HomeMy WebLinkAboutBLD1990-00162 OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account 4I
PP Account II
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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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Get -VC . ;0L1►�N- A- 54 A-►.ci , T E
Name(s) tiL/ ���
Stre t or Box e )
City State/Zip 1 g 5 wg ''\\
Home phone` v_-4l1 Work phone 3 xp„ Oj O � _u
Best time to call /--�/t &--- ANy7/ 3! 30
(specify home or work) -- -• —
NOTE: If you rent the bile ome -Ave name, address, and telephone number of
owner here
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MOBILE HOME DATA:
Length xclude hitch) &C) W'dth Model Year 6 7
Make a Model Euc...6 N6 1-1•i1 VV1
Serial number A 1 7 D C 5.2147
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M T O �TION IN PARK
MOBILE HOME LC tiva� r-
Park name
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which obile home is'located or do you
rent the land? (CIRCLE) OWN BUYING �f/ RENT
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
9 (38 300 0 a_, .
What is the street address of this land?
Street 0 A I:rW4/\
City ci-b-iy4 41 1Ye )
If you rent the land what is the name iling address of the land owner?
Name l'
f.
Street or Box
/
City State/Zip
Telephone number
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MOBILE HOME HISTORY
Date you purchased
Purchase price y 3/ goo,
How did this mobile home get to its present location: I
Moved into Jefferson County from Kt� V"
SA'p C-U' -01-`�
(County or State)
Delivered by dealer (name) hg 0y 41- 1 -0 44& �- IVY-
_,,,-..,,,,._.,.-- ved fYom another Jefferson County-.1.ocation? YES or NO If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes or
Name of previous owner
Address
City State/Zip
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 or E)
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 toe
assessment valuation notice will be mailed to
you when it's valued and added to
Please send completed form to: JEFFERSON COUNTYPO Box 1220
PORT TOWNSEND, WA 98368 .
[AWING 'ERMIT APPLICATION
Jefferson County Building DepartmentvP .O . Box 12200APTt Townsend. WA 98368
..-
'IOW,
LOCATION ,
SPECIFIC LOCATION SITE ADDRESS --\./ e r-6:,_.efm -Lan,f_
POSTAL DISTRICT ef4 , /suBbAvIslom Larylarac
LEGAL DESCRIPTION LOT 3.R. BLOCK DIVISION TAX NUMBER
PARCEL NUMBER tk: .-3(X ) (),-J- 1 / 4 SECTION
PLANNING AREA SECTION_ TOWNSHIP , - NORTH RANGE ///(_; WM
BUILDING INFORMATION -
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY NEW BUILDING MAIN FLOOR
XMOPILE HOME 0 ADDITION 2ND FLOOR
0 MODULAR HOME 0 ALTERATION BASEMENT _
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL _
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL
SIZE _11 2. $ao
O INDUSTRIAL
YEAR 9 f3G1 0 2 $20
O HOTEL/MOTEL/DORMITORY -- —
MAKE 1 I Ver C Cff-21t. VI @ $ 10
NUMBER OF UNITS . --
r-
0 OTHER - SPECIFY 0 @ $ 10
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
--__ -
SELECTED CHARACTERISTICS OF BUILDING
. . .
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ''iLELECTRICITY 0 COLLECTIVE SOLAR
/-14 ANUFACTURED
0 WOODSTOVE
0 GAS 0 PASSIVE SOLAR
STRUCTURAL STEEL
0 COAL
O REINFORCED CONCRETE U OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
D OTHER - NUMBER OF STORIES TOTAL LAND AREA ,
1
DEPARTMENTAL REVIEW
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HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUM3ER OF PROPOSED BEDROOMS
O PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
INDIVIDUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM c2
APPROVED DATE
[1] I ND I V I DUAL WELL NUMB EIR OF EXIST I NC BATHROOM
PUD TYPE OF WATER SUPPLY
I* PUBLIC ( NAME OF WATER SUPPLY 1 n (-V
APPROVED DATE D PRIVATE ( NftLF=2.__TATF. )._
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
. " _ -------
O 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 0 YES 0 NO
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IDENTIFICATION
NAME
1 MAILING ADDRESS ZIP ----
TEL NO
0 W N E Ft* (-) ,
riif CaPa_L5(YIL I 7-2(> CaRLS i PT
. .
CONT —_
— _L L=b I A i L 17.17-"S'T, 17.1J i
— - ' —
ARCH
I _
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
----. --..---SIGNATURE OF APPLIC UT ./.., APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
/.A ./ Zd‘277' --•- jitee‘d 03 I 0 CT 67 Ca&PA
i -
APPROVED BY PERMIT FEES
75, (DO BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ F9
tb(2) TOTAL
) ()/ 00 911 NUMBER REFUND DATE DATE I SSUED
BUILDING OFFICIAL
460....worm..*................... w.,