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Home My WebLink AboutPermit File BLD-2022-0358 4117 Oakes Avenue 1T Y 0 City of Anacortes Invoice/Permit#: BLD-2022-0358 G � 6 904 th Street 904 Applied date: 05/16/2022 P.Ox re Anacortes, WA 98221-0547 Issue date: 05/16/2022 <� Expire date: 05/16/2023 Job Address: 4117 OAKES AVE Permit Type: Mobile Home Real Property ANACORTES WA 98221-1126 Project: APN: Remarks: Title Elm ination for VIN#PHH3100R2114669AB, 60'X 27', new 2022 Palm Harbor Homes, plate#: 1827404118 Owner: WEST COAST INVESTORS Contractor: Address: 1613 S 10TH ST Address: MOUNT VERNON WA 98274 Phone: (360)610-6343 Phone: License#: General Information: Fees: Mobile Home Conversion Fee 25.00 Total Calculated: 25.00 Deposits/Receipts: 0.00 Total Due: 25.00 The issuance or granting of this permit shall not be construed to be a permit for,or approval of, any violation of this Code or any other ordinance or order of the City, of any state or federal law, or of any order, proclamation, guidance advice or decision of the Governor of this State.To the extent the issuance or granting of this permit is interpreted to allow construction activity during any period of time when such construction is prohibited or restricted by any state or federal law, or order, proclamation, guidance advice or decision of the Governor of this State, this permit shall not authorize such work and shall not be valid. The building official is authorized to prevent occupancy or use of a structure where in violation of this Code, any other City ordinances of this jurisdiction or any other ordinance or executive order of the City, or of any state or federal law, or of any order, proclamation,guidance advice or decision of the Governor. The building official is authorized to suspend or revoke this permit if it is determined to be issued in error or on the basis of incorrect, inaccurate or incomplete information, or in violation of any City ordinance, regulation or order, state or federal law, or any order, proclamation, guidance or decision of the Governor.This permit becomes null and void if work or construction authorized is not commenced within 180 days or if construction work is suspended or abandoned for a period of 180 days at any time after work is commenced. I have read and examined this application and know the same to be true and correct. /1 � 1 a SIGNATURE OF OWNER OR AUTHORIZED AGENT ISSUED BY RETURN RECORDED DOCUMENT TO: Jozef Mendoza 4117 Oakes Ave. Anacortes,WA 98221 620050270 EDEPARTMENT OF Manufactured Home ' ClLICENSING Application V Title Elimination For full instructions on completing this form, [:]Transfer in Location see Manufactured Home Application Instructions,form TD-420-730. ❑Removal from Real Property Manufactured Home Title purpose only(TPO)/Plate no. Year Make LengthAA/dth(feet) Vehicle identification no.(VIN) 182 440 1118 2022 PLMH 60 X 27 PHH310OR2114669AB Land Manufactured home will be Real property ✓❑Affixed ❑Removed Tax parcel no. P31679 Legal description on page Exhibit A Lot Block Plat name or Section/Township/Range Quarter/Quarter section Manufactured home physical location(Street address, City, State,ZIP code) Is location mobile home park? 4117 Oakes Ave., Anacortes, WA 98221 ❑Yes 0 No Grantors Re i wners —Additional names on page County no. No.registered owners No.legal owners I Grantee name(if applicable) 1 1 Name of registered owner Washington driver license or UBI no. Jozef Mendoca V\)►)L,y 1 &ZJD-ie� Name of additional registered owner Ownership—Joint tenants Washington driver license or UBI no. none w/right of survivorship JTWROS ❑Yes ❑No Address(Address, City, State,ZIP code) 4117 Oakes Ave., Anacortes,WA 98221 Name of legal owner Washington driver license or UBI no. Home Pointe Financial Corporation Name of additional legal owner Washington driver license or UBI no. none Address (Address, City State,ZIP code) 14255 49th St. North, Bldg#1, Clearwater, FL 33762 l declare under penalty of perjury under the law of Washington that I am/we are the registered owners of this manufactured home and the foregoing information is true and correct. M+. Vernc,,► x Date and�, 1Qq f f r—sig nty)signed stered'aw snature Title,if signing for a business IA Da ig� ai ituigr lik/,signed Registered owner signature Titl ,if signing for a business Natarizall i,{'c4yi I State of County of v 49186 i Signed or attested before me on U s2 n ( N 'l4,a AJ 8%`G — O by `�DZ� Mgt I 1 c�—CA by Z 4 5 //// �0 �q19 Print�gE te�red owner na eynt red+ eked owner na 1,11 OF WASN� �� Notary tinted or stamped met Notar ignatur IIIIIII\\�� and C" I`�r Title Dealer/county office number or notary expiration TD-420-729(R/10/20)WA Page 1 of 3 Continued on next page Manufactured home TPO/Plate or Vehicle Identification number(VIN) 1827404118 Title Company Certification PRINT or TYPE Name of person signing Title company name Position (Area code)Phone number I declare that the legal description of the land and ownership is true and correct according to the real property records. X Signature Date Building Permit Office Certification I ce 'y that tie 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. PRINT or TYPE Name of p rson si ning Building per mit office Building permit number Position (Area code)Phone number �c` c r 2q 523 X 5 06 2 6 Z-2- Sig re v I Dat Signature of Legal Owner(s) Signature of legal owner indicates consent for Elimination of Title or Removal from real property. X Legal owner signature Title, if signing for a business X Legal owner signature Title, if signing for a business Notarization/Certification State of County of Signed or attested before me on — (Seal or stamp) by by Print legal owner name Print legal owner name Notary printed or stamped name ktary signature and JJ�� Title Dealer/county office number or notary expiration El Land Description Legal description of land See Exhibit"A" hereto attached and made a part hereof. TD-420-729(R/10/20)WA Page 2 of 3 Continued on next page Manufactured home TPO/Plate or Vehicle Identification number(VIN) 1827404118 [I Dealer Report of Sale-Selling dealer complete this section PRINT or TYPE Dealer name Washington dealer no. Date of sale Purchase price Tax jurisdiction/Tax rate ❑Sales Tax Exempt—Sale to a Certified Tribal member on the reservation (attach notarized statement of delivery). /declare under penalty of perjury under the law of Washington that this information is correct. The manufactured home is clear of encumbrances except as shown.Any required sales tax has been collected. X Date and place(city or county)signed Dealer authorized signature County Auditor/Agent Licensing Office Approval (not for use by subagents) PRINT or TYPE Name County office/VFS operator no. l declare that the above application appears to be completed correctly, and the applicant has sufficient documentation to proceed with the recording of this form. X Signature Date Title Fees Filing fee Application Mobile home fee Elimination fee Use tax Subagent fees Total fees and tax 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, imprisonment, or both. RCW 46.12.750 TD-420-729(R/10/20)WA Page 3 of 3