HomeMy WebLinkAboutBLD1989-00121r .,. ..
LOLDING 0,"ERMIT APPLICATION
Jefferson County Building DepartmentaP.O. Box 1220rt Townsend/ WA 98368
rLOCATION
SPECIFIC LOCATION' SITE ADDRESS
. 4/21Aa�'
POSTAL DISTRICT /SUBDIVISION, ..
LEGAL DESCRIPTION LOT6' I D BLOCjC �te, DIVISION TAX NUMBER
PARCEL NUMB R114 O 420Q.01 / 41 SECTION
PLANNING AREA SECTION �'i TOWNSHIP C) NORTH RANGE / UJ WM
BUILDING INFORMATION
BUILDJ/NG TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ S �'I�IGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
/O/DILE HOME ❑ ADDITION 2ND FLOOR •
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REP ACEMENT GARAGE
❑ WOODSTOVE ❑ W CKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE I-I ES4�
❑ COMMERCIAL
SIZE ��`y' a' ' 35
❑ I NDUSTR IAL YEAR �r ef9I 0 " $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE FA a $6
NUMBER OF UNITS
❑ OTHER = SPECIFY ESTIMATED COST OF a $8
IMPROVEMENTS T• AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PR NCIPLE TYPE OF HEATING FUEL
❑ WO D FRAME j ECTRICITY ❑ COLLECTIVE SOLAR
ANUFACTURED Q/WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA,
DEPARTMENTAL REVIEW .
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM*_
(014/91A ❑ PU 1 C OR PRIVATE NUMBER OF EXISTING BEDROOMS
ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM_�„�„
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM_R
PUD TYPE OF WATER SUPPLY
[/PUBLIC ( NAME OF WATER SUPPLY,)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY mimmimm
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES AME OF ADJACENT WATER BODY
O
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD
! • NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL 0
OWNER IUAV�ICIrrrl•1VRVt/f I_V.►� = U
I
CONT
STXT6. L I LTT'5- w• 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE
I SIGNATURE OF APPLICANT APPLICAT O D�T'E r EIP BER I CHECK NUMBER.1c 4, 1
APPR V D BY PERMIT_FES
VV BASE FEE INSPECTION
A P SD BLDG SURCHARGE PLAN CHECK
2
1989 ENERGY SURCHARGE oq
TOTAL
JEFFERSON COUNTY
PLANNING&SLUG DEPT Q j,I
( N�`U(;JMM�( REFUND DATE T/ I
BUILDING OFFICIAL. �� W/
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY ,. , ., T,v _ -„ - „, ,- :;vjl .
MOBILE HOME QUESTIONNAIRE
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RP Account # .
PP Account # . .
DATE • . . • . , , , ,..-
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Please read the entire form and provide as much information as possible. This will
help us identify the unit correctly and avoid double assessments. It will also aid
in placing a correct value on your property.
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REASON FOR INQUIRY: . .
Field visit ' Excise tax
( .__ Building Moving
by deputy affidavit permit permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
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A .
• MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) al-PSE., 4 0 L L-1 1 Ac )')'1-
Street or Box 70f) 16 1 4411 474
City 44Pe932-(-) State/Zip 004 C,
9833
Home phone ---- Work phone
Best time to call
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here •
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MOBILE HOME DATA:
Length (exclude hitch) 181 Width Cg.2e.7) Model Yea8
Make , Model
Serial number • ,
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MOBILE HOME LOCATION - IN PARK
Park name
/ •
Space # Date placed in park
. , .
(PLEASE COMPLETE REVERSE SIDE)
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MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which mobile home is located or do you
rent the land? (CIRCLE) OWN BUYING RENT
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
% 8C)C0 ( o -
What is the street address of this land?
Street UC). f(K
City 4---k(344100.1:31 LO-Pf-
If you rent the land what is the name and mailing address of the land owner?
Name
Street or Box
City State/Zip
Telephone number
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MOBILE HOME HISTORY
Date you purchased al(C1--059
Purchase price
How did this mobile home get to its present location. / •
Moved into Jefferson County from r
(County or State)
Delivered by dealer (name)
Moved from another Jefferson County location? YES o (NO If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes r NO
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? YES or 0. If yes, to which County
Does the mobile home replace a previous mobile home at this new locati n? YES o NO
If this is a replacement, to whom and where did the previous mobile home go?
Thank you for your assistance. If you need help or information about the assessment
of your mobile home call the Assessor's Office at 385-9105. Questions about taxes
call the Treasurer's Office at 385-9150.
(NOTE: If mobile home is new to this county a valuation notice will be mailed to
you when it's valued and added to the assessment roll.)
Please send completed form to: JEFFERSON ASSESSOR OFFICE
PORT TOWNSEND, WA 98368
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