Loading...
HomeMy WebLinkAboutBLD2000-00407 r e 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 #: BLD00-00407 Received Date: 6/19/2000 SITE ADDRESS: 7026 SR20 Issue Date: 8/1/2000 PORT TOWNSEND, 98368 Expiration Date 8/1/2001 APPLICANT: CONRAD MILLER 15711 NE 18TH ST VANCOUVER WA 98384 SUBDIVISION: Block: Lot: T 17 PARCEL#: 001283023 Section: 28 Township: 30 N Range: 01 W CONTRACTOR/ DEALER INSTALLER: JAIME KOZELISKI WAINS0626 Expires: 7/22/200 1112 JACOB MILLER RD PORT TOWNSED WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION MAKE: GOLDENWEST YEAR: 2000 SIZE: 27 x 52 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 8/1/2001. REQUIRED INSPECTIONS: [e]----/Footing/Setback (If continous footings are used): j f 0-- `C''' c id4_..- (,„t._ri,_ / BIocng/ etbam . ; _ •(1' -",)-- >//;— (1/411- O/C Y797©C [Lfrrfinal/Skirting/Vents/Porcfjes/etep5�, 7/C ` 1. 9< '/ r )(, 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 r MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00407 Received Date: 6/19/2000 SITE ADDRESS: 7026 SR20 PORT TOWNSEND, 98368 APPLICANT: CONRAD MILLER PHONE: (360)256-7704 15711 NE 18TH ST VANCOUVER WA 98384 SUBDIVISION: Block: Lot: T 17 PARCEL NUMBER: 001283023 Section: 28 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: JAIME KOZELISKI WAINS0626 7/20/2000 (360)385-3215 1112 JACOB MILLER RD PORT TOWNSED WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: GOLDENWEST SETBACK: VALUATION 49,000.00 YEAR: 2000 LABOR & INDUSTRIES APPROVAL? SIZE: 27 x 52 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CITY BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 3 Prop: 2 Wetland Erosion Total: 3 Total: 2 Seismic Streams Flood Way Food Plane Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $141.00 MAM 06/19/00 31690 i Potable Water Application $30.00 MAM 06/19/00 31690 �+ v I 7.F Total: $171.00 ur U' 2000 Jefferson Corny Planning a Building Dopartnnurt I:\F_BLD_App_Mob.rpt 10/29/99 T JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION NEW BUILDING 0 REPLACEMENT SIZE 2 /7 X S L- YEAR O[� /' , MAKE Gdl—Q—L(J c- 5 f COST BEDROOMS: BATHROOMS: EXISTING EXISTING 4eEE%'-. PROPOSED 3 PROPOSED TOTAL TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL XtINDIVIDUAL SYSTEM 0 Conventional kUBLIC PERMIT # SEP'1 ❑ Alternative Name of water systerr/�i �/ > IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft SIGNATURE J DATE - / j ->c) NAME (PLEASE PRINT) Cop FOR OFFICE USE ONLY BASE FEE /y/• 00 RECEIPT # �l9 /C� 6 ADDITIONAL SECTIONS CASH/CK # SUBTOTAL /'y/ 0 0 DATE (Q /C?l (/V POTABLE WATER �3Q E ° U 911/ROAD APPROACH `1 TOTAL !/ / 1 v U H:\HOME\PLNCNTR\FORMS\MOBILEAP.5/97 ���goN c.„ Jattorsan County Permit Center Department of Community Development 4 , 621 Sheridan Street,Port Townsend WA 86368 (368) 379-4450 0 ' Ucrllptp lNGtio [.K '(e oad.lflf &cud,• 44 Canggt cad Ac144iele: Project Description: - Installation of New. Manufactured Home (9 Digit Parcel Identification Number (from your tax statement): Vs() /?4 3c>2-3 Site Address • L 911#: 702-4, I Road Name: )J "`l y Zip Code: g3 6S Legal Description , J Subdivision Name: LSIP✓ r 6 Block: Lot(s): Section: Township: Range: Parcel Size (acres or square footage): c"ea Property Owner: Cob 4 4/ 1 b 4 Phone: �� Phone: — ZS 6- 770 Y- Mailing Address: /5 7// /v. E. y✓ ovt. Applicant/Occupant: Phone: (if different from owner) Mailing Address: Authorized Reph restige Properties , IncInc , , one:Lowell Matthew 385-9033 MailingAddress: 11524 Rhody Drive , Port Hadlock, WA 98339 General Contractor: Prestige Properties , Inc . Or Manufactured Home Installer: Jamie Kozelisky Phone: 385-9033 Nl,ilingAddress:11524 Rhody Drive, Port Hadlock, WA 98339 Contractor's State