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Home My WebLink AboutBLD1990-00013 BIDDING .,, 'ERMIT APPLICATION Jefferson County Building Department*P .O . Box 122O r* Townsend. WA 98368 • LocATioN SPECIFIC LOCATION SITE ADDRESS n 1 POSTAL D I STR I CT / /SUB I V I S IOi adi�2 r 'kJ) LEGAL DESCRIPTION LOT 4 BLOCK DIViSI9N TAX NUMBER PARCEL NUMBER GY.) Ad -1 / 4 SECTION--- PLANNING AREA SECTION /7 TOWNSHIP NORTH RANGE 1 Wm BUILDING INFORMATION BUILDING TYPE Ty E OF IMPROVEMENT _QUARE FOOTAGE ❑ SINGLE FAMILY NEW BUILDING MIN FLOOR MOO I LE HOME ❑ ADDITION 2N• FLOOR ` ❑ MODULAR HOME ❑ ALTERATION BASE` ENT ❑ DETACHED/ATTACHED 0 REPAIR CARPOT GARAGE 0 REPLACEMENT GARAGE ❑ wOODSTOVE 0 WRECKING/DEMOLITION ICOMMERCI L ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES ❑ COMMERCIAL SIZE /'T 0 a 40 ❑ INDUSTRIAL YEAR 0 ., $20 ❑ HOTEL/MOTEL/DORMITORY r� MAKE r @ $10 NUMBER OF UNITS,_____, ❑ OTHER - SPECIFY ESTIMATED COST OF 0 a $ l 0 IMPROVEMENTS T• AL FAIR MAf4KET VA UE UBG OCCUPANCY GRQUN $ --._ SELECTED CHARACTERISTICS OF BUILDING \\ PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAME 0 ELECTRICITY ❑ COLLECTIVE SOLAR MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL GAS ❑ GOAL ' ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS A^ • 50X/1,6 ❑ OTHER - NUMBER OF STORIES __ TOTAL LAND AREA DEPARTMENTAL REVIEW /4(i �GLS .�_L, HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ae. / 'd4 0 PUBL I C OR PR I VATE NUMBER OF EXISTING BEDROOMS I/ '/ ( TrK . X I ND I V I DUAL ( SEPTIC) NUMBER OF PROPOSED BATHROOM / APPROVED DATE , ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY ❑ rUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE IIQ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YE NAME OF ADJACENT WATER BODY NO 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 L/ V r f� �-7i3 iE CO N T (l_S P� 7ig /`^ ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAW \\ SIGNATURE F,APPLICA T APPLIC T DATE RF_CEiPT UMBER ICE NU IL R CASH) P RMIT F ES APPROVED BX PE BASE FEE INSPECTION BLDG SURCHARGE PLAN CHECK ENERGY02_ SURCHARGE i e9 TOTAL AL I 911 NUMBER REFUND DATE D SSUED BUILDING OFFICIAL 9'C 411 OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account # PP Account 1f DATE // 6 ********************************************************************************** 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 r permit Dealer report Application Delinquent State transfer by sale for title taxes report ******************************* MOBILE HOME OWNERSHIP/OCCUPANT DATA Name(s) Street or Box `- /720A City State/Zip 6c6- 7 Home phon 7213 72g-8_ Work phone - ( C9d/03 Best time to call (specify home or work) NOTE: If you re t th mobile home give name, address, and telephone number of owner here ***************** MOBILE HOME DATA: 1-7 Length (exclude hitch) — Width / Model Year Make Model Serial number ***************** MOBILE OME •CATION - IN PARK Park name Space # Date placed in park (PLEASE COMPLETE REVERSE SIDE) III 411 MOBILE HOME LOCATION - NOT IN A PARK Do you own (or are buying) land on whic mobile home is located or do you rent the land? (CIRCLE) BUYING RENT Assessor's Real Property accoun (parcel) number (The 9 digit number on the tax statement or valuation notice) y06 o What is the street address of this land? _k.-1:) Street City ------prvi-- _A If you rent the la d what is t name and mailing address of the land owner? Name Street or Box State/Zip City Telephone number *********** MOBILE HOME HISTORY 011L k Air Date you purchased ) Purchase price How did this mobile home get to its present location: J / Moved into Jefferson County from (County or State) Delivered by dealer (name) Moved from another Jefferson County 1 ation? YES or NO. If yes, please give previous address/location. Didn't move - pruchased in place. .Yes or NO Name of previous owner Address State/Zip City If moved, was advance tax paid? YES or NO. If yes, to which County Does the mobile home replace a previous mobile home at this new location? YES orC, If this is a replacement, to whom and where did the previous mobile home go? for our assistance. If you need help or information about the assessment Thank you y of your mobile home call the Assessor's Office at 385 9105. Questions about taxes call the Treasurer's Office at 385-9150. 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