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Home My WebLink AboutBLD2012-00189 • CERTIFICATE OF OCCUPANCY Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 Carl Smith, Director/Building Official PERMIT #: BLD12-00189 SITE ADDRESS: 1763 OAK BAY RD Issue Date: 07/31/2012 PORT HADLOCK, 98339 Final Date: 12/13/2012 APPLICANT: ALLAN BROWN PHONE: 253-606-7313 VICKI BROWN 21015 6TH AVE S DES MOINES WA 98198-3268 SUBDIVISION: SURACE/LARSON SHORT PLAT Block: Lot: 1 PARCEL NUMBER: 921073022 Section: 7 Township: 29 N Range: 01 E PROJECT DESCRIPTION: NEW M/H W/ATT PORCHES THE PROJECT LISTED ABOVE COMPLIES WITH THE REQUIREMENT OF THE BUILDING CODE 2009 EDITION. OCCUPANCY GROUP: TYPE OF CONSTRUCTION: SPRINKLER SYSTEM yes , "Do THE PROJECT PASSED ITS FINAL INSPECTION AND RECEIVED FINAL SIGN OFF ON 12/13/2012 \\tidemark\data\forms\F_BLD_Occupancy.rpt 12/18/2012 MANUFAPURED/MOBILE HOME INSTAfLATION PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD12-00189 Received Date: 6/21/2012 SITE ADDRESS: 1763 OAK BAY RD Issue Date: 7/31/2012 PORT HADLOCK, 98339 APPLICANT: ALLAN BROWN VICKI BROWN 21015 6TH AVE S DES MOINES WA 98198-3268 SUBDIVISION: SURACE/LARSON SHORT PLAT Block: Lot: 1 PARCEL#: 921073022 Section: 7 Township: 29 N Range: 01 E CONTRACTOR/ PARAMOUNT BUILDERS INC PHONE: 253-606-7313 DEALER P.O. BOX 2143 YELM WA 98597 Contractor's License PARAMBI001JE Expires 3/25/2014 PROJECT DESCRIPTION: NEW M/H W/ATT PORCHES MAKE: SKYLINE YEAR: 2010 SIZE: 27X56 Directions To Site: 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. Office Hours 9:00 -4:30 MONDAY-THURSDAY 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 Lrosio>reerel MH Foundation ` -f L Blocking&Tie Down 2.,0,Z /45 Skirting&Ventilation 1213_12 ' a�'s'tine!-EEi4ecicu Perak-. P essu :Tcct Drywell/Alt Drainage h,./3 ,2 Address Posted / g /2 l`'j4 FINAL INSPECTION I Z,/3/2_ fr-of FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR SPECIAL CONDITIONS APPLY-SEE REVERSE MLA12-00142 ILDING PERMIT APPLICAN Review Type: I Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD12-00189 Received Date: 6/21/2012 SITE ADDRESS: 1763 OAK BAY RD PORT HADLOCK, 98339 OWNER: ALLAN BROWN PHONE: 253-606-7313 VICKI BROWN 21015 6TH AVE S DES MOINES WA 98198-3268 SURACE/LARSON SHORT PLAT SUBDIVISION: Block: Lot: 1 PARCEL NUMBER: 921073022 Section: 7 Township: 29 N Range: 01 E CONTRACTOR: PARAMOUNT BUILDERS INC PHONE: 253-606-7313 P.O. BOX 2143 YELM WA 98597 Contractor's License PARAMBI001JE Expires 3/25/2014 REPRESENTATIVE: PARAMOUNT BUILDERS INC PHONE: 253-606-7313 MIKE SAPP PO BOX 2143 PROJECT DESCRIPTION NEW M/H W/ATT PORCHES TYPE OF WORK MOB SQUARE FOOTAGE: TYPE OF IMP NEW VALUATION MAIN: 1,568 CODE EDITION: 2009 ADD'L: HEAT TYPE: EEE OCCUPANCY: HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: 05783 BEDROOMS: BATHROOMS: Exist: 0 Exist: 0 Prop: 2 Prop: 2 Total: 2 Total: 2 Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Manufactured Homes $222.00 LYK 06/21/12 134928 APPROVED Potable Water Application $64.00 LYK 06/21/12 134928 Total: $286.00 JUL51 2012 Jefferson County Planning & Building Department • • SPECIAL CONDITIONS CASE # BLD12-00189 1.) DESIGN CRITERIA FOR SPLASH BLOCKS: A VEGETATED FLOWPATH OF AT LEAST 50 FEET SHOULD BE MAINTAINED BETWEEN THE DISCHARGE POINT AND ANY PROPERTY LINE, STRUCTURE, STEEP SLOPE, STREAM, WETLAND, LAKE, OR OTHER IMPERVIOUS SURFACE. SENSITIVE AREA BUFFERS MAY COUNT TOWARD FLOWPATH LENGTHS. A MAXIMUM OF 700 SQUARE FEET OF ROOF AREA MAY DRAIN TO EACH SPLASHBLOCK. A SPLASHBLOCK OR A PAD OF CRUSHED ROCK (2 FEET WIDE BY 3 FEET LONG BY 6 INCHES DEEP) SHOULD BE PLACED AT EACH DOWNSPOUT DISCHARGE POINT. NO EROSION OR FLOODING OF DOWNSTREAM PROPERTIES MAY RESULT. FOR SITES WITH SEPTIC SYSTEMS, THE DISCHARGE POINT MUST BE DOWNSLOPE OF THE PRIMARY AND RESERVE DRAINFILED AREAS. 