License Number: PRESTPI065CM Expiration Date: 11-13-99 Septic Designer: _ / ` 5� qS /7 _ Phone: Mailing Address: 47 Architect./Engineer: _ - - Phone: Mailing Address: I Loan Lender/General Phone: Contractor's Bond Holder: `(ailing Address: FOR OFFICE USE ONLY Fire District Planning Area. School District: : Zone: ./9 l H:\borne\pincntr\Forms\univeaal plot play PLEASE MAIL TO: JEFFERSON COUNTY ASSESSOR " JACK WESTERMAN III JEFFERSON COUNTY COURTHOUSE ASSESSOR PO BOX 1220, PORT TOWNSEND WA 98368 (360) 385-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME / MAILING ADDRESS: THIS /S NOTA TAX STATEMENT ' NAME: ,f 44/ L L C fe The purpose of this questionnaire is to obtain information Zv regarding either the current location of a mobile home or the ADDRESS: 7 D� MAI previous ownership and location of a mobile home. This will 69N� help our office determine whether the mobile home is already 0 eel 5 G I✓cL / W ' - on the tax rolls in Jefferson County or if it has been moved to Z 5(� r, this county from another area. Please see reverse side for TELEPHONE NO: 3(00 d7 _ additional information. 1 ) MOBILE HOME DATA:// /I I', , (A) MAKE GLO B/v VV�� (B) MODEL V 149 S 2... G OO / 7 (C) YEAR jd O (D) LENGTH 5 2.__- (E) WIDTH 2--� (F) SERIAL NUMBER (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) (H) PURCHASE DATE 2) PREVIOUS OWNER / LOCATION OF MOB LE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE ('`�5 l�'�?-P Pg451,V72--it tfr-"S iv�-- ADDRESS (/ _ .� � . — Li,^ (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO,WHAT COUNTY? IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO (B) IF LOCATED IN A MOBILE HOME PARK: NAME ai ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: LOCATION (ADDRESS) REAL PROPERTY PARCEL NUMBER/ DESCRIPTION THANK YOU FOR YOUR HELP! �� c --/S- 7_6-700 SIGNATURE KELLI LARSON, roperty Technician • THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. • CAP--00--OO"�-6s MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00407 Received Date: 6/19/2000 SITE ADDRESS: 7026 SR20 PORT TOWNSEND, 98368 APPLICANT: CONRAD MILLER PHONE: (360)256-7704 15711 NE 18TH ST VANCOUVER WA 98384 SUBDIVISION: Block: Lot: T 17 PARCEL NUMBER: 001283023 Section: 28 Township: 30 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: JAIME KOZELISKI WAINS0626 7/20/2000 (360)385-3215 1112 JACOB MILLER RD PORT TOWNSED WA 98368 PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: GOLDENWEST SETBACK: VALUATION 49,000.00 YEAR: 2000 LABOR & INDUSTRIES APPROVAL? SIZE: 27 x 52 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: CITY YL'I '11) BEDROOMS: BATHROOMS: PARCEL TAGS: YES ' STORMWATER: YES vSir Exist: Exist: Prop: 3 Prop: 2 AREA Plat •r•itio r (r\� Total: 3 Total: 2 Wetland Erosion Seismic Streams Flood Way . Food Plane Routing Date: -2 L F&w Landslide W Shoreline Aquifer ��'� r . Forest: Commercial (\ Rural k rype Amount Paid By: Date: Receipt: '.•r•1`d/j A Q) C Manufactured Homes $141.00 MAM 06/19/00 31690 9 t Potable Water Application $30.00 MAM 06/19/00 31690 tieV je Q Total: $171.00 ! (/ v 3 .aralnifftwypb ' lilted" 6 t5 BLD_App_Mob.rpt 10/29/99 ,...- \/ Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 June 23, 2000 (360) 379-4450 CRITICAL AREA STANDARD WAIVER Applicant: CONRAD MILLER 15711 NE 18TH ST VANCOUVER WA 98384 Critical Area Review Case Number: CAR00-00268 Project Description: manufactured home installation Parcel Number. 