HomeMy WebLinkAboutBLD1989-00138 (3UI•N 'ERr1IT APPLICATION -
Jefferson County Building Departmen*tcP .C•. Box 1220*Po c Townsend. WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS ICI. cc442.11,12£'Qe.-7
POSTAI. DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT'--2- I BLOCK p DIVISION TAX NUMBER
PARCEL NUMBER 9CIPJ ,3 0, if6- ) 1 / 4 SECTION
PLANNING AREA SECTION 2-- TOWNSH I P.`Z9 N NORTH RANGE ( li-) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 7g, NEW BUILDINGS MAIN FLOOR
''$ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
l DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENTGARAGE SAO
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ICOMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES ,-/,
❑ COMMERCIAL SIZE 9 . 6 ._._._.__O @_ $35
❑ INDUSTRIALYEAR
W ^\
$ 16
❑ HOTEL/MOTEL/DORMITORY' MAKE -,;T �5&0 W @ $8r'� o
NUMBER OF UNITS
❑ OTHER - SPECIFYESTIMATED COST OF 1] @ $6
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
1Z
4
SELECTED CHARACTERISTICS OF aJILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
(71 WOOD FRAME a ELECTRICITY ❑ COLLECTIVE SOLAR
0 MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES S TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 3
'C-,.
I� A - [i PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
Xy INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 4_,
APPROVEDDATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
_PUD TYPE OF WATER SUPPLY
cil PUBLIC ( NAME OF WATER SUPPLY) P-T. L.PC.1Z
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNI G DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH 601
NAME OF PUBLIC ROAD r'S L(. ay.
/ • NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED AYES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER 1.,• 'ea _ ZLI I ' C>L3OC� -33- 3'S-ivr4
•
CONT r/7-(,..)rl .t.t_- -
S PA I'E LI LENSE HO I
• RCH
I
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
c GNATURE OF APPLICANT APPLICATION�iDATE IRI " R [ cr-71
HECK NUBER OR CASH
�\.-S 'L--_. �l' - 84F '111//I�/,f,
A P VED BY PERMIT FEESEE�
A F► ( /701P + -5 BASE FEE I NSPECT I ON
a
BLDG SURCHARGE PLAN CHECK
kil
_
A 6 19 _ _ / / 0
6
ENERGY SURCHARGE $ / TOTAL
JEFFERSON COUNTY 7
PLANNING&BLDG DEPT 9 1 1 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
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MOBILE HOME LOCATION - NOTIN 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) .
961£3 3O° n7_ I
What is the street address of this land?
Street 14-- q-I,e„( 6 -L--,_
City -_\''cOl C0L<
If you rent the land what is the name and mailing address• of--t-he,land owner?
Name �.
Street or Box
City _ State/Zip
Telephone number
MOBILE HOME HISTORY
Date you purchased \l 15..
Purchase price 30/ o 00
How did this mobile home get to its present location:
Moved into Jefferson County from TA crsI
(County br State)
Delivered by dealer (name) �uv�vVct\..�-e2 _
• Moved from another Jefferson County location? YES of Nb If yes, please give
previous address/location.
Didn't move - purchased in place, .Yes or NO
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? YES or NO. If yes, to which County }U/4
Doesthe mobile home replace a previous mobile home at this new location? YES dr/NJ
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 COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
•
MOBILE HOME QUESTIONNAIRE
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.
*******************************
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
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) � ���`—�=��-'
•
Street or Box r. Cl b 2-tk1
City \O1.Dc-S - State/Zip °t 3 3 '
Home phone ? 3 - ( Work phone 9/4/0
Best time to call
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here
*****************
MOBILE HOME DATA:
Length (exclude hitch) (i `') Width - t 1, Model Year ev e i
Make Model
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name
Space 41 Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
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JEFFERSON COUNTY
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