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HomeMy WebLinkAboutBLD2000-00054 MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360) 379-4450 FAX (360) 379-4451 (800) 831-2678 PERMIT#: BLD00-00054 Received Date: 1/21/2000 SITE ADDRESS: 43 S STROMBERG AVE Issue Date: 1/27/2000 -PORT-HADLOCK,98339 1 T c--3((,K Expiration Date 1/27/2001 APPLICANT: M V STONE PO BOX 624 PORT HADLOCK WA 98339 SUBDIVISION: IRONDALE Block: 149 Lot: 11-16 PARCEL#: 962114911 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ M & E TRUCKING INC PHONE: (360)379-0799 DEALER PO BOX 524 PORT HADLOCK WA 98339 Contractor's License METRUI*055MU Expires 10/21/2000 INSTALLER: JAIME KOZELISKY WAINS0626 Expires: 7/1/2001 1112 JACOB MILLER RD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: GOLDEN WEST YEAR: 2000 SIZE: 27X66 THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE. THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR. THE EXPIRATION DATE IS 1/27/2001. REQUIRED INSPECTIONS: [ ] Footing/Setback (If continous footings are used): .7.. i C /11-L <� rr �Q A,Q. [ ] Blocking/Setbacks/Plumbing: eCC'/ - j/c-- T7 .t;eVi N eflW. /1/4 '+ r [[/ Final/Skirting/Vents/Porches/Steps: C) /�/\ // , ' c1 HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9:00 a.m. -4:30 p.m. Inspector's Phone Hours 8:00 a.m. - 9:00 a.m. SPECIAL CONDITIONS MAY APPLY - SEE REVERSE HOT-LINE AVAILABLE 24 HOURS A DAY . .MAN`UFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00054 Received Date: 1/21/2000 SITE ADDRESS: STROMBERG AVE PORT HADLOCK, 98339 APPLICANT: M V STO NE PHONE: (360)379-0799 PO BOX 624 PORT HADLOCK WA 98339 SUBDIVISION: IRONDALE Block: 149 Lot: 11-16 PARCEL NUMBER: 962114911 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ M & E TRUCKING INC PHONE: (360)379-0799 DEALER: PO BOX 524 PORT HADLOCK WA 98339 Contractor's License METRUI*055MU Expires 10/21/2000 INSTALLER: JAIME KOZELISKY WAINS0626 7/1/2001 (360)385-321 1112 JACOB MILLER RD PORT TOWNSEND WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: GOLDEN WEST SETBACK: VALUATION 4-7,500.00—o YEAR: 2000 (-32)000° SIZE: , BANK HEIGHT: LABOR & INDUSTRIES APPROVAL? a7Xlpe SEWAGE DISPOSAL: OSS WATER SYSTEM: PUD BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA Wetland Erosion Exist: Exist: Seismic Streams Prop: 3 Prop: 2 Flooding Landslide Total: 3 Total: 2 F&W Plat Conditions Shoreline Aquifer Routing Date: O� Forest: Commercial Rural Z '� Proximity Type Approved/Date yp Amount Paid By: Date: Receipt: Permit $137.00 MAM 01/20/00 23142 ED Potable Water Application $30.00 MAM 01/20/00 23142 Total: $167.00 , AO 0 Jefferson County Planing I:\F_BLD_App_Mob.rpt 10/29/99 MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00054 Received Date: 1/21/2000 SITE ADDRESS: STROMBERG AVE PORT HADLOCK, 98339 APPLICANT: M V STO NE PHONE: (360)379-0799 PO BOX 624 PORT HADLOCK WA 98339 SUBDIVISION: IRONDALE Block: 149 Lot: 11-16 PARCEL NUMBER: 962114911 Section: 35 Township: 30 N Range: 01 W CONTRACTOR/ M & E TRUCKING INC PHONE: (360)379-0799 DEALER: PO BOX 524 Criticai PORT HADLOCK WA 98339 � ' Contractor's License METRUI*055MU Expires 10/21/2000 tnitaw 1 2, 1106 '� 2 tlt INSTALLER: JAIME KOZELISKY WAINS0626 7/1/2001 (360)385-321 1112 JACOB MILLER RD PORT TOWNSEND WA 98368 thwymitsBirsd 1 1 i___ PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: GOLDEN WEST SETBACK: VALUATION 47,500.00 YEAR: 2000 LABOR & INDUSTRIES APPROVAL? SIZE: 27X53 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PUD BEDROOMS: BATHROOMS: STORMW T R: YES NO AREA Wetland a Erosion •UOil Exist: Exist: Seismic Streams Prop: 3 Prop: 2 Flooding Landslide ç9/ . Total: 3 Total: 2 F&W Plat Conditions VV' v Shoreline Aquifer • Routing Date: Forest: Commercial Rural I-2;1-U,-) Proximity Type Amount Paid By: Date: Receipt: Approved/Date Permit $137.00 MAM 01/20/00 23142 Potable Water Application $30.00 MAM 01/20/00 23142 Total: $167.00 I:\F_BLD_App_Mob.rpt 10/29/99 - 4 . .