2.) CONSTRUCTION ENTRANCES SHALL BE STABILIZED WHEREVER TRAFFIC WILL BE LEAVING A CONSTRUCTION SITE AND TRAVELING ON PAVED ROADS OR OTHER PAVED AREAS WITHIN 1,000 FEET OF THE SITE. THE ENTRANCE SHALL BE CONSTRUCTED ON A FIRM COMPACTED SUBGRADE. QUARRY SPALLS (OR HOG FUEL) SHALL BE ADDED IF THE PAD IS NO LONGER IN ACCORDANCE WITH THE SPECIFICATIONS. (BMP C105, 2005 DOE STORMWATER MANUAL). ANY SEDIMENT THAT IS TRACKED ONTO PAVEMENT SHALL BE REMOVED BY SHOVELING OR STREET SWEEPING. THE SEDIMENT COLLECTED BY SWEEPING SHALL BE REMOVED OR STABILIZED ON STIE. ANY QUARRY SPALLS THAT ARE LOOSENED FROM THE PAD, WHICH END UP ON THE ROADWAY SHALL BE REMOVED IMMEDIATELY. UPON PROJECT COMPLETION AND SITE STABILIZATION, ALL CONSTRUCTION ACCESSES INTENDED AS PERMANENT ACCESS FOR MAINTENANCE SHALL BE PERMANENTLY STABILIZED. 3.) The application was reviewed by the Jefferson County Department of Community Development staff on July 30, 2012 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: coastal SIPZ. 4.) Marine shorelines and islands are susceptible to a condition that is known as seawater intrusion. Seawater intrusion is a condition in which the saltwater/freshwater interface in an aquifer moves inland so that wells drilled on upland areas cannot obtain freshwater suitable for public consumption without significant additional treatment and cost. Maintaining a stable balance in the saltwater/freshwater interface is primarily a function of the rate of aquifer recharge (primarily through rainfall) and the rate of groundwater withdrawals (primarily through wells). The Washington Department of Ecology is the agency with statutory authority to regulate groundwater withdrawal for individual wells in Jefferson County. New development, redevelopment, and land use activities on islands and in close proximity to marine shorelines in particular should be developed in such a manner to maximize aquifer recharge and maintain the saltwater/freshwater balance to the maximum extent possible by infiltrating stormwater runoff so that it recharges the aquifer. 5.) The parcel is located within aestal SIPZ (seawater intrusion protection z• according to the County GIS map. There are voluntary and mandatory measures identified in the Jefferson County Seawater Intrusion Policy(Resolution 44-22, effective September 23, 2002) that apply to well drilling proposals and building permit applications on existing lots of record. A Coastal SIPZ is defined as: all islands and area within one-quarter mile of marine shoreline, but no history of chloride concentration above 100 mg/L in groundwater sources within 1000 feet. 6.) To help prevent seawater from intruding landward into underground aquifers, all new development activity on Marrowstone Island, Indian Island and within 1/4 mile of any marine shoreline shall be required to infiltrate all stormwater runoff onsite. 7.) The property owner shall comply with Water Conservation Measures (per list maintained by the UDC Administrator). 