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Home My WebLink AboutBLD2011-00155 • •- CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 (800) 831-2678 Al Scalf, Building Official PERMIT #: BLD11-00155 SITE ADDRESS: 4042 HASTINGS AVE W Issue Date: 08/8/2011 PORT TOWNSEND, 98368 Final Date: 2/13/2012 APPLICANT: ROBERT E LUNDGREN JR PHONE: 714-824-9415 NANCY L LUNDGREN 12432 BAJA PANORAMA SANTA ANA CA 92705-1375 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001072005 Section: 7 Township: 30 N Range: 01 W PROJECT DESCRIPTION: NEW M/H W/A/G 250 GAL PROP TANK - SER# PH2O-10305AB&C. THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes (o THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON2/13/2012 I:\F_BLD_Occu pancy.rpt 10/29/19 MANUFACTURED/MOBILE HOME INSTALLATION PERMIT JeffersIrCounty Department of Community .velopment 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD11-00155 Received Date: 6/20/2011 SITE ADDRESS: 4042 HASTINGS AVE W Issue Date: 8/8/2011 PORT TOWNSEND, 98368 APPLICANT: ROBERT E LUNDGREN JR NANCY L LUNDGREN 12432 BAJA PANORAMA SANTA ANA CA 92705-1375 SUBDIVISION: Block: Lot: PARCEL#: 001072005 Section: 7 Township: 30 N Range: 01 W CONTRACTOR/ SITE SERVICES LLC PHONE: 360-542-8301 DEALER 1500 E COLLEGE WAY STE A-289 MT VERNON WA 98373 360-854-0536 Contractor's License SITESSL945CZ Expires 2/9/2012 PROJECT DESCRIPTION: NEW M/H W/A/G 200 GAL PROP TANK MAKE: PALM HARBOR YEAR: 2012 SIZE: 70X40 To schedule inspections, call (360)379-4455 no later than 7:00 AM the day of the inspection. Requests received after 7:00 AM will not be scheduled for that day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks 1r/�/.v Erosion Control /' MH Foundation A/i3(2 Blocking&Tie Down ,0_13 Skirting&Ventilation '- Gas Line: Exterior ... ., Propane Tank �'j 1Z- J� Pressure Test Drywell/Alt Drainage Address Posted 1/3//01.- Water Meter Inspection Miscellaneous Stormwater-SPLASH BLOCKS WITH 50 FEET OF VEGETATED FLOWPA .)( S' i cf) . r1at 4 Mt, 1 ) 1 c r FINAL INSPECTION )//3 4 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY-SEE REVERSE BUILDING PERMIT APPLICATI MLA11-00111 Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD11-00155 Received Date: 6/20/2011 SITE ADDRESS: HASTINGS AVE W PORT TOWNSEND, 98368 OWNER: ROBERT E LUNDGREN JR PHONE: 714-824-9415 NANCY L LUNDGREN 12432 BAJA PANORAMA SANTA ANA CA 92705-1375 SUBDIVISION: Block: Lot: PARCEL NUMBER: 001072005 Section: 7 Township: 30 N Range: 01 W CONTRACTOR: SITE SERVICES LLC PHONE: 360-542-8301 1500 E COLLEGE WAY STE A-289 MT VERNON WA 98373 Contractor's License SITESSL945CZ Expires 2/9/2012 REPRESENTATIVE: SITE SERVICES LLC PHONE: 360-542-8301 JOHN LEE 360-854-0536 1500 E COLLEGE WAY STE A-289 PROJECT DESCRIPTIOr NEW M/H W/A/G 200 GAL PROP TANK TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 2,800 CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: PRO OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: 1PWELL BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 4 Pro Total: 4 Routing Date: Type Amount Paid Bv: ate: Receipt: Approved/Dte Manufactured Homes $213.00 LYK 06/20/11 123605 APPROVED, Add. Manufactured Home $37.00 LYK 06/20/11 123605 Potable Water Application $62.00 LYK 06/20/11 123605 AUG % 2011 Propane Tanks/Stoves $142.00 LYK 06/20/11 123605 Jefferson County Planning; Total: $454.00 & Building Department • • SPECIAL CONDITIONS CASE # BLD11-00155 1.) Surface drainage, roof run-off, splash blocks, etc. must be directed away from ALL septic components. 2.) The project is located within WRIA 17 and thus is subject to compliance with the WA State Department of Ecology In-Stream Flow Rule for that region. The parcel is located within the quimper sub-basin in a designated Coastal Management Area; as such, state regulations require the following: 1. INSTALLATION OF A WATER METER, MEETING DEPARTMENT OF ECOLOGY SPECIFICATIONS, IS REQUIRED FOR ALL NEW USES THROUGHOUT THE WATERSHED. (WAC 173-517-180). BROCHURES WITH SPECIFICATIONS ARE ENCLOSED WITH THE PERMIT. Refer to enclosed documents for more INFORMATION; see Ecology web site at http://www.ecy.wa.gov/programs/wr/instream-flows/quilsnowbasin.html or contact Ecology at 360-407-6300. 3.) SPLASH BLOCKS MAY BE USED FOR DOWNSPOUTS DISCHARGING TO A VEGETATED FLOWPATH AT LEAST 50 FEET IN LENGTH AS MEASURED FROM THE DOWNSPOUT TO THE DOWNSTREAM PROPERTY LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT OF ALL DISPERSION SYSTEMS MUST BE DOWNGRADIENT OF THE DRAINFIELD. 