�501r co Jefferson County Permit Center Department of Community Development t � 621 Sheridan Street Port Townsend WA 88368[3601379-4d5D 4..., .""--•.---'-'7fy Uavri 2'll is de 6ollowi e9 G1a aka 44 co ke1ere4 ad Isaoditle: Project Description: INSTALLATION OF NEW MANUFACTURED HOME 9 Digit Parcel Identification Number(from your tax statement): 962114911 SiteA�ots 11-16 911#: Road Name: Stromberg Ave Zip Code: 98368 + Legal Description Irondale 5?-6 149 11-16 Subdivision Name: Block: Lot(s): Section: Township: Range: Parcel Size (acres or square footage): 150 ' x 100 ' Property Owner: M.V. STONE Phone: 379-0799 Mailing Address: P .O . BOX 624 Port Hadlock, WA 98339 Applicant/Occupant: Earl Green Phone: (if different from owner) 379-0799 Mailing Address: P.O. Box 524, Port Hadlock, WA 98339 Authorized Rep: Prestige Properties , Inc. Phone: 385-9033 Mailing Address: 11524 Rhody Drive, Port Hadlock, WA 98339 General Contractor: M & E Trucking Inc, 379-0799 Or Manufactured Home Installer: Kozel isky Home Service Phone: 385-3215 Mailing Address: M & E P. O. Box 524 Port Hadlock, WA 98339 YozPlisky 1112 Jacob Miller R Port Tsws.ond,. WA 98368 Contractor's State License Number: Rd.M & E METRI055MU Expiration Date: 10-21-02 Septic Designer: Kozelisky -e626V1AINS. Phone: Exp - 7-22-01 Mailing Address: Tillman Engineering 3 7 9-%-61 141 Oak Bay Rd, Port Hadlock, WA 98339 Architect:/Engineer: Phone: Mailing Address: Loan Lender/General Phone: Contractor's Bond Holder: (A • C) • , Mailing Address: FOR OFk ICI;:USE ONLY Fire District Planning Area. School District: Zone: .. ...............:... 4/98 H:\homc\pincntr\forms\universal plot plan Jefferson County Permit Center Date 621 Sheridan Street Fee Port Townsend WA 98368 Rec # CRITICAL AREAS QUESTIONNAIRE Ck # Case # Applicant Name Earl Green X Building Application Land Use Application __ Shoreline Application On-site Sewage Application _ Subdivision Application Other: 1 . Is there any standing or running water on the surface of the YES X NO property or on any nearby property at any time during the year? If YES, please describe: 2. Has any portion of the property or any nearby property ever been YES X NO identified as a wetland or swamp? If YES, please describe: 3. Are any willows, skunk cabbage, alders, or cottonwoods present YES X NO on your property or adjacent properties? If YES, please describe: 4. Are there any indications on any portion of the property or on any YES X NO nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: 5. Please indicate which line best represents the steepest slope found on your property. (Check appropriate box) 0 0 4 Q o a ❑ , , , , , , / , , , , , , i , , ,' ,❑ , , / / / / / , , , , , / / / / / , ,, / / / , / I / / / / , , , , , , , / / , / /' , , , , , , , ,,/ ,, I I ///,' ,' ,' / ' ,,/// / , , , ,I,,,,, i / ,' -- ,,,,,,, /,' - —fl ,,,///,,,/,-'--'---' ,,,/////,%-�-� —' —' ,,,,i,,,,, - - --- _--.❑ ❑ (Questionnaire Continues on Back) a 6. Does the site have steep slopes with little to no vegetation? YES X NO If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES X NO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES X NO surface of the ground? If YES, please describe: The applicant hereby certifies that all of the above statements and the information contained in any other transmittals made herewith are true, and the applicant acknowledges that any action taken by Jefferson County based in whole or in part on this application may be reversed if it develops that any such statement or other information contained herein is false. Signature Date /— FOR OFFICE USE ONLY ❑ Wetlands ❑ Seismic CRITICAL AREAS ON OR ❑ Aquifer Recharge Area (zone_) ❑ Fish & Wildlife Area 1 IMMEDIATELY ADJACENT TO SITE: ❑ Frequently Flooded Area ❑ Fish & Wildlife Area 2 ❑ Erosion O Landslide Zone: Parcel Size: Status: Comprehensive Plan Land Use Designation: Reviewed by: Community Plan: Date: • STORMWATER CALCULATIONS Owner/Applicant: 0 PROPOSED LAND DISTURBING ACTIVITY Site Address: Drainfield area cleared sq.ft. Driveway Length ft. X Width ft. 9 Digit Parcel Identification No.: = Total Driveway sq.ft. Permit Number: Clearing and Grading for Site Development PLOT PLAN (Well/Structures/Utilities/etc.) sq.ft. 1(gc sq.ft. INDICATE the following information. Total Land Disturbance 1(00 v sq.ft. Draw entire parcel to scale. Indicate scale of plot plan: One inch equals ❑ IMPERVIOUS SURFACE Proposed Structures (all roof area) /5 70 sq.ft. = 1. North arrow Existing Structures (all roof area) sq.ft. = 2. All property boundaries and dimensions Sidewalks sq.ft. 3. Names of adjacent streets Concrete Patios sq.ft. = 4. Driveway/s & parking spaces Proposed: �-7� � = 5. Major features such as ravines, Driveway Length .� ` ft. seasonal creeks, bodies of water, etc. X Width 1 ' ft. = 6. Septic tank, drainfield and reserve area location, = Total Driveway ! S - sq.ft. existing or proposed, and distance to Total Impervious Surface 2,3 sq.ft. closest structure = 7. Sewer lines The Stormwater Manual sets forth the following Small Parcel Minimum Requirements: = 8. Wells and/or water lines • Construction Access Route Stabilization: 9. Neighboring wells within 150 feet Construction vehicle access shall be, whenever feasible, limited to one route. Access points shall be stabilized with 10. Paved surfaces (patios) quarry spalls or crushed rock to minimize the tracking of = 1 1. Structures, existing and/or proposed sediment onto public roads. If sediment is inadvertently transported onto public roads, roads shall be cleaned = 12. Setbacks (distances to property thoroughly at the end of the day by shoveling or sweeping. Street washing should only be done after the bulk of the boundaries, structures, banks, sediment has been removed by sweeping. and shorelines) • Stabilization of Exposed Soil: All exposed and unworried soil shall be stabilized by sodding, = 13. Easements for access or utilities seeding, mulching, plastic covering, application of gravel base 14. Arrows showing direction of slope on roads and driveways, or other appropriate means within seven days during the period from May 1 to September 30 assume an elevation of 100 feet at one and within two days during the period from October 1 to April lot corner and indicate the other lot 30. Mulch shall be applied to a minimum depth of two inches. • Protection of Adjacent Properties: corner elevations in relation to it Adjacent properties shall be protected from sediment deposition by appropriate use of vegetative buffer strips, sediment barriers or filters, dikes, mulching, or by a FOR APPLICATIONS ADJOINING SHORELINES, combination of these measures and other appropriate Best Management Practices (BMPs). INDICATE: • Maintenance: 15. Ordinary high water mark All erosion and sediment control BMPs shall be regularly inspected and maintained to ensure continued performance of = 1 6. Top of bank, if over 10 feet high their intended function. = 1 7. Slope of bank in degrees • Other Appropriate BMPs as required by Jefferson County to mitigate the effects of increased runoff shall be applied. H:\H 0ME\PLNCNTR\FORMS\PLOTPLN.FRM9/97 1 A R0) +-7 N O) LL m` 1L VM IL'VM S V 0 _4_—� ________.____s. U) 0 N m co cv ~ o o 3 3 - • CIIII 0 C) o 3 V •C . E ..._ .... , .,-,-, : ., 15 CCI H QQ�' _(-1------) — ~ tl R J a 03 CI y u 01 T7 + 10 b o a M 0 0 0 w 2 • 0) Q 3 � rnO — N o Ul a) C' a- ° o< • p o ri•3 CI); Y o °c t� 0 +, o 4 M g ,_ ,eg�I�..S \ CO ___ _.._ N 3 E C Cl) A 73 co —T ^ CO V C < 9 e Zli IT \ r /r_ ---ip,-,i_'- ifA) Q C 4 1 I < L .Cr) y CO 'ac \/1 s I; \\}"mi e L rr, 3J • N AL CV iii ,moo ld0.