8.) The applicant is proposing to create or add 1528 square feet of impervious surface and 7552 square feet of land disturbing activities. JCC 18.30.060 and 18.30.070 require the project applicant submit a stormwater plan meeting Minimum Requirements#1 through#5 of the Department of Ecology Stormwater Management Manual for Western Washington. The stormwater plan shall address measures to control stormwater, erosion and sediment during construction and shall address permanent measures to stabilize soil exposed during construction, and in the design and operation of stormwater and drainage control systems. 9.) 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). 10.) The site plan as submitted with the manufactured home building permit application on June 21, 2012 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 July 30, 2012 shall be resubmitted for review and approval by Jefferson County Department of Community Development. 11.) This approval is for a manufactured home installation 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. 12.) The parcel has been designated as RR 1:5 under the Jefferson County Comprehensive Land Use Map effective August 28, 1998. 13.) Outdoor residential storage shall be maintained in an orderly manner and shall create no fire, safety, health or sanitary hazard. 14.) 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. 15.) A minimum of two (2) on-site parking spaces shall be provided for the single family residence. 16.) This parcel is within Chimacum-Hadlock no shooting area per JCC 8.50. 17.) 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. 18.) 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. 19.) Minimum setback from Oak Bay Road right-of-way shall be 30 feet. Minimum side and rear yard setbacks shall be 5 feet. 20.) The building height is not to exceed 35 feet. 21.) Maximum lot coverage is not to exceed 25%. Lot coverage is defined as amount of impervious surface which includes roof tops, driveways, concrete, etc. 22.) An address of 1763 Oak Bay Road, Port Hadlock has been assigned to the parcel. Oak Bay Road is a county major collector(C569908). 23.) The parcel is served by the Qiker public water system. • 24.) The lot was created throught hte Surace/Larson Short Plat on February 5, 1996 under AFN 388411. 25.) A septic permit(SEP08-249)was approved on October 22, 2009. A septic permit (SEP96-108)was finaled on April 6, 1998 and is now filed with SEP08-249. A building permit(BLD99-02) for a garage was cancelled on January 25, 1999. A critical area review (CAR99-09) for a septic permit was finaled on April 6, 1998. 26.) NOTICE: This permit does not excuse the proponent from complying with other 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. \\tidemark\data\forms\F_BLD_Perm it_Mobile.rpt 7/31/2012 ,+.w N cod 6 JEFFERSONfOUNTY • DEPARTMENT OF COMMUNITY DEVELOPMENT `-) ` `4 621 Sheridan Street • Port Townsend •Washington 98368 360/379-4450 • ,qs � pment5 www.co.jefferson.wa.us/commdevelo360/379-4451Fax HIN Master Permit Application MLA: ( - 1 { Project Description(include separate sheets as necessary): Cnf(-\ t ATT Razc-( . Tax Parcel Number: t.14 '7 00�� Property Size: , 5/ g' � (acres/square feet) Site Address and/or Directions to Property: /7 G 3 D A1-A 474 /6 ) Pv� /-/-td (,),1- ` Property Owner(s)of Record: AL.