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Home My WebLink AboutBLD0443, BLD25408, BLD18082, BLD17953 Mobile Home and Vehicle Transport/Disposal Addendum - BLD Permit / Conditions - 10/3/2005 Fn/Nti��X� „.< MASTER LICENSE SERVICE s DE MENT OF LICENSING ; �3 '3 UB( BOX v� G� euSINESS OLYMPIA WA 98507-9048 h+1t�l NAME jor VEHICLETRANSFi n DISPOSAL ADDENDUM (For licensure as a Registered Tow Truck Operator, Vehicle Transporter, Hulk Hauler, Wrecker and/or Scrap Processor) This addendum form may only be submitted as an attachment to the Master Application form. LICENSES REQUESTED(All applicants) OR ElRegistered Tow Truck Operator(244) Hulk Hauler(247) ❑ Scrap Processor(254) ElVehicle Transporter(242) Motor Vehicle Wrecker(250) NOTE:Corporations or Limited Liability Company ownership types must attach the Corporate Information or LLC Information sheet listing all individuals with 10%or more interest in your business. TOW TRUCK OPERATOR ADDITIONAL INFORMATION Have you ever been assigned a Registered Tow Truck Operator registration number?..................................❑ Yes ❑ No If"Yes,"give the previous Business Name: and number: Have you ever had that registration suspended or revoked?...............................................................................❑ Yes ❑ No If"Yes,"attach an explanation of the suspension or revocation. If you maintain additional secured vehicle storagelmpound areas away from this location, please see the instruction sheet. You must attach all of the following lists and completed documents to this application (see instruction sheet for descriptions): • Names&addresses of all employees who serve as tow truck drivers • Proof of Registered Tow Truck Operator liability insurance • Registered Tow Truck Operator bond • Fee schedule • Washington State Patrol Tow Truck-Business-Operator-Equipment Inspection Report 7I LE AN TE ADDITIONAL INFORMATION 1ndicate nsporter plates/license cannot be used to transport vehicles owned or registered to the licensee or business,unless you to truck operator. (RCW 46.76.065) transport business available to the general public?...........................................................................................❑ Yes ❑ No the number of Vehicle Transporter License Plates you require: —OFFICE USE ONLY This Section Will Be Completed by Washington Utilities and Transportation Commission This will certify that ame o uslness ❑ has been issued a common carrier permit, number pursuant to chapter 81.80 RCW. ❑ is exempt under chapter 81.80 RCW and therefore not required to obtain a common carrier permit. ❑ requires a WUTC permit but has not been issued a WUTC permit. ❑ WUTC is unable to determine if a WUTC permit is required based on information submitted. Signature of WA.Utilities&Transportation Comm.Representative Title of Representative Dale of Signature The Department of Licensing has a policy of providing equal access to its services. If eLS70Pf e3 VEHI(xETRNSPTA)ISPADD(lVf2A2pq Page 1012 you need special accommodation, call(360)664-1400 or TTY(360)664-888& HULK HAULER,WRECKER AND SCRAP PROCESSOR ADDITIONAL INFORMATION Hulk Hauler,Wrecker&Scrap Processor Applicants If applying for any of these three licenses,you must attach a list of the vehicles owned, leased, rented, or otherwise operated in the conduct of your business. A blank Listing of Vehicles Used to Conduct Business form is enclosed. Scrap Processor&Wrecker Applicants Only You must also complete a State Environmental Policy Act(SEPA)checklist,present it to the local zoning official for review(see section 6), and then attach the completed checklist to this application. A blank checklist is enclosed. Wrecker Applicants Only,attach the following completed forms(blank forms provided): • Personal/Criminal History Form • Bond of Motor Vehicle Wrecker If you have additional (branch) Motor Vehicle Wrecker business locations in the same county as this business location, please see the instructions sheet for information about registering those other locations. BUS ESS SITE IDENTIFICATION (Certifications in sections 6 and 7 below apply to this ffoollowiin1 business location But s 411 Go, Name: / Business Phone Number Physical Location � �® dZn Ss� �C✓ s� � Address of Business: Street or Rural Roue Address of Place of Business(do NOT use a PO Bo &fita�" �rgsa� 9�5 City county State Zip Code ZO ING CERTIFICATION(Registered Tow Truck Operator,Wrecker Hulk Hauler and/or Scrap Processor applicants onl This se tion to be completed by the local zoning authority. Check either yes'or'no'for each option and sign. cant is applying as a Registered Tow Truck Operator......................................................❑ Yes atdt No Applicant is applying as a Hulk Hauler..................................................................................................k Yes ❑ No If'yes'is checked,my signature below certifies that this Registered Tow Truck Operator or Hulk Hauler applicant's place of business is in compliance with all applicable local land use ordinances. Applicant is applying as a Motor Vehicle Wrecker....................................................................... ies Jib No Applicant is applying as a Scrap Processor...............................................................................................