HomeMy WebLinkAboutBLD1989-00132 THIS BUILDING IS
NOT FINALED .
THIS IS AN INCOMPLETE
BUILDING APPLICATION . THE
PERMIT WAS NEVER ISSUED .
r� A
•LDING O'ERnIT APPLICATION �L 3t.3oz,te
Jefferson County Building Department ^P .O . Box 1220 ort Townsendr . WA 98368
LOCATION _..__
o'
SPECIFIC LOCATION SITE ADDRESS �G / /iiit-. -�� '
POSTAL DISTRICT ,P T/SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK 1 /DIVISION() TAX NUMBER
•
W�
PARCEL NUMBER C01 33i OI1 / 4 SECTION
PLANNING AREA SECTION _TO:YNSFI I P U NORTH RANGE /AV 7 WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF I HPROVEi4ENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW rUILDIFIG MAIN FLOOR
j' MOBILE HOME ❑ ADD I T I ->N 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/L)EN OLITION I COMMERCIAL
❑ MULTI - FAMILY ❑ RELoCATIO /MOVING`!— INDUSTRIAL
NUMBER OF UNITS �y
❑ SI TSILG t:tn,irS�d a7.
COM`1ERC 1 AL
SIZE ZE ' 3 5
❑ INDUSTRIAL YEAR_ ZZ 1 $ I6
❑ HOTEL/MOTEL/DORM 1TORY
� MAKE , ,71/LiiyG�- —
$g
NUMBER OF UNITS
❑ OTHER - SPECIFY _„„_,-, 0 @ $8
ESTIMATED COS •
1 hiPR'JVEF4F' a T%TAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP s
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PR I,"C 1 PLF_ TYPE OF HEATING FUEL
❑ WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
yg MANUFACTURED ❑ wOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) t DIMENSIONS
-._-._...
❑ OTHER - NUMBER OF :,TOR 1 ES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SR1?Ar2 DI Sros- '.- Itu(^oER OF PROPOSED BEDROOMS
1Iel Y U\ il�• ❑ PUBLIC CR PRIVATE NUMBER OF EXISTING BEDROOMS o
I (� ';f IND! V I DUAL ( SEFT I C ) NUMBER OF PROPOSE') BATHROOM_
APPROVED DATE Li I -'D I V I DUAL WELLPM
_ dBER OF EXISTING BATHROOM
^
PUD TYPE Cr WATER SUPPLY71:11r27- 70001/1--COA,-
0 PUBLIC ( NAME OF MATER SUPPLY1. / /G G,...ev _
APPROVED DATE 0 PP I VATE ( NANF_ OF WATER SUPPLY ��77//``�_ /
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME CrADJACENT WATER BODY
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD -.—,_-,-
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
—
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
L7-AC-/C- /Gc r I-S00 /9 / K NO_ie-i-CvTpFF 3d78- /YDtiE,
CONT L. .,.
-STA I Z-TM_� 7N' L I
ARCH
THE OWNER OF THIS BUILDING AND THE UNDr:RS IGNZD AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIGNAT OF APP CANT w APPLICATION DATE REfiENVhS�ER L
C HF�C,IC� R OR CASH
AP-R0 ED BY PERMIT FEES /`}II. J''(\Y ll/
/
A R� . BASE FEE „_,_- 1 PISPECT ION
0416, .
`� BLC^^� SURCHARGE PLAN CHECK
_ , ENERGY SURCHARGE .$ -D 5 TOTAL
JEFFERSON COUNTY -----�
PI PNNING&8106 DEPT
P11 NUMDER REFUND DATE DATE ISSUED
^—A
BUILDING OFFICIAL
OFFICE OF THE ASSESSOR, JEFFERSON ;OUNTt
MOBILE HOME QUESTIONNAIRE
RP Account i_
PP Account 11
DATE ///8/a9
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 permit permit
Dealer report Application el:inquent State transfer
by sale for title taxes report
*******************************
MOBILE HOME O[ ERSHIP/OCCUPANT DATA
Name(s) 4
Street or Box ♦ a -1611/A -- a
City< 1P-1- State/Zip A V
Home phone none Work phone
Best time to call
(specify home or work)
NOTE: If you rent the mobile, home ive name, address, and telephone number of
owner here l /
*****************
MOBILE HOME DATA:
Length (exclude hitch) Width l Model Year
CAVMake \,\N\P Model
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name
Space if Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
OW i
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land 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) .
cc! 3-31 c
What is the street address of this 1 d?
Street 1 fatI 0,,,,„„,
City I
If you rent the land what is the name and mails : address of the land owner?
Name
Street or Box
City State/Zip
Telephone number
***********
MOBILE HOME HISTORY
Date you purchased
Purchase price
How did this mobile home get to its present location:
Moved into Jefferson County from Al /-/(/ .
(County or State)
Delivered by dealer (name)
lam ,
Moved from another Jefferson CountylocationES )r NO. If yes, lease give
previous address/location.AYES
DO r r) arftY-
Didn't move - pruchased in place. Yes o-/NO
Name of previous owner
Address
City State/Zip
If moved, was advance tax pail/YES or NO. If yes, to which County WI
Does the mobile home replace a previous mobile home at this new • :tio- . S or 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.)
li Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
PUGET POWER NESTERN DI , OFFICE F.
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PLANNING&BLOC DEFT
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