-4& c1 t/i c-kC.i j�+.v/v Telephone: 2 c3 4)&7-3/ Fax: -- • email: --- Mailing Address:Z/ 0%c t l 74 i9",Y- .�o 7 E Applicant/Agent(if different from owner): P/-)P.el-snr.A1 rvf BLit 4-O&7 ZS •4761)4.-- (/i rc-%4i-S./9-j 0j Telephone: 2S-3 (v(24& ?-3 #3 Fax: ?6,/2 Le Sik 4 Yi?f email: AirKL%ff A.fis Int:n,-s%i Mailing Address: Rar.-0.=/1--C Ni,! c-e)iv at kind of Permit? (Check each box that applies 0 Lot or Road Segregation wilding 0 Critical Areas Stewardship Plan ❑ Demolition Permit 0 Variance(Minor, Major or Reasonable Economic Use) ❑ Single Family 0 Garage Attached/Detached 0 Conditional l (a),_c _ uk_Cl** - i�ManufacturedHome .0 Modular • 0 Discretionary,"D"\qr tilnn AdIO1se1 �,si ation ❑ ommercial* 0 Special Use(Esse fP bieracih ios`)**-. ❑ Change of Use 0 Boundary Line Adjustment ❑ Address _ ❑ Road Approach_ 0 Short Plat** ❑ Home Business ❑ Cottage Industry 0 Binding Site Plan** ❑ Propane 0 Long Plat** ❑ Sign - 0 Planned Rural Residential-Developmeht(PRBD)/Amendments** ❑Allowed"Yes" Use Consistency Analysis 0 Plat Vacation/Alteration i i I.' (i'N! ' ':hr ❑ Stormwater Management 0 Shoreline MasterPPr'.ogtgm.Ex 'njitibn/Perrnit:Revisions** ❑ Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance ❑Wireless Telecommunication* 0 Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium 0 Jefferson County Shoreline Master Program Amendment *May require a Pre-Application Conference 0 Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: - / /C r9-EL . - ' DESIGNATION OF AGENT I hereby designate '✓1 / N•___________________________________to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE `-Zi, Date: b//'$/"/ 2__ By signing this application form,the owner/agent attests that the information provided herein,and in any attachments, is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material 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 all 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 of entry will be assumed unless the applicant informs the County in writing at the time of the appl' t e or nts prior notice. / Signature: Date: G/ t9 7/ L. The action or a tions Applicant ill undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as 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 yyand non-transfe `ns. ..ity � adhering to and complying with the ESA. The Applicant has read this discjaimer and signs and dates it below. " 1�Signature: /.). I i4 ' . — Date: (,• 7( ( c L 1 , . • • BUILDER STATEMENT • ' The signer of this st• -• ent does hereby certi► .t they are the Owners of the parcel referenced herein,that they are not licensed contractors and that they will be as,// g - resrest:). 1 y oft F eral Contractor for the proposed j / Signature: �L�� i/d Date: 'project./,.S(/ GENERAL CON"•CTOR OR MANUF TURED HOME INSTALLER: PHONE: FAX: ��le il/��l-�S-ff 1�fie/9'/�ta ,(3i/, .e�i�� (2 r3)��.ri�.'/ -&o) Ycb'c' W d MAILING ADDRESS: '> ,(). I�GJx Zi •�_t;,/�i�:�q- EMAILA,<<(raP ��'�-Avm/ 4t/1-65-fil CONTRACTOR'S LICENSE /6,y Gj y2 WAINS NUMBER: P4/1—['I v'[ r3JVJ00�� NUMBER ARCHITECT/ENGINEER: ' / ivv 4 PHONE ( k'--) FAX:( 1=._s MAILING ADDRESS: N714 EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: e•stlew K Wood Existing: 45— C Sewer C Addition C Steel Proposed: Bank C Community System C Alteration/Remodel C Concrete Total: 2 _ Height: l--tti<fvidual System C Repair C Masonry SEP Permit# � o -C 2 l G Demolition C Other: Bedrooms: g