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Home My WebLink AboutBLD2003-00069 • • MANUFACTURED/MOBILE HOME INSTALLATION PERMIT Jefferson County Department of Community Development 6261 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT #: BLD03-00069 Received Date: 2/4/2003 SITE ADDRESS: 211 MEADE RD Issue Date: 3/10/2003 NORDLAND, 98358 APPLICANT: JENISE Y REEVE 211 MEADE RD NORDLAND WA 98358-9694 SUBDIVISION: Block: Lot: T 88 PARCEL#: 921042047 Section: 4 Township: 29 N Range: 01 E CONTRACTOR/ MCEWEN CONSTRUCTION PHONE: (360)379-9565 DEALER PO BOX 1397 PORT HADLOCK WA 98339 Contractor's License MCEWEC*9820Z Expires 09/09/2004 PROJECT DESCRIPTION REPLACEMENT MANUFACTURED HOME INSTALLATION MAKE: SKYLINE YEAR: 1999 SIZE: 52 X 40 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 3/10/2004. REQUIRED INSPECT e : [V—Setba c. '$ � o -/Footi � (CONTINUOUS FOOTING, SLAB or PADS USED): ` C'� L�� [f_17Blocking/Plumbing: 5-4c3 et � 77e i 77_ .z . [ ] Zoning Approval: [ ] Septic System Approval: [(Y Final/Skirting/Vents/Porches/Steps:(/�(,� �,1 �7/ � ' 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. SPECIAL CONDITIONS APPLY-SEE REVERSE HOT-LINE AVAILABLE 24 HOURS A DAY • • SPECIAL CONDITIONS CASE # BLD03-00069 1.) The application was reviewed by the Jefferson County Department of Community Development staff on 3/04/03 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Coastal Seawater Intrusion Protection Area (SIPZ). 2.) The proposal will utilize an existing well and a new well will not be constucted and therefore SIPZ measures do not apply. 3.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 4.) The applicant is proposing to create or add 1,880 square feet of impervious surface. Sections 6.6 and 6.7 of the Jefferson County Unified Development Code requires that your proposal adhere to Best Management Practices (BMPs) to control sedimentation and erosion on the subject property. 5.) The project shall adhere to the Best Management Practices (BMPs) to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 6.) The site plan as submitted with the buildling application on 2/20/03 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated 3/04/03 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 7.) The building height is not to exceed 35 feet. 8.) The property is serviced by a access easement on the western lot line which requires a minimum 20-foot setback. The remaining side and rear lot lines requires a minimum 5-foot lot line setback. r , 'A 4 111 �� i s :::-------:.i.;&-7.1.,.:- .:-.7-:„":1,z, 0 . . g - 1411 7.---.-,...:::::,,,-,„:. iii:::$4-NAzIP bt,„_,.. ...,.. - ----,-,--x-3,-,-,,,.. -*-Ne.--,,,1,-- i 0 E Axa4 ` S/GP e (av. %.-•-.. •- .---. -•. -"..7,4,-" ,, ,T,,_'•':';::-.::N l'.4:•-,---7'-:,...--.:-,-1-"::-'',7.'•4---:7,Z.f',.,.:,- . : °4 =3 M p:1 iti 'Li IV 0 —'____, 8 ;y, v. t/ c so T f�TI ,11N _ ` 3:ni 5 , oN i r:.--1' (1 em :N. 4'7si "D L .___ J h K .. \ O _ R— `JO � e � Rd. S • • MLA03-0005C Review Type: t MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD03-00069 Received Date: 2/4/2003 SITE ADDRESS: 211 MEADE RD NORDLAND, 98358 APPLICANT: JENISE Y REEVE PHONE: (360)379-0337 211 MEADE RD NORDLAND WA 98358-9694 SUBDIVISION: Block: Lot: T 88 PARCEL NUMBER: 921042047 Section: 4 Township: 29 N Range: 01 E CONTRACTOR/ MCEWEN CONSTRUCTION PHONE: (360)379-9565 DEALER: PO BOX 1397 PORT HADLOCK WA 98339 Contractor's License MCEWEC*9820Z Expires 9/9/2004 REPRESENTATIVE: WILLIAM MCEWEN PHONE: (360)379-9565 PO BOX 1397 PORT HADLOCK WA 98339 PROJECT DESCRIPTION: MANUFACTURED HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: SKYLINE SETBACK: VALUATION 65,000.00 YEAR: 1999 LABOR & INDUSTRIES APPROVAL? SIZE: 52 X 40 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: PWELL 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 Floodplain Routing Date: q�� F&W Landslide /6/ai �� Shoreline Aquifer Type