HomeMy WebLinkAboutMFG Home - BLD Application - 3/1/2007 1890630 TLELM Pages: 2
Receipt 715083 03/05/2007 01 51 PM
Mason Colrn Eyy WR Roc Fee $33.00
PLICE a LEROY ERRLES
RETURN ADDRESS II 111111IIII11111 lit 111111111111111111111111111111111111111EIN
51-,P_1 pn Wa Qg�s�l
""'N°"'N MANUFACTURED HOME L•�L,,;w.,.�,,,,'°� TITLE ELIMINATION
KEnsinic APPLICATION TRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material facttsguilly ❑REMOVAL FROM REAL PROPERT
of a felony,end upon canvlcllon maybe punished by aline,Imprisonment,or both.(RCW 46.12.21dJ
MANUFACTUREDffOME
IPO/PI AIE NUMnE.n YEAR MAKE IFNGIIIAYIp Infr EE I VE/IIGLE KIENTIFICAMN NUMUER(VINI
1 (03 iC) G X O °ILI145 3 LPY\ U
LAND LEGAL DESCRIPTION ON PAGE
MANUFACTURED HOME WILL BE [-]AFFIXED ❑REMOVED nc,�^Lr�+jr�r rrAx�RcgL�ur�e �
IOI nLOCK� PLAT NAM oo!! dd SEC TIGVOW70WUNSHIPIRANGE
U r`l(\y
GRANTOR(S REGISTERE /LEGALOWNER(S) ADDITIONAL NAMESON PAGE
COUNrY NUMBER NUMBER OF REGISTERED OWNE RS NUMBER OF LEGAL OWNERS
NAM F nEGIs IEnED OWNER
N E OF A71TIONAL RE OI TERED O NE Z �—
AD`DRREEESSSS` bly STATE TIP CODE
NAME Or LFnAT OWNF1��S/��
NAME OF ADDITIONAL LEGAL OWNER
An7NM5q CITY STATE IIPCQO€
_GRANTEE
IIAME
I DO SOLE dNLY ATTEST U DER PENA TV OF PERJURY THA71/W AM/ RE T 1E REGISTERED OWN R S O T IS
VEHICLE AND THI5INFORMATION IS ACCUflATE;
Signatuleof Registered Owner and Tills.IF APPLICABLE
Sign;dureofArldlltonalRegisleredOwnerenn((ITTIIle IFAPPUCABLE
NOTARY UBVq!,!l ATION/CERTIFICATIONFORAEGISTEREDOWNER(S)SIGNATURE
, IOIVyasl�ilngl n JJ�n r-� Signed or site sled y
State of .W4s g y 1 /� before me on
KATHLEE 0L
CommteslonExpires Jy 4Y / or GIVEnroOWNER Slg'n/ "CoYonA E T
by .1_ .1 �f/ Li��a) SO,
t PRINT H—EE OF E01S1EREb OWNER PPI�ITEb NAME OF NOTARY
t County/oll)ca No.OR
Tllle AND: Doer No.O
DEALERSr1IP PO5111ON7AG T/NOTARY TT01e F, lretlOR Dale
TITLE COMPANY CERTIFICATION
I cerlily Ilm(Ilia legal descllpllon of the land and ownelshlp Is true and correct per the reel property records.
NAME(TYPED 09 PRINTEUI TITLE COMPANY I PHONE NUMBER
SIGMA I UnE 7 POSITION DATE
Finalize Oil application with a Licensing Ago III within 10 calendar days of the dale Tills Company Rapnsentalive signs.
BUILDING PERMIT OFFICE CERTIFICATION
I cerlily that: 'amanufaclured home has boon offlxadto the isa]props rtyasdoscdbed.
e building permil has been Issued Tor Ihls purpose and the aliachmen(wlll be Inspecled upon compielion.
NAM U On,SIN ME BLDG PERMIT OFFICE/P/10NE E Ctoo PERAMT F 1
00
IIO A IPOS1IION —'r DATE
—[ ✓�N 'IiI/ L 1U17077 IUi HOME APPL(1VbWIOR P�e 1 al "`