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Home My WebLink AboutBLD1989-00130 BODING o'ERMIT APPLICATION 0 ep Jefferson County Building D artment'P .O . Box 1220*Port Townsend. WA 98368 LOCATION >� ' ■SPECIFIC LOCATION SITE ADDRESS __ �° E-T2. POSTAL DISTRICT /SUBDIVISION ' 4111100' LEGAL DESCRIPTION LOT BLOCK DIV 10 TAX NUMBER • PARCEL NUMBER b i 'C t ® * 4 SECTION PLANNING AREA SECTION TOWNSHIP - NORTH RANGE ! 0 WM BUILDING INFORMATION i J BUILDING TYPE TYPE IMPROVEMENT SQUARE FOOTAGE ❑ SING FAMILY BUILDING MAIN FLOOR F.IILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION 1COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES ,1/ ❑ COMMERCIAL SIZE 0 �L`�1� - _0 @ $ • 5 ❑ INDUSTRIAL YEAR / YClin% ? 0 @ $ 1.8 ❑ HOTEL/MOTEL/DORMITORY MAKE 0 ■ $8 NUMBER OF UNITS ❑ OTHER - SPECIFY ESTIMATED COST OF AM @ $8 IMPROVEMENTS TO AL FAIR MARKET VALUE UBC OCCUPANCY GROU $ SELECTED CHARACTE ISTICS OF BUILDING 1 PRINCIPLE TYPE OF FRAME PRI IPLE TYPE OF HEATING FUEL ❑ WD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR \! r �MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS ■ ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW ./J r'.4.— e. �4/.y HEALTH DEPARTMENT TYPE • SEWAGE DISPOSAL NUMBER OF PROPOSED BEDR■ • ❑ P d B L I C OR PRIVATE NUMBER OF EXISTING BEDROOMS._ 9 D I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE 1 ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY, APPROVED DATI ❑ PRIVATE ( NAME OF WATER SUPPLY ..imm PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY 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 MAILING ADDRESS ZIP TEL NO OWNER //J7/ YSs. _ //C�� " CONT ._ '-"STATE LICENSE NO j ARCH !1 THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. / P 1CAN'ANT AAPP AT 1 O �TE R i PT NV R CHECK UMBE OR CASH '2( APPROVED BY PERMIT EES -7,45 U BASE FEE INSPECTION •-�J/ BLDG SURCHARGE PLAN CHECK / ENERGY SURCHARGE C 9? 4CC) TOTAL 911 NUMBER REFUND DATE DATE ISSUED BUILDING OFFICIAL ie5.-' ,a7/42-M'i __ MOBILE HOME LOCATION - NOT IN A PARK on whic mobile itbme is located or do you Do you own (or are buying) la oOWN BUYING RENT rent the land? (CIRCLE) Assessor's Real Property account (parcel) number (The 9 digit number on the tax statement or valuation notice)) . " a • 3 4#r What is the street add ess of this land Street City `�. If you rent the land what is the name and mailing address of the land owner? Name Street or Box City AIL State/Zip Telephone number *********** MOBILE HOME HISTORY / Date you purchased / Purchase price How did this mobile home get to its pre P.?),e-AP) nt location: Moved into Jefferson County from iIi) / A-2)V C'_ ') , •. (County or State) Delivered by dealer (name) Moved from another Jefferson County location? YES 'r NO. If yes, please give previous address/location. Didn't move - pruchased in place. .Yes o NO Name of previous owner Address AL State/Zip City e tax d' or NO. If yes, to which County , r �L.:1.�---0�2� If moved was advance P _ previous mobile home at this new ocf' on? YES or NO Does the mobile home replac e a P If this is a replacement, to hom and where did the previous mobile home go? . A. Thank you your assistance. If you need help or information about the assessment of of your mobile e 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 aluationinotice will be mailed to you when it's valued and added to the assessment Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE PO Box 1220 PORT TOWNSEND, WA 98368 OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account # PP Account # DATE 4 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. ******************************* REASON FOR INQUIRY: Field visit Excise tax Building Moving by deputy affidavit mit permit Dealer report Application Delinquent State transfer by sale for title taxes report ******************************* • MOBILE HOME OWNERSHIP/OCCUPANT DATA Name(s) y(� � / = L. �' Street or Box /S1 � � State/Zip City � �.�.�� ` Home phone 34 0 4 Work phone Best time to call (specify home or work) NOTE: If you rent he mob e home give name, address, and telephone number of owner here ***************** MOBILE HOME DATA: .// Length (exclude hitch) �G `� Width Model Year 6/7" Make Model Serial number ***************** MOBILE HOME LO ATI'N - IN PARK __ Park name llr Space I Date placed in park (PLEASE COMPLETE REVERSE SIDE) • _ f /c ZL g<. `1/. All i , t(3,1i\ s__4__: / i A i1---------4 :p Q ... .. fti •4 n \(-) n -ri. \/ i Z orr .„-KI-a-z--e-/ 4,,,z),,,, ,() i' •. (x3. 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