4.) The road approach permit RAP11-00030 must be inspected and finaled by the Jefferson County Department of Public Works prior to the final inspection/certificate of occupancy of this residence. Contact Terry Duff, Department of Public Works at 360-385-9159 for the final road approach inspection. 5.) The application was reviewed by the Jefferson County Department of Community Development staff on 8-3-2011 for the potential presence of Environmentally Sensitive Areas (ESAs) under the provisions of the Unified Development Code (UDC). After an initial Geographic Information Systems mapping review and an investigative site inspection, the following ESAs were confirmed to be present on the subject property: Susceptible Aquifer Recharge Area (SUSC). 6.) Aquifer Recharge Areas in Jefferson County are characterized by porous geological formations that allow percolation of the surface water into the soils and the underlying zone of saturation. Aquifers are geologic formations that contain sufficient saturated permeable material to yield significant quantities of water to wells and springs. Aquifers serve as the source of drinking water within most of the rural portions of Jefferson County. 7.) Susceptible Aquifer Recharge Areas are those with geologic and hydrologic conditions that promote rapid infiltration of recharge waters to groundwater aquifers. 8.) If your real property is within five hundred (500)feet of real property within an area designated as Mineral Resource Land (MRL), you may be subject to inconveniences or discomforts arising from such operations, including but not limited to noise, tree removal, odors, fumes, dust, smoke, the operation of machinery, and the storage and disposal of aggregate products. One or more of the inconveniences described may occur as a result of extraction and processing operations which are in conformance with exiting laws and regulations. Jefferson County has determined that the use of certain real properties for mineral resource extraction and processing activities is necessary to ensure resource availability in the County. The County will not consider to be a nuisance those inconveniences or discomforts arising from extraction and processing operations, if such operations are consistent with commonly accepted best management practices and comply with local, state, and federal laws. 9.) The applicant is proposing to create or add 4,900 square feet of impervious surface and 6,000 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require your proposal comply with Minimum Requirement#2 (Construction Stormwater Pollution Prevention) of the Department of Ecology Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 10.) The project shall comply with Clktruction Stormwater Pollution Prevention*PP) Elements#1 through#12 of the Department of Ecology's Stormwater Management Manual for Western Washington to control stormwater, erosion and sediment during construction. BMPs shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 11.) A Stormwater Site Plan has been submitted and approved by the Department of Community Development. Once the subject permit has been issued the applicant shall fully implement the provisions of the submitted plan and contact the Jefferson County Department of Community Development to arrange a schedule to inspect the property for plan compliance. A Certificate of Occupancy will not be issued until the Department verifies plan compliance. No clearing for roadways or utilities shall occur on the project site until clearing necessary for the installation of temporary sedimentation and erosion control measures have been completed. 12.) Jefferson County determined that this proposal is categorically exempt from review under the State Environmental Policy Act(SEPA) pursuant to WAC 197-11-800(1)(b)(i). 13.) This approval is for a Manufactured Home only. Any future permits on this site are subject to review for consistency with applicable codes and ordinances and does not preclude review and conditions which may be placed on future permits. 14.) The parcel has been designated as RR 1:10 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 15.