Amount Paid By: Date: Receipt: APPROVED Manufactured Homes $151.00 MAM 02/04/03 54949 Total: $151.00 MAR 1 0 2003 Jefferson County Planning & Building Department 4�i„,,/fn A' IV ea) Sfr JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION NEW BUILDING ❑ REPLACEMENT SIZE xK) YEAR /' ? MAKE SKy ( I / COST (p5, ""--- BEDROOMS: BATHROOMS: EXISTING EXISTING PROPOSED PROPOSED TOTAL TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: ❑ SEWER 0 COMMUNITY SYSTEM g PRIVATE WELL 0 TWO PARY WELL 0 INDIVIDUAL SYSTEM 0 Conventional ❑ PUBLIC PERMIT#SEP 0 Alternative Name of water system: IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE /- ft BANK HEIGHT ft By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet may result in this permit being null and void. I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and shall occur during regu�b siness ho rs. SIGNATURE \ 1z �� 2 e�{ � n � DATE NAME(PLEASE PRINT) Filer,: _ FOR OFFICE USE ONLY CONSISTENCY REVIEW FEE =gg41 RECEIPT# , BASE FEE t • l/l_J ADDITIONAL SECTIONS 6 CASH/CK# V C F 3F SUBTOTAL /57• DATE /9-/ f /0 POTABLE WATER 911/ROAD APPROACH TOTAL f�f H:UiO M E W LN CNTRU N F O B L DU=O R M SUVI O B I LEAP.11/26/01 • RETURN ADDRESS FORREST MILLER JENISE MILLER 211 MEADE RD. NORDLAND, WA 98358 h S''1Alr mtlr 11nrGT°v MANUFACTURED HOME (�4 6yxN;r �I:�•3dr� liJrw`r <' APPLICATION TITLE ELIMINATION cEnsinG DTRANSFER 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) El MANUFACTURED HOME TPO I PLATE NUMBER YEAR 1 MAKE I LENGTHAVIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 1999 SKYLINE 52 X 42 El LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE AFFIXED El REMOVED R�gL�F3oPERTy�{+x PaRE�NUMBER LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE y L 1 V 4 L FUART/EWQUARTER SECTION GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE ...._—._._._ COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER DOI.CUSTOMER ACCOUNT NUMBER Forrest Miller NIILLEG/Z4' oc, NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Jeni se Miller YY1 I LIU V.4-31 S ADDRESS CITY STATE ZIP CODE 211 Meade Road Nordland WA 98358 NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER Long Beach Mortgage NAME OF ADDITIONAL LEGAL OWNER DUL CUSTOMER ACCOUNT NUMBER ADDRESS ��•_.._.—_._._..___.—......_.__CITY—__._.__--_—_____. STATE ZIP CODE ---- 4160 Dublin Boulevard Suite 400 Dlin CA 94568 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE A ARE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE«l Signature of Additional Registered Owner and Title,IF APPLICABLE ^ 1%)-7"-%/"---- Noir f A ditto 39�P NOTARIZATION/CERTIFICATIO OR REGISTERED O, (S)SIGNATURE ▪ ....° .B/ State of Washington PIERCE Signed or: % ed 5/2 3/2 0 0 3 ��N -v .1 County of bef o • T� �' FORREST MILLER ' Y o t> Lpy Signature `�.. 'Y`-`•'-i01► \ PRINT NAME OF REGISTERED OWNER TARY OR AGENT j-"C'.. �b JENISE):MILLER _ BARBARA CUNNINGHAM • .,r,r..Qom. /�� 1 y`INT NAM- PRINT NAME OF REGISTERF_D OWNER PRINTED NAME OF NOTARY _' ......• ' y�?I�'' ffice No.OR 8/2 9/0 5 ▪ I�bt[IifII I TitleAND: OR DEALERSHIPPOSITIONIAGENT/NOTARY NotaryExpirationDaate - 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: the manufactured home has been affixed to the real property as described. 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# �1�_ tiR�, Yk�jn StAicv ,. (0o s -lot 445 _ _ -000(0 SI TURE 1 POSITION V 1 � { DtTE TD-420.729 MANUF HOME APPL(R/2i02)OR(W)Page 1 of 2 \ .X . 0 0 RETURN ADDRESS FORREST MILLER JENISE MILLER 211 MEADE RD. NORDLAND, WA 98358 1,1 ,;, ,,. ,,`;,r MANUFACTURED HOME r:744marg rg-ewv4 lICEnSInG APPLICATION TITLE ELIMINATION QTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact Is guilty ]RENIOVAL 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 I MAKE 1 999 AMBERCV 52 X 42 LENGTHANIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE 112f AFFIXED ID REMOVED I R y L 1oPEA 4 x FSR�F�NUMBER Lr�I BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE VV 4 QUARTER,, OUAR'i'ERSECT!UN Ei GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE _....._.