Water Supply:Existing: Setback: C. U.vate well S Two Party Ty of Heat: Proposed: ublic � • Eked-f?1 C Total: 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 Prpposed ;BC Occupancy: IBC Type of construction: Will you have Food S � '? IN IV f, '\f If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: 1,,— '-� 1 Underground Tank 1 Above ground Tank Size of Propane Tank: 1 Heat Stove 1 Cook Stove 1 Woodstove 1 Fireplace Insert 1 Hot Water Tank 1 Pellet Stove 1 Other Is this appliance being installed in a Manufactured/Mobile Home? Yes / No ,1 ! When applying for a permit to install a propane tank you must also submit a site plan showing all,_of the buildings all proper4I lines,tank location and size,distances from the propane tank to all property lines,buildings and septic,syst m pktaponents, including the reserve area. D °' Or C'_liJiUNITy E','LLO,V0ENT Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated ' EH Bid App Review: ��, - 21-4 Floor Heated Consistency Review: n 2.2 Other Heated Base fee: 2-22. Mezzanine Additional Section: Heated Basement Plan Check fee: Unheated Basement State Surcharge fee: Other Unheated Pot Water Review fee: Q - Garage/Carport SUBTOTAL 23 Decks 911/Rd Approach fee: �x(S70.3(s Other TOTAL: $(,2B ,----- Receipt Number: 13Lri2Q Cash/Check Number: 1 2r ESTIMATED COST(REQUIRED) Date: ��_��_ •Fair market value of all labor and materials foundation to finish (0'2-{ ._...>•.�_.-› Initials: 4 JACK WVESTERMAN III • .1cf`crpoon Coui•'oarthousc ASSESSOR 1'O Ilox I220, Port Townsend, W % 90:160 13601 :1115-9105 MOBILE HOME INFORMATION FORM OWNER'S NAME/MAILING ADDRESS: NAME: 4L1-/471J RYckw/L. /� ADDRESS: Zl1)( .5-- 'rq /''✓ <t� ��'t -�' G' %7/117 PHONE NO. 2,s 3 (v ' yz3/_3 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the previous ownership and location of a mobile home. This will help our office determine whether the mobile home is already on the tax rolls in Jefferson County or if it has been moved to this county from another area. h►MOBILE HOME DATA: / r (A) MAKE �'`4(i 4 (B) MODEL / 7c� (C) YEAR 2 /a (D) LENGTH -S-40 (E) WIDTH / (F) SERIAL # (G)YOUR PURCHASE PRICE (Do not include sales tax)7 //33 PURCHASE DATE -4/(2_ 2) PREVIOUS OWNER/LOCATION OF MOBILE Il0:11E: (IF NEW MOVE TO QUESTION 3) (A) FROM WHOM DID YOU PURCHASE MOBILE DE-M4 &/S G'us7"4I"1 G7/D4 SI 1,9 ADDRESS /0;40 q ST Pt-t 41la, tf, %83 yo_,, (B) WAS MOBILE HOME ASSESSED IN J> FFIl _ 'IF EAR? Yes If Yes, Previous address of mobile. ! f j 1 If No, What County was Mobile asses-cd laIt r a �� aP 1 2012 3)WHERE MOBILE DOME IS TO BE LOCATED: I 11L5 J i JEFFERSON COUNTY (A) WILL THE MOBILE HOME BE IN MO 3ILISEIIQ1MIPAIWORINps o (B)IF LOCATED IN MOBILE HOME PARK: NAME 41 ADDRESS OF PARK Lot/Space # (C) IF NOT LOCATED IN MOBILE HOME P RK:, NAME OF LAND OWNER: LGfi1✓ vecz, /1h1 LOCATION ADDRESS (?63 04-4- el 1 y / �l�/''T `7' eia-c,e1C_ REAL PROPERTY PARCEL #/DESCRIPTIOri ( P �G�Glili �� i of a of app �cmt THANK YOU FOR YOUR HELP! Lauralee Kiesel, Property Technician r 1 ' . .a. 11 0 t 1 \dia ! ) ) ,:,,‘ , , CL. , . 1 I 14\All 1 I •I:4.,,,,,„gai '-1---- il , lif ,..• ' ' L.A... a_ CD CD I CZ 8 cr 4.....4 a) ,- r) .- 1 0) CL --11: cn 0 i CC ‘-% -- C, -, L s,1 MA (----- - 3 4-1ki, .....kif_asty•5.K.,"77 - 't mo- \0 I Cs.J I i I 0 CIO C3 i i ...../ ae"..: g :;1 It 44 goin,1 0.0.4 = --- rA. 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