❑Yes )% No If'yes'is checked,my signature below certifies that the environmental impact from this proposed land use for a Motor Vehicle Wrecker or Scrap Processor business appears insignificant,pursuant to Chapter 43.21 RCW,the state Environmental Policy,WAC 197-11-305,WAC 197-11-820, and WAC 197-11-800(14)(i). A completed State Environmental Policy Act�(,SEPA)checklist must be rattached. ' `��n�rr�+r /�tlSK41('�✓ 6 22 c�S�. Signature of Local Zoning Official Title of oval Zoning Offi al Date of Signature ECTING OFFICER APPROVAL for Hulk Hauler,Scra Processor,and/or Wrecker a licants onl ) jjIN s ction to be completed by the Washington State Patrol,or by the local Chief of Police(if business is located in a city more than 5,000 population). Check either yes'or'no'for each option and sign. Applicant is applying as a Hulk Hauler................................................................................................BLYes ❑ No Applicant is applying as a Scrap Processor......................................................................................❑Yes Ji( No If'yes'is checked, my signature below certifies that this Hulk Hauler or Scrap Processor applicant is located at the address shown in section 5 above and has suitable equipment for the safe and lawful transport of vehicle salvage on the public highways. The applicant has displayed with letters and numerals at least three inches high, painted or permanently affixed to each vehicle, the business name, complete address of place of business, and current business telephone number on all vehicles operated by the applicant on highways of this state and which are equipped for lifting or transporting vehicles or hulks. Applicant is applying as a Motor Vehicle Wrecker..................................................................... Pes >LNo If'yes'is checked, my signature below certifies that this Motor Vehicle Wrecker applicant is located at the address shown in section 5 above, as defined by RCW 46.80.010, and has displayed with letters or numerals at least three inches high, painted or permanently affixed to each vehicle, the business name,city name of place of business, and current business telephone number on all vehicles operated by the applicant on highways of this state and which are equipped for lifting or transporting vehicles or hulks. Signature of Inspecting Officer Title of Inspecting Officer Date of Signature V-S-700-133 VEHICLETRWSPTOISPADD(W12102PR Page2 oil HULK HAULER,WRECKER AND SCRAP PROCESSOR ADDITIONAL INFORMATION Hulk Hauler,Wrecker&Scrap Processor Applicant§ If applying for any of these three licenses,you must attach a list of the vehicles owned, leased, rented,or otherwise operated in the conduct of your business. A blank Listing of Vehicles Used to Conduct Business form is enclosed. Scrap Processor&Wrecker Applicants Only You must also complete a State Environmental Policy Act(SEPA)checklist, present it to the local zoning official for review(see section 6), and then attach the completed checklist to this application.A blank checklist is enclosed. Wrecker Applicants Only,attach the following completed forms(blank forms provided): • Personal/Criminal History Form • Bond of Motor Vehicle Wrecker If you have additional(branch) Motor Vehicle Wrecker business locations in the same county as this business location, please see the instructions sheet for information about registering those other locations. BUSINESS SITE IDENTIFICATION (Certifications in sections 66 and 7 below apply to this following business location Business Firm Name: (J� ) b Physical Location ^/ /� / .p Business Phone Number Address of Business: / " ' Ei z-26 Street or Rural Route Address of Place of Business(do NOT usee PO Box) city County State ZipCode ZONING CERTIFICATION(Registered Tow Truck Operator,Wrecker Hulk Hauler and/or Scrap Processor applicants only) This section to be completed by the local zoning authority. Check either yes'or'no'for each opti d sign. Applicant is applying as a Registered Tow Truck Operator.................................................. Yes A No Applicant is applying as a HulkHauler..................................................................................................j9Yes O No If'yes'is checked, my signature below certifies that this Registered Tow Truck Operator or Hulk Hauler applicant's place of business is in compliance with all applicable local land use ordinances. Applicant is applying as a Motor Vehicle Wrecker.................................................................. 