__-._..... COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS NAME OF REGISTERED OWNER Forrest Miller not.CUS/TOMERACCOUNT�NUMBER NAME OF ADDITIONAL REGISTERED OWNER - �"DOL CUSTOMER ACCOUNT NUMBER Jenise Miller rA I LLJ k..14-3 .ADDRESS - — .__.._._...__�__...._._....�.._._.__... CITY t STATE ZIP CODE 211 Meade Road Nordland NAME OF LEGAL OWNER WA 98358 LongDOL CUSTOMER ACCOUNTNUMBER Beach Mortgage NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER • ADDRESS _....._.._........._,........_._. C:ITY'`. STATE ZIP CODE 4160 Dith n Boulevard Suite 400 Dublin ____CL 94568 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE A 'ARE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: f Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE �'a; Q.:,,,, NOTT yr, ,4 fR-$AMP I NOTARIZATION/CERTIF,ICATIO 1 OR REGISTERED 0 a '--(S)SIGNATURE �/7-"` I State of Washington COuntgtof Signed or \� f. •'' -,�,�cN • .'� '_ PIERCE g - ed \ ,.,4 ; ' T AA y E� j Y _ bef.' o, 5/2 3/2 0 0 3� s� �,y FORREST MILLER / ��.- •- I° Signature :X l`; PRINT NAME OF REGISTERED OWNER ITARY OR AGENT �''(PA •, " ' 'w, ..r., by. JENISE::MILLER BARBARA CUNNINGHAM :. 'r",-. "„,,, .+, ti,: 0 PRINT NAME OF REGISTERED OWNER _ 0 PRINTED NAME OF NOTARY `-- C,,�.. �y y.'*:,.t.."1 0 1 Title NOTARY County/Office No.OR 0 .., DEALERSI•IIP POSITION/AGENT/NOTARY AND; (dealer No.OR 8/2 9/0 5 TITLE COUPANY CERTIFICATION Notary Expiration Date---- --....-„, 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 I POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 13 BUILDING PERMIT OFFICE CERTIFICATION I Certify that: El the manufactured home has been affixed to the real property as described. L: a building permit has been issued for this purpose and the attachment will he inspected upon completion. NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# SIGNATURErSI N POTIU •-._......_..._...__......................._._...._..._...�_.__..._._....._......_.._._. DATE TD-d'2U-729 MANUF'TOME APPL(R/2102)OR(W)Page I of 2 • �► . s MANUFACTURED HOME - FROM SECTION 1 TPO;PLATE NUMBER I YEAR...---..�_...---MAKE LENGTI,INVIDTI-UFEET) VEHICLE IDENTIFICATION NUMBER(VIN) —�� -- 1999 _AMBERCV 52 X 42 aSI.4NATURE OF LEGAL OWNER SIGNATURE OF LEGAL OWNER INDICATES CONSENT FOR,ELIMINATION OF TITLE/REMOVAL iFRR M REAL PROPERTY. Signature of Legal Owner and Title,IF APPLICABLE v ✓�£ i Sj'C {(� i. Signature of Additional Legal Owner and Title, IF APPLICABLE NOTARY SEAL OR STAMP I NOTARIZATION/CERTIFICATION� FOR LEGAL OWNER(S)SIGNATURE State of t as ifl Cl0{�d� Signed or attested County of 3A. \fe ( before me on 1 1,,,,e,.: ,,,,,..,:„,,,,,,,, r�EfiEE'C.RAULEHSON ; �� S i�Pits�'F viYCOP)MIS 10�1#DD035001 I byQwerl'ge,Se 'e"*P`S jnature�PRINT NAM F LEGALOWNER �Jf� �-, I NOTARY R AG� T �= Bonded Thru Notary Public Underwriters I -, _ I v ncc C. VatA- So PRINT NAME OF LEGAL-OWNER Pi PRINTED NAME OF NOTARY • Title County/Office No.OR DEALERS)-LIP POSITION/AGENT/NOTARYAND: Dealer No.OR Notary Expiration Date LAND DESCRIPTION (A legal description of the land can be obtained from the local County Assessor's Office I Ca 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(TAPED OR PRINTED) WA DEALER NUMBER DATE OF SALE Fleetwood Homes 4173 6/16/02 PURCHASE PRICE I TAX JURISDICTION/TAX RATE. DEALER'. AU ORIZED SIGNATURE $65,190.00 8.5 Pj4,.._ 0 USE TAX EXEMPT Sale to a Certified Tribal member on the reservation(attach notarized statement of delivery). 9 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 S TAX 'rsiFOR(6 AN i: Of iue the appliGatitirtlies beef t approved by the County Audio;r Vc,ecic 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 t 1 Y(360)664-8885. TD•420-729 MANUF I-TOME APPL(R/2/02)OR(W)Page 2 of 2