• j CI ,c. s------ — LH g PAYS.9'I 0 Ir....H 3 A"el 170j‘ ... \I VM g�4I ir it, o v m 3 0 JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION AY NEW BUILDING 0 REPLACEMENT 27 `x 53 ' SIZE 2000 YEAR MAKE Golden West COST 47 , 500 BEDROOMS: BATHROOMS: EXISTING 0 EXISTING 0 PROPOSED 3 PROPOSED 2 TOTAL 3 TOTAL 2 TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL INDIVIDUAL SYSTEM 0 Conventional a PUBLIC PUD #1 PERMIT # SEP 99-0231 0 Alternative Name of water system: IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft SIGNATURE DATE /—/ - C>D NAME (PLEASE PRINT) FOR OFFICE USE ONLY t BASE FEE 13"7 O" RECEIPT # 2'3 1 "1 2- ADDITIONAL SECTIONS CASH/CK # 07 4 9 � SUBTOTALe 3�°c7 DATE �/�/jy7 o11e o POTABLE WATER //�7 911/ROAD APPROACH ` 9 °1' TOTAL 2 1(0 H:\HOME\PLNCNTR\FORMS\MOBILEAP.5/97 1 I 41. ^WJ 11 ( d 1 i 0 % i 11 ar<____________ -t-c..\ I\.. I i q I II 0 w P . a ,.� ' S(;4 C I .MHI RIM RM.1“1 1b I $r i I I 1 1, I iis._. �11 11`r is fl t I I■■ ■e I* a . k III 111 m ( Q , /11119j $ 01 ii:IN g IT. I r,...! :7,1 in- ) lel I . IM ' ■ ■•■vom - �■■ 1 n0 Mp i of ..: ■..��.. M :11 JR:rat.1191 •111=4";711*v°:0 . �,� 3 q',(4' \-,...% c i : I T1L t1/4 - 4 ----- -------- bu Tb E4_5, 177 L�/v 1- Fo 2Ge T D \l/. I.V s. • • RETURN ADDRESS naid, tun K A1/1Y 4v6r RI e-n:7(- 61SI CD Ora "Dr. —�1 , c\s 48098 WASNINGTDN STATE DEPARTMENT Di Manufactured Home ELIMINAgITITLE TION Il dia LICENSING Application DTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty DREMOVAL FROM REAL PROPERTY 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) 2000 GOLDEN 66 X 27 GWOR23N24228AB © LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE AFFIXED 0 REMOVED 962-114-911 LOT BLOCK PLAT NAME OR SECT1ONrTOWNSHIP/RANGE QUARTER/QUARTER SECTION 11-16 149 IRONDALE DIVISION NO.6 © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER EDWARD L.PARKER NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER BONI L.PARKER ADDRESS CITY STATE ZIP CODE 43 SOUTH STROMBERG AVENUE PORT TOWNSEND WA 98368 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME 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 before me on by Signature PRINT NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date 0 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. © BUILDING PERMIT OFFICE CERTIFICATION I C2rtif that: r the manufactured home has been affixed to the real property as described. ID 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 N BLDG PERMIT N t�-.A hnr S evi- ( o)3 Kt 44ti'o --- SI NA REy/POSIPO{(�\" ��°°� 7 r{5.M1 p ,, 4 k1�!P�,,,, DATE �`�`"�-/Q TD-4 -72��IU6�W Page1 � N��4"►I N.i�1P' r .114 V 1 • • MANUFACTURED HOME-FROM SECTION 1 TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIE) 2000 GOLDEN 66 X 27 GWOR23N24228AB SIGNATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR EUMINATION 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 LEGAL OWNER(S)SIGNATURE State of Washington Signed or attested County of before me on by Signature PRINT NAME OF LEGAL OWNER NOTARY OR AGENT by PRINT NAME OF LEGAL OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date p LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) LOTS 11 THROUGH 16 INCLUSIVE,IN BLOCK 149,IRONDALE DIVISION NO.6,AS PER PLAT RECORDED IN VOLUME 2 OF PLATS,PAGE 139,RECORDS OF JEFFERSON COUNTY,STATE OF WASHINGTON. 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 U USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). 0 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 FIUNG 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(R/6/O6)W Page 2 of 2