1es V No Applicant is applying as a Scrap Processor...............................................................................................OYes D( No If'yes'is checked,my signature below certifies that the environmental impact from this proposed land use for a Motor Vehicle Wrecker or Scrap Processor business appears insignificant,pursuant to Chapter 43.21 RCW,the state Environmental Policy,WAC 197-11-305,WAC 197-11-820, and WAC 197-11-800(14)(i). A completed State Environmental Policy Act(SEPA)checklist must be attached. Signature d Local Zoning orfiam rdle cPL..m Zoning O dal Efate of bignature INSPECTING OFFICER APPROVAL(for Hulk Hauler,Scrap Processor,and/or Wrecker applicants only) This section to be completed by the Washington State Patrol,or by the local Chief of Police(if business is located in a city with more than 5,000 population). Check either yes'or'no'for each option and sign. Applicant is applying as a Hulk Hauler................................................................................................WYes ❑ No Applicant is applying as a Scrap Processor......................................................................................❑Yes A No If yes' is checked, my signature below certifies that this Hulk Hauler or Scrap Processor applicant is located at the address shown in section 5 above and has suitable equipment for the safe and lawful transport of vehicle salvage on the public highways. The applicant has displayed with letters and numerals at least three inches high, painted or permanently affixed to each vehicle, the business name, complete address of place of business, and current business telephone number on all vehicles operated by the applicant on highways of this state and which are equipped for lifting or transporting vehicles or hulks. Applicant is applying as a Motor Vehicle Wrecker..................................................................... Yes �rNo If yes'is checked, my signature below certifies that this Motor Vehicle Wrecker applicant is located at the address shown in section 5 above, as defined by RCW 46.80.010, and has displayed with letters or numerals at least three inches high, painted or permanently affixed to each vehicle, the business name, city name of place of business, and current business telephone number on all vehicles operated by the applicant on highways of this state and which are equipped for lifting or transporting vehicles or hulks. Signature of Inspecting Officer Title of Inspectng Officer Date of Signature BLS-70p 183 VEHI CL E TRNSPTCSP ADD(R/12tl2)OR Page 2 d 2 SENDER: DELIVERYTHIS SECTION ON ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Dat of Deliv ry item 4 if Restricted Delivery is desired. ■ Print your name and address on the reverse so that we can return the card to you. C. SS /pature - ■ Attach this card to the back of the mailpiece, "1�( � Agent or on the front if space permits. """LL�� <�' h0 ,(zv Addressee 1. Article Addressed to: D. Is delivery address different from item 19 ❑ Yes If YES,enter delivery address below: ❑ No LIDO DILUCK 6130 28 AVE S SEATTLE 98108-3100 12332 50 00050 3. ice Type ertified Mail ❑ Express Mail t^ 6-5-6d Registered ❑ Return Receipt for Merchandise ❑ 12.33Z-t v-00 4Insured Mail ❑ C.O.D. . Restricted Delivery?(Extra Fee) p Yes 2. 1 7001 1940 0001 9392 5665 PS Form 3811,July 1999 Domestic Return Receipt 102595-99-M-1789 !l f /e TYPE MOBILE HO o% /C Permit No. 17953 No. Floors Sq Ftg 784 Owner MORGAN, Roger Tel Date 9-18-R5 Address P. 0, Box 524 Allyn Zip Contractor None Address Zip Legal Description Sam Thelers H & G Tr, #20 92-27-1 Direction to project site Golden Bell Mobile Home Park Plumbing _ Mechanical Sewer Wood Stove _ Fireplace Deck Garage Carport _ Basement Loft Other 7 �q�� `` 1986 14x56 2 bdrm, l233z � (/(/w--o TYPE MGBILE HOME Permit No. 18082 No. Floors der ss ZPIB,E0L, , 3S9 Ft g 980amS Tel -342 Date-Addre Box 721 1 8 Contractor Belfair Zip Leisure Homes of Auburn Address Legal Description Sam Thelers H & G. Tracts Tr120 Direction to project site Golden Bell Trailer Court 2- -1 Plumbing Mechanical Sewer Fireplace Deck_ Wood Stove Basement Garage Carport Loft Other 233a-3o -WD5o Shorelines: Plunbing: Setback: Mechanics : Special Interior: Conditions: FINAL: Mobile Home: Smoke Detector: Remarks: noting: Setback: Foundation Walls: Framing: PER,"'T Fireplace: R 11a Wood Stove: TYPE MOBILE HOP,1E Permit No. 25408 No. Floors Sq Ftg 924 Owner BREr YER. Kevin Te1432-3003 Date 4-4-90 Address 20010 SE 206th Maple Valley Zip Contractor Designer Ha es Address P 0 Box 98823 Tacana Zip Legal Description Sam Theler How & Gar. Trs. Tr 20 Direction to project site Hdy 3 to Roessel Rd to Golden Bell Mobile Ham Park um ing Mechanical Sewer Love Fireplace Deck image _port _ Basement Loft Other 1990 14x66 3 bdrm TYPE MOBILE HOME Permit No. 0443 No. Floors Sq Ftg 1680 Owner RAYMOND, Dean Te1377-6778 Date 9-23-86 Address 56-A Olding Rd Br m rton Zip Contractor Belfair Quality Homes Address NE 23840 Hwy 3 Belfair Lip Legal Description Sam Theler Home & Garden Tr. Tr 20 Direction to project site Golden Bell Mobile Home Park Plumbing Mechanicalewer oo tove Fireplace Deck 1 arage _port _ Basement _ Loft Other 1986 28x60 3 bdrm