001283023 S-T-R: 28-30N-01W Site Address: 7026 SR20 PORT TOWNSEND WA, 98368 FINDING: The development, as proposed and portrayed on the Universal Plot Plan, does not encroach on an identified critical area nor any associated buffers. CONCLUSION: The proposed development meets the waiver requirements established in Jefferson County Ordinance 05-0509-94. CONDITION: The development shall be as proposed and portrayed on the Universal Plot Plan. Deviation, additions or relocation of proposed development activities will require further review pursuant to the Jefferson County Critical Areas Ordinance. /dAY — Department of Community Development Staff c: File I:1F_CAR_Waiver Standrd.rpt 12/13/99 I RETURN ADDRESS WASHIN6TDN STATE DEPARTMENT OF Manufactured Home W:T1�eFy�e':I 3af]`1i� LICENSING Application DTITLEELIMINATION �• ['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) MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 2000 GOLDENWI 52 X 27 ® LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE [AFFIXED REAL PROPERTY TAX PARCEL NUMBER ❑ REMOVED 001 283 023 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION ® GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 1 NAME OF REGISTERED OWNER GORDON E. SHADBURNE DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER JANICE M. SHADBURNE d021 DRE HC�V6' 3�i 1 esADSS STATE ZIP CODE -7c Dk H 4' G° PORT TOWNSEND WA 98368 NAME OF LEGAL OWNER FIRST FEDERAL SAVINGS AND LOAN DOL CUSTOMER ACCOUNT NUMBER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 105 W 8TH STREET PORT ANGELES WA 98362 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 �,.- y�` �r--'� Signature of Additional Registered Owner and Title,IF APPLICABLE` VA1-Q /k.., \51 VAA fW NOTARY SEAL OR MP ,`A�1ltif1l/jff,��/ NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE �` t� •Q,ENee./ 114;State of Washingtof it "� •....... '�Kerb Si r attested • ?Y•�G No,., ( before eon �' ) • LIIA___ �S :I -PRINT NAME OF REGISTERED w- � Signature '('t1• ,^ GNOTARY OR ENT SOS•. <Pt i C `k i f A- OP i11 .x c�'al*%.�''' ., ? ,€ (linker �j� �'•••'.•�... •\ \. PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY 'r�r��s�iC?���`��Title �h!',2lvL�//� County/Office No.OR ' DEALERSHIP PO TION/AGENT/NJrARY AND: Dealer i No. at y . �IZa � Notary Expiration Datt\. 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 certify that: • X the manufactured home has been affixed to the real property as described. ED 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# ,aa x, A w pp ) 3f l q - 4450 ` (-Do()-r o4o7 SIGN T E/POSITIO tFiQ `� ,f m i Te_c I l i ►/0'7 TD-420.729 (R/6/06)W P el of 2 t f. MANUFACTURED HOME-FROM SECTION 1 TPO/PLATE NUMBER YEAR 2000 MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) GOLDENWI 52 X 27 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 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 Title County/Office No.OR DEALERSHIP POSITION/AGENT/NOTARY AND: Dealer No.OR Notary Expiration Date ®LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office) 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 A HORIZED SIGNATU 1 s \ ❑USE TAX EXEMPT Sale to a Certified Tribal membee er tion ttach notarized statement of deliver . 9 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Subagents) y) 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 I APPLICATION MOBILE HOME FEE ELIMINATION FEE I USE TAX SUBAGENT FEES 1 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/6/06)W Page 2 of 2 ) • lT• \'\ s_____._._._._..___...._.____._..___._.______.____.__________.._ \\ f______.__.______ - - - - Lill, q '' •--->i \ 3 0 L (jr6 A ,-.• • • in V .c.c/A y rtis- /-ii . --• ,5N A,sgts, ° I A a \ cwN 0 ill c'•\ -ct, - ,I\ c -.31— \ \._.... a \ \ , `-' \--) , . '-. I A , - \ M i -Ci I \‘IN‘A . 1 • C.1-. , L - 3 Pen f /64/ Z A \ ' ,, ' ... I .., . NI : \-1\—/ \ \ . , • -1Q1c). \ \ >• -±,,, - ,-,' : / \ ,--„, ----s r1-. ---) i \ \ 4 VI l \ ‘\ 0 n , ' I ---\- \ - -. \ \ '. \• • t,51 ceW --—- ____ _ ._ ),,