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HomeMy WebLinkAboutMFG Home - BLD Application - 8/11/2006 RETURN ADDRESS Lbw itaDiajow Po a A U)A % cg LJS7ATC OF WAf7HINGTON MANUFACTURED HOME ' I'=aYln'�'IUJ � APPLICATION HTITLE ELIMINATION icEnsinc ©TRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact is guilty EIREMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) MANUFACTURED HOME T1 0/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) o065574 11993 DARTM � 60 X 28 1113065 LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE ■ AFFIXED REAL PROPERTY TAX PARCEL NUMBER U � REMOVED 3247 54 00097 C1c'1�' LOT BLOCK PLAT NAME OR SECTION/rOWNSHIP/RANGE QUARTER/QUARTER SECTION 97 Lake Limerick No. 5 El GRANTOR(S) REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE OF LEGAL OWNERS COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER 30-09075 2 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER SHIRLEY J.NELSON NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER RICHARD M. DEMUT ADDRESS CITY STATE ZIP CODE 681 E. OLDE LYME ROAD SHELTON WA S NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER TAYLOR,BEAN WHITAKER NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE 1309 114TH AVE. se#101 BELLVUE WA 98004 GRANTEE NAME SHIRLEY J.NELSON AND RICHARD M. DEMUT I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I 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 ot&tRUhW istered Owner and Title, IF APPLICABLE /Y NOT s ��� NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE '6.tate of Washington Signed or attested Count y m/,�� r 'y of ► ' `fibefore me on ? `Ib Signature Iz. ' —Z P NT NAME OE GISTERED OWNER NOTMOOR AGENT i�,'���'�✓rw. Lam,;.•'�C,� PRINT NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY (/ Z/'14 WASH,����� � Title /V�)�i�i� AND: CountYDeaee No.OR r No.OR��� dt1 DEALERSHIP POSITION/AG NT/NOTARY Notary Expiration Date 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. Ej BUILDING PERMIT OFFICE CERTIFICATION I certify that: L.'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( PED OR PRINTED) ^ BLDG PERMIT OFFICE/PHONE# .��^-�/: BLDG PERMIT# SIGNAT /PQS1331ON DATE TD-420-729 UFHOMEAPPL(R/2/0 )OR(W)PageIof2 BUILDING PERMIT PLOT PLAN MASON COUNTY DEPARTMENT of GENERAL SERVICES P.O. Box 186 SHELTON, WASHINGTON 98584 427-9670 DATE ISSUED PERMIT NO. NAME AIL ADDRESS I &STATE ZIP PHONE OWNER i:. Anderson 200 Tacoma St . Grants Pass , Or. 97526 503-476-618 DIRECTIONS Gut to Lake Mason Rd . Turn right to Lake Limerick—Go straight TO JOB SITE ahead at stop sign--tilde Lyme Rd. at bottom of hill . PARCEL LEGAL NUMBER 132127-54_000 'bESCR Lake Limerick--Liar. 5 Lot 97 Indicate below. O Property lines and dimensions. O Easements and roads. O Septic, drainfield and reserve area, or sewer. O Septic tank and drainfield setback distances from foundations. O Location of proposed construction on property. O Building & septic system setback distances from all property lines& easements. Indicate North O Well and water line. In Circle O Saltwater, lakes, rivers, streams, wetlands, drainage. O Attach copy of septic system "as built' or septic permit approval O Indicate topography profile of property and structure on reverse side. 1 I I � I i I/we certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without first obtaining approval. SIGNATURE OF OWNER(S)OR AUTHORIZED REPRESENTATIVE DO NOT WRITE BELOW THIS LINE APPROVED DISTRICT ASLNnTFr) nATG Ilh TOPOGRAPHY PROFILE OF PROPERTY AND LOCATION OF STRUCTURE Y J C I c o 4-,ID _ P fl y Y CM ed _ ti "19IP cif V X�XS -e ll. o n 1 -9 01, �t y I � y y�// 'a•"tit •.� ti /- 4 4 F�c e/d nod