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 16.) Not more than 2 unlicensed vehicles shall be stored on any lot unless totally screened from view of neighboring dwellings and rights-of-way. Such screening shall meet all applicable performance and development standards specific to the district in which the storage is kept, and shall be in keeping with the character of the area. Screening shall meet the requirements of Chapter 18.30 JCC. Outdoor storage of 3 or more junk motor vehicles is prohibited except in those districts where specified as an automobile wrecking yard or junk(or salvage) yard and allowed as a permitted use in Table 3-1 or Chapter 18.18 JCC, and such storage shall meet the requirements of JCC 18.20.100, Automobile wrecking yards and junk (or salvage) yards. In no case, shall any such junk motor vehicles be stored in a critical area. 17.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 18.) The building height is not to exceed 35 feet. 19.) Hasting Avenue W setback is 20 ft, side and rear setbacks should be no less than 5 ft. If an environmentally senstive area (ESA) if present, then the more restrictive setback shall apply. 20.) Exterior lighting for residential uses shall not exceed twenty feet(20') in height from the finished grade, excepting when such lighting is an integral part of a building or structure. Ground level lighting is encouraged. 21.) Lighting fixtures shall be designed and hooded to prevent the light source from being directly visible from outside the boundaries of the property. The intensity or brightness of all lighting, during construction and after project completion shall not adversely affect the use of surrounding properties or adjoining rights-of-way. 22.) Hasting Ave W (C691008_) is a County road. A road approach (RAP011-00030)was approved on 8-3-2011 and an address of 4042 Hastings Ave W has been assigned to the parcel. 23.) A septic permit(SEP09-00052)was approved on 8-7-2009 for a capacity of 900 gallons per day. USR permit(USR 11-00017 was applied for on 7-6-2011 and finaled on 7-6-2011. 24.) The site plan as submitted with the New Manufactured Home application on June 20, 2011 has been reviewed for consistency under the UDC, and has been approved by Jefferson County Department of Community Development. Any modifications, changes, and/or additions to the stamped, approved site plan dated June 20, 2011 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 25.) NOTICE: This permit does not use the proponent from complying with oil local, state, and federal ordinances, regulations, or statutes applicable to the proposed development, but consistent with RCW 90.58. Development pursuant to this permit shall be undertaken subject to the applicable policies and performance standards of the Jefferson County Shoreline Management Master Program and the Jefferson County Unified Development Code. If during excavation or development of the site an area of potential archaeological significance is uncovered, all activity in the immediate area shall be halted, and the Administrator shall be notified at once. The Federal Endangered Species Act rules to protect threatened Chinook and Summer-run Chum salmon became effective on January 8, 2001. Bull trout have been listed as threatened since early 2000. Under the ESA, any person may bring lawsuit against any individual or agency that"takes" listed species (defined as causing harm, harassing, or damaging habitat for the listed species). In addition, the National Marine Fisheries Service can levy penalties. All areas in Jefferson County are included as "critical habitat"for a listed species. Development of property along any marine shoreline, freshwater shoreline, or floodplains could harm habitat if protective measures are not taken. To minimize the potential to damage habitat, all property owners developing adjacent to marine shoreline, freshwater shoreline, or floodplains are advised to do the following: -All development activities should avoid unstable slopes, wetlands, and forested areas near surface waters - Remove minimal vegetation for site development, especially large trees -Allow trees that have fallen into surface waters to remain there - Infiltrate stormwater from buildings and driveways onsite through drywells rather than discharging directly into surface waters or roadside ditches The Federal Bald and Golden Eagle Protection Act requires landowners within 660 feet (1/8th of a mile) of an eagle nest to consult with the US Fish and Wildlife Service. This Eagle Act prohibits anyone from "taking" bald eagles. This federal law defines the term "take" and describes the possible legal consequences when a "take" occurs. Among other actions, "take" includes a disturbance of bald eagles or