF APPLICABLE 4.11.4 2 A / ������ NOT,�� /0, NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER )SIGNATURE 4, f �-....- +r ' ate of Washington Signed or attested �/��� ®v�. County of Jefferson before on }/ 11 a Harold E.Shearer Signature L�—(/ •��/ _ 5 RINTED NAME OF REGISTERED OWNER NOTARY OR AGENTit 140/ y aura M.Shearer C y P te. PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY t IS '1/4 d ♦ County/Office No.OR AND: Dealer No.OR 4/4s. 4 0 DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 7/o riot © TITLE'MAW Y 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 Jefferson Title Company (360)385-2000 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 property as descrbed. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# pshif Sc.-he,vi V (360)379-4450 31cl tcl —' 9.1 1- SI NA�'[JR ITIO t1(�` fAdM in P 5/54- n-a- 44/ q (08 TD-420-729 OME APPL(R/2/02)EXT(W)Page 1 of 2 MANUFACTURED HOME—FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) %002282 1989 Dartm 28/56 _ 110025 D SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR ELI NATION O� A:F�TIT E/REMOVA�LFROM REAL PROPERTY. Signature of Legal Owner and Title,IF APPLICABLE )(la \,1 S 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 /y ,' ,., County of Jefferson befor e on r Y ., i LINDA L. EJBERT by American General Finance sign re , ~ i NOTARY PUBLIC � PRINTED NAME OF REGISTERED OWNER ARY R AGENT i :TATF C`r.NASHINGTONf COMMISSION EXn1141b by �(x(6�� ..., t .-Q.Y i, OCo COMMIS=R 2'I 2IRES PRINTED NAME OF REGISTERED OWNER PRINTED AME OF NOfARY T ..,,• 00+ • County/Office No.OR Q `.x �,.. Title Notary Public AND: Dealer No.OR t- --,1('9"1 DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date DLAND DESCRIPTION(A legal description of the land can be obtained from the local County Assessor's Office.) Lot 1 of Seamount Estates Division No.2,as per plat recorded in Volume 2 of Plats,pages 88 to 90,inclusive, records of Jefferson County,Washington. © 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) WA DEALER NUMBER DATE OF SALE PURCHASE PRICE TAX JURISD1CTION/TAX RATE DEALER'S AUTHORIZED SIGNATURE $160,000.00 0 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). a 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 OFFICE/VFS OPERATOR NUMBER SIGNATURE DATE ® TITLE FEES FILING FEE APPLICATION MOBILE HOME FEE ELIMINATION FEE USE TAX SUBAGENT FEES TOTAL FEES&TAX 49.00 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. I APPLICANTS: Once recorded, you must return to a Vehicle Licensing office to file the I 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 77'Y(360)664-8885. TD-420-729 MANUF HOME APPL(R/2/02)EXT(W)Page 2 of 2 . _ ...., ,....._ • Si _,J )1.fes-' ---)a. ' ,..,. ------------180:,. 6 -- 1 • i igi, COAVY 1,4FAI,TH D1-7\ ' I \I ' R 2 C i s'•A07-e/r ! Hi . , I I I I i I i 1 r•lk.... ' i 1 1 i ) . I i ! .k . ,... I 0 • , . . i] • V \t, 1 1 , 1 i 1 CD . ._., '.. 1 1 lin3.. . I t. - ---- c) --- ; 1 . \741. \ . . , . . . \ -------i A). — - •-ik . i . k . ..__., , - .._ ... , kv) . . - . . . ' --,s •..,.: .__ riAC, ii .. ... h. „, — ,I6 - / -&Al' ,c- ",,,,,„/7/, APPt, VED 1 c IA _ _ i 1 vw- - ; _ ___.. , ., 4 JEFFERSON COUNTY PLANNING&BLDG DEPT /06/ '9 44's