1996, 12-10 Permit App: 96010683 MHPROJECT NUMBER= 96010683 APPLICATION DATE= 12/10/96 PAGE= 01
****** THIS IS NOT A PERMIT ******
PENALTIES WILL BE ASSESSED FOR COMMENCING WORK WITHOUT A PERMIT
SITE STREET= 19014 E MARLIN DR PARCEL#= 55082.0613
ADDRESS= OTIS ORCHARDS WA 99027
PERMIT USE= RELOCATE DOUBLE WIDE MOBILE
PLAT#= 000145 PLAT NAME= BARKER ROAD MOBILE HOMES ADD.
BLOCK= 5 LOT= 13 ZONE= UR -7 DIST#= G
AREA= F/A= F WIDTH= 75 DEPTH= 120 R/W= 60
# OF BLDGS= 1 # DWELLINGS= 1 WATER DIST =
OWNER= RUDOLPH, CINDY
STREET= 19014 E MARLIN DR
ADDRESS= OTIS ORCHARDS WA 99027
CONTACT NAME= CINDY RUDOLPH
PHONE= 509 927 1727
PHONE NUMBER= 509 927 1727
BUILDING SETBACKS: FRONT= 20 LEFT= 5 RIGHT= 5 REAR= 20
****************************** REVIEW INFORMATION ******************+**********
DEPARTMENT REVIEW REQUIREMENT
BUILDING SETBACK REVIEW REQUIRED
COMMENTS:
HEALTHDIST NEW OR ADDITIONAL WASTE WATER
COMMENTS:
oficie 4.104,
?zeta --
PLANNING INADEQUATE FRONT YARD SETBACK
COMMENTS:
0j re ---11-9b
/240h
****************************** MOBILE HOME PERMIT *****************************
CONTRACTOR= OWNER PHONE=
YR/MAKE= 1978 GOLDEN STATE MODEL=
SERIAL#= GF9Q56336 WIDTH= 24 LENGTH= 68 HEIGHT= 10
ITEM DESCRIPTION
QUANTITY FEE AMOUNT
INSPECTION FEE 2 100.00
STATE SURCHARGE Y 4.50
COUNTY SURCHARGE Y 22.00
PERMIT TYPE
FEE AMOUNT AMOUNT PAID AMOUNT -OWING
PROJECT NUMBER= 96010683 APPLICATION
PERMIT TYPE
DATE= 12/10/96 PAGE= 02
FEE AMOUNT AMOUNT PAID AMOUNT OWING
MANUFACTURED HM 126.50 .00 126.50
126.50
PROCESSED BY: JOHN LARSON
PRINTED BY: JOHN LARSON
.00 126.50
******************************** THANK YOU ************************************
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L01 ST TE OF WASHINGTON
MANUFACTURED HOME
KERNING G APPLICATION
RECORDER'S CLOCK
FILED AT THE REQUEST OF:
NAME
ADDRESS
Please check one
TITLE ELIMINATION (Complete all but section 3, below)
TRANSFER IN LOCATION (Complete ALL sections below)
REMOVAL FROM REAL PROPERTY (Complete all but section 4, below)
;l' MANUFACTURED HOME
TPQ/PLATE NUMBER
'- t 336
YEAR
rt7�
MAK�A_ ,/. f,,.�
/,-/5U:'.rr � _
WIDTH/LENGTH
VEHICLE IDENTIFICATION NUMBER (VIN)
Cal= 9 s6, 3 46
NA LAND
Attach a copy of the legal description land. It be from Coun
of your can
Assessor's office or it may be typed or printed on an Additional
Manufactured home will be AFFIXED
obtained your y
Attachment Form (TD -420-732).5
REMOVED
PROPERTY TAX PARCEL NUMBER
,.
5U r . 06/•.7
xj
el TITLE COMPANY CERTIFICATION .
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME
TITLE COMPANY/PHONE NUMBER
SIGNATURE
X
DATE
Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs.
BUILDING PERMIT OFFICE CERTIFICATION
I c fy that the manufactured home has been affixed to the real property as described, or a building
p rmit has bee ;i ued for this purpose and the attachment will be inspected upon completion.
BLDG PERMIT I
4� t /lig/�j
N ME �
id
SIGNATU OFOKANE COANTY
X DIVISION OF BUILDING AND PLANNING
BLDG PE IT pppFFICEPMONE
� / ��
/rC,(//,%,-,o175
l �O
DATE Cl
4/006
OWNER INFORMATION
FEES
CO NTY # INC UNINC
1 ❑
# REGISTERED OWNERS
# LEGAL OWNERS
Provide the Washington Drivers License or I.D.
card number (PIC) for each owner:
FILING FEE
Iy+lyL NAME OE FIRST OWNER
Ag'o rt //�/' /
'µIII�f (/1 //-��
Roma
APPLICATION
+4V,` NAME OF SECOND ER ///
j>S
(E
MOBILE HOME FEES
fi Ei
iii ADDRESS OF OWNER /n �n/
'S,P..
ii
if is business,
ELIMINATION
,. E T' /
/ 90/q ti /l'7CE' ee t 1(I
--OR-- the owner a
''`D.=.1 CITY
/� I2 , / Z- 4G�
svh�, CJS (—(/J (.(�
STATE
tt
ZIP CODE
nD `�
y
provide the Unified Business
Identifier (URI), found on the
business Registration & Licenses
USE TAX
NAME OF FIRST LEGAL OWNER' /
Jf
t.' CNG Ew HALO uR�a 14elio, K.,'ADDR
Document.
SUB -AGENT FEES
.'. MAILING ADDRESS OF FI LEGAL OWNER
N' -y
. H J, z 9'— f
More than two owners or one
lienholder7 Please use attachment
TOTAL FEES & TAX
..1 , CITY it
ZIP CODE
form(s) #TD -420-732.
$
"D}' aii-c-Q
E
�STATE
[eJit
9'2002 -9'2002 -DEALER'S
REPORT OF SALE
¢
p\ 'SIG TORE OF LEGALOWNER INDICATES CONSENT FOR ELIMINATION OF TITLE/REMOVAL
}'( FROM REAL PROPERTY. X
I certify that this information is correct. The vehicle is clear
of encumbrances except as shown.
Anyone who knowingly makes a false statement of a material fact is guilty of a felony, and
upon conviction may be punished by a fine o/ up to $5.000 and/or 10 years imprisonment
46.12.210) 1 DO SOLEMNLY
WA DLR NO.
DATE OF SALE
PURCHASE PRICE
$
(RCW ATTEST UNDER PENALTY OF PERJURY LAW
THAT UWE ARE THE REGISTERED OWNERS OF THIS VEHICLE AND THIS INFORMA-
TION IS ACCURATE: Owner Slgneture(s) & TIUe(s):
X
DEALER NAME
TAX JURISDICTION/TAX RATE
DEALERS AUTHORIZED SIGNATURE
X
USE TAX EXEMPT Sale to a Certified Tribal member on
the reservation (attach notarized statement of delivery)
X
NOTARY OR LICENSE AGENT &NUMBER
X
SUBSCRIBED TO AND SWORN BEFORE ME THIS
DAY OF 19
Residing in (County)
6 COUNTY AUDITOR/AGENT LICENSING OFFICE APPROVAL: (Not for use by Sub -Agents)
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
SIGNATURE
X
OFFICENFS OPERATOR NUMBER
DATE
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