their habitat. Under federal law a permit may still be required for activities that impact bald eagles or their habitat. Contact the US Fish and Wildlife Service (http://www.fws.gov/pacific/eagle/) to learn more about how this law affects your project. Any individual, group, or agency can bring suit for a listed species "taking", even if you are in compliance with Jefferson County development codes. The risk of a lawsuit against you can be reduced by consulting with a professional fisheries habitat biologist, and following the recommendations for site development provided by the biologist. For more information, contact the National Marine Fisheries Service in Seattle, or the U.S. Fish and Wildlife Service. • • .�ON eOd JEFFERSON COUNTY 4 k DEPARTMENT OF COMMUNITY DEVELOPMENT 4. 621 Sheridan Street• Port Townsend•Washington 98368 $ 360/379-4450- 360/379-4451 Fax � .SO www.co.jefferson.wa.us/commdevelopment • Master Permit Application MLA: 1 - 111 Project Description(include separate sheets as necessary):/ has-7,f.� .5-�, 47/`11 •-, �G�ji` -r l+G„'7l c.Q Tax Parcel Number. OO/C,-7aob S— Property Size: Y l��m,c C.. r (acres/square feet) Site Address and/or Directions to Property: ne y f:S !cc ,c,Pe"71,-1 frC G2 ' 4,-4 /_-m-i l f& Q n -4) c,-e)S5-cj7.-xu ite'finrfd Ave rJ. Property Owner(s)of Record: Ie, f /L, ,/9r. _ Telephone: 77 py—fy"- Fax: email: Mailing Address: t? ,a7,//;s.. Aaaa,1 nR..f -Sa �,flri Chi ` 27o c•- Applicant/Agent(if different fr6m owner):34a le ' Sn e ,��-c J2...e L .,. c.„;"„ ,r,,- Telephone:36o —t /— !34 y Fax: 0 ajacef-a S..n. email: ',Aar 65/Yr ear-v res.a L r.lrS Mailing Address: Aron E: l'd,/l,- : ' r? - f tcy,—.7L tic.a.-ic<�r t.P 1 C9 .2 7.? What kind of Permit?(Check each box that applies O Lot or Road Segregation ❑building ❑Critical Areas Stewardship Plan 0 Demolition Permit ❑Variance(Minor,Maj. . [a-Sin fe Family 'easonable Economic Use) 9 ❑Garage Attached/Detached 0 Conditional Use fC(a) ►, Dalelanufactured Home .❑ Modular • - D Discretionary or " o .��• ❑ Commercial* �,,• o�� ❑ Change of Use D Special Use(FcSen6• " . ❑ Address 0 Road ApproachEl Boundary Line Adjus 0 Short Plat" i ❑Home Business 0 Cottage Industry ❑Binding Site Plan"* JUN 2 0 2011 ❑Propane ❑Lon Plat"` ' ❑Sign - - - g ❑Allowed"Yes'Use Consistency Analysis 0 Planned Rural Resi• ntia o me/It(PRRD)/Amend d' 0 Allowed *Y s'Use onst 0 Plat Vacation/Altera .ni JEFFER ON 0 Site Plan 0 Shoreline Master Prl.rdrrD�et . 'gag: .t -3 :ins•,• Approval Advance Determination(SPAAD)* 0 Shoreline Management u•s . is q yl;!• P ENT❑Temporary Use ❑Shoreline Management Variance • ❑Wireless Telecommunication• ❑Comprehensive Plan/UDC/Land Use District Map Amendment 0 Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment 'May require a Pre-Application Conference 0 Tree Vegetation Request "Requires a Pro-Application Conference Please identify any other local,state or federal permits required for this proposal,if known: herebydesignate DESIGNATION OF AGENT I g ee -j ��✓- to act as my:,ent in matters relating to this ap lication orpermit(s). OWNER SIGNATURE ' 1 arta �'+ I� 8Date: C ' L. By signing this application form,the owner/agent attests th t inform. 9. provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any - sion of a : erial fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,Indemnify and hold harmless Jefferson County against alt liabilities,judgments,court costs,reasonable attorney's fees and expenses which may In any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. i further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any required later inspections. Staffs access and right oµf entry will be assumed unless the applicant informs the Coun in writing at the time of the applica' h wa : dor no- Signature: at / J '�` Data: Z l The action or actions Applicant will undertak a res of the issuance of this endangered Speclee and Could lead to&potential"take'of an endangered species asttho a t may erms are defined In the federaatively Impact upon one or more lawtkneown pass the' 'Endangered Species Act'or'ESA.'Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you are in compliance with the Jefferson County development code.The Applicant acknowledges that he,she or it holds Individual and non-transferab lies n ' II: dh tin o and cgmplyin wi Ems.. The Signature: //r� Applicant has read this clinch' r signs and dates it below. g L G' t✓ alal Garr Cate: to 7' l G:1PamitCenur\tt##FORhfS t##\DRD FORMS\Current ID Fornu\Muir!Pormit Application 5-29-08.doc • • • BUILDER STATEMENT • • The signer of this statement does hereby certify that they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be assuming the responsibility of the General Contractor for the proposed project. • Signature: Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: • Si/e sSe,--,1/�_;/ 1 e L (3 E 6/- v36 y (34)SYY--c 5�, 6 MAILING ADDRESS: rcU0 E C.)//c�e �.'J S$ AgEMAIL: v e• 5- S�i-r//C[�LLG : 44-1 CONTRACTOR'S LICENSE "� WAIN NUMBER: 5./TC55-'.9wc-c.-2_ NUMBER Le .-- i..7'H 0 ,.,P0 CA) ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: E ' New 2-Wood Existing: 0 Sewer O Addition 0 Steel Proposed: .3 Bank 0 Community System ❑ Alteration/Remodel 0 Concrete Total: 3 Height: it-individual System O Repair 0 Masonry SEP Permit# cPO9 coon O Demolition 0 Other: Bedrooms: Water Supply: Existing: Setback: ptrivate well ❑ Two Party Ty of Heat: Proposed: Y 0 Public Total: 41 Name of System:. If this Is a Commercial Project you must answer the following:" Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed ' IBC Occupancy: IBC Type of construction: Will ycju haverrAo ryii ._.. +fe . if this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply r , _ �, lam. ---.7) . 1 Underground Tank i AAbove ground Tank) Size of Propane Tank: ,40]a ' 1 Heat Stove I Cook Stove 1 Woodstove 1.Fireplace Insert 1 Hot Water Tank I j Pellet Stove 1 Other Is this appliance being installed in a Manufactured I Mobile Home? Yes / No 11 i i!I 1 a U N 2 0When applying for a permit to install a propane tank you must also submit a site Dian sh owing all of the building l property lines, tank location and size,distances from the propane tank to all property lines,buildings-a ponents, including the reserve area. 1E14ERSOnN COUVT1 Square Footage Current Proposed ffice us Oh ;. „3,_. Apunt s, 0?siott:, t3- 3 1 Main Floor Heated �' �.-� .} � Hex�$ EH Bid App Review: a s -j _ q;3' -2nd Floor Heated . ,r , Consistency Review: j 12� Other Heated r< Base fee: �y�m tis Mezzanine • ; <� 5: r ion. ,Q� Heated Basement t.it , fi Plan Check fee: r Unheated Basement . " , S �� VA :S . Other Unheated - ,( v F t Wa r Review fee: r��j� .. - ' l /L/ Garage/Carport � 'Y, SUBTOTAL Decks 4 . )t x a 911/Rd Approach fee: cea r Other ' °. TOTAL $ Cj. csitiRgy ,r Receipt Number 1� a k .1aa StM" Cash/Check Number 2Jl'' ESTIMATED COST(REQUIRED) Date: ` j ,. ) •Fair market value of all labor and materials foundation to finish Jr ' 5-4 e pa Initials: — JACK WESTERMAN III • Jefferson Conn•ourthouse ASSESSOR PO Box 1220, Port Townsend, WA 98368 (360) 385.9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: W r 6 fi L ADDRESS: /cA. Y3 . 3<< � , _, S�, I4-11 cl 9- 'os-- PRONE NO. 7/s/ - cf02y - 9Y(S- The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous i t• _ • +aid location of a mobile home. This will help our office dete - ftie$ilyeA home is already on the tax rolls in Jefferson County or if it i _ • • I o a 1. ity from another area. 1)MOBILE HOME DATA: J U N 2 0 2011 JEFFERSONSS11/ (A) MAKE i1,f, , /1<fY 9PT44 SEC ' = 9 e (C)YEAR v2O/ (D) LENGTH 7 d (E) WIDTH y 0 (F) SERIAL # 7 jamO (G) YOUR PURCHASE PRICE (Do not include sales tax) /5'0("00 PURCHASE DATE e-/Qo(� 2) PREVIOUS OWNER/LOCATION OF MOBILE HOME: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE Pk-/ir-, hiie-r6tY ADDRESS r6065 St" - • rci/e wff- `k4F-2- (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR?Yes ( If Yes, Previous address of mobile. If No, What County was Mobile assessed in last year. /./1/ — /'e--J ku--)-pv- 3)WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN MOBILE HOME PARK? Yes To (B)IF LOCATED IN MOBILE HOME PARK: NAME at ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME PARK: NAME OF LAND OWNER: Ro LOCATION ADDRESS 1161- 7 -u /4Lj 1--3) ./t9er777/47t,S-t c REAL PROPERTY PARCEL #/DESCRIPTION OQ/O7 CO 6�n- - � Signature of applicant THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician • • _._...., .3. ,.-• : . oi , ip, I J 3: 11 , 6, ;.,.. [lc v 1 1 MOM .1 i i as I , . , 0 - tvaL S•R 1 r-,--- ----il ... ) - us '..J ....___ - ea_ c) t 1 I 1 -U 14 2 i C=;# ill C.) c..1 . ,...., 1.......,„„,„,..„ i ,..... , IN 11111=46,"=V111111 al 111111MWEIM ii , IIta_ — E=51 1 1 r.= .5 11111111M ' MN I (,„,. I Li ......11111M11111111.11 .4_,,s 11 I •;;P 1' i I , i IL I' •,, 1 0 3 I ' ! 1 I i 0 c**"" 1 s A R .z-Lr •, ,..._.) i i 44te%NW IA 1 i . . 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