HomeMy WebLinkAboutBLD1995-00247 JEFFERSON COUNTY MOBILE HOME TITLE ELIMINATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan St.
Port Townsend, WA 98368
360-379-4450
PERMIT # •BLD95-0247 DATE ISSUED. : 05/09/95
SITE ADDRESS:809 E GO-ANNA BEACH RD
:QUILCENE, WA 98376
APPLICANT. . . :KENNETH RANDALL PHONE:
MAILING ADDR: 1614 S 220TH ST
:DESMOINES WA 98198
PROPERTY OWNER: 4yr PHONE:
MAILING ADDR. . :
CONTRACTOR. . : PHONE:
MAILING ADDR:
•
CONTR. LIC #: EXPIRATION DATE: / /
PARCEL NO. . . : 601274012
LEGAL DESC. . :STR 27-26-01 WWM, TAX # 34
LOT , BLOCK ,
DESCRIPTION OF IMPROVEMENT: Mobile home title elimination
THIS IS NOT AN INSTALLATION PERMIT.
AFTER INSPECTION IT WILL CERTIFY THAT THE MOBILE HOME WAS
AFFIXED TO THE PROPERTY ACCORDING TO RCW65.20. 020 (A)
( ) Footing/Setbacks (If continuous footings are used) :
( ) Blocking/Setbacks/Plumbing:
( ) Final/Skirting/Vents/Porches/Steps:
CALL 379-4455 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9 a.m. to 4: 30 p.m.
Inspector's Hours 8 - 9 a.m.
24 Hour Recorder for Inspections
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JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center `afi' i b l 4�
Castle Hill Mall �w
621 Sheridan St. /�/
Port Townsend, WA 98368 Vl�
360-379-4450 eCiA> 6,6. 0. o -)
PERMIT # •BLD95-0247 DATE RECEIVED. : 05/09/95
SITE ADDRESS:809 E GO-ANNA BEACH RD
:QUILCENE, WA 98376
APPLICANT. . . :KENNETH RANDALL PHONE:
MAILING ADDR: 1614 S 220TH ST
:DESMOINES WA 98198
CONTRACTOR. . : PHONE:
MAILING ADDR:
•
CONTR. LIC #: EXPIRATION DATE: / /
ARCHITECT/ . . : PHONE:
DESIGNER
MAILING ADDR:
PARCEL NO. . . : 601274012 ALT: CON :
LEGAL DESC. . :STR 27-26-01 WWM, TAX # 34 BY: DATE:
LOT , BLOCK ,
WATER: DATE:
CAR : DATE:
DESCRIPTION OF IMPROVEMENT: Mobile home title elimination
BUILDING TYPE •T E BEDROOMS--- BATHROOMS-- MAIN FL. . . : 0 sf
TYPE OF IMPROVEMENT:NEW EXIST. : 1 EXIST. : 1 ADD'L FL. . : 0 sf
GARAGE/CARPORT PROP. . : 0 PROP. . : 0 HTED BSMT. : 0 sf
WOODSTOVE TOTAL. : 1 TOTAL. : 1 UNHT BSMT. : 0 sf
UBC OCCUPANCY GROUP: SEWAGE DISP. . :SEPTIC OTHER 0 sf
TYPE OF CONST • WATER SUPPLY. : CRPT/GAR. . : 0 sf
UNITS. : 0 STORIES: 0 HEAT TYPES. : DECKS 0 sf
DIMENSIONS: MOBILE HOME COMMERCIAL: 0 sf
FRAME TYPE: MAKE:CONTOUR YR: 85 INDUSTRIAL: 0 sf
EST COST. $: 0 SIZE: 12 X 36 BANK HT. . . : 0 ft
PROJ GRP. . : 6708 SH SETBACK: 0 ft
Owner/agent FEES
Signature: type amount by date recpt
PRMT $ 125. 00 AK 05/09/95 106498
Date: B.C. $ 4 .50 AK 05/09/95 106498
Issued By: / 7
Date:
$ 129. 50 TOTAL
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**JEFFERSON COUNTY MOBILE HOME INSTALLATION PERMIT APPLICATION
BUILDING TYPE IMPROVEMENT TYPE UBC OCCUPANCY
K MOBILE ❑ NEW BUILDING GROUP
SIZE /a X3&
YEAR /%SSA
MAKE CO.a Tavi
COST �y}�� �p �/��yy� y�y�
DESCRIPTION OF IMPROVEMENT: ' � 'V 61 l Y �vl ' `� ��V' 1 . -ArYniti+
TYPE OF SEWAGE DISPOSAL: (4)-)/' TIX✓ ❑ INSTALLED 19_
❑ SEWER K INDIVIDUAL SEPTIC
❑ NOT INSTALLED
TYPE OF WATER SUPPLY: PRIVATE DRILLED WELL OTHER
NoT ileT,r,i
PUBLIC ❑ CITY OTHER: NAME
❑ PUD STATE I.D.
NUMBER OF EXISTING BEDROOMS / NUMBER OF EXISTING BATHROOMS /
NUMBER OF PROPOSED BEDROOMS 8 NUMBER OF PROPOSED BATHROOMS Z/
TOTAL NUMBER OF BEDROOMS ( TOTAL NUMBER OF BATHROOMS /
IF WATERFRONT PROPERTY NAME OF ADJACENT BODY OF WATER 4 0, ��i`)/91...--
BANK HEIGHT SETBACK 90
=� 9s'
SIGNATUR / '/ DATE
APPL ANT E (PLEASE PRINT) G�,L4� �/fG/f1,.,-.iJ
********* *****************************************************************************************
FOR OFFICE USE ONLY
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT
BASE FEE I
PLAN CHECK RECEIPT # 1(;)671.161)
..4. 6 5/ /1C
STATE SURCHARGE DATE
TOTAL / 29 CASH/CHECK #��
h:\HOME\PLNCNTR\FORMS\MOBILE.APP
JEFFERSON COUNTY PERMIT CENTER
REFUND REQUEST/PO TING MEMO
DATE: 6/1/61
The amount of g5, 06 received from .A4/4//26
for (case #) ..5i-D 95 02R 47 is to be refunded to:
/64 Nt V464 JS�
7� -D 4 ..
v()At �a7/ /cV
as a result of: G� G� /o9Date & number of original receipt: ' < / (�
REVENUE
FUND CODE NO. REVENUE SOURCE NAME AMOUNT
PERMTPENTERfUN4iiiiiESE
001-130-000 322.10.00 BUILDING PERMITS ,g.S-d�
001-130-000 345.83.00 PLAN CHECK FEES
001-130-000 343.97.00 RADON KITS
001-130-000 322.40.20 ROAD APPROACH PERMITS
001-130-000 322.40.30 UTILITY PERMITS
001-130-000 322.40.80 ADDRESS FEES
001-130-000 345.80.10 SHORELINE PERMIT FEES
001-130-000 345.80.20 CURRENT USE REQUEST FEES
001-130-000 345.80.30 ENVIRONMENTAL REVIEW/SEPA FEES
001-130-000 345.80.40 ZONING APPROVAL FEES
001-130-000 345.80.50 CRITICAL AREA REVIEW
001-130-000 345.81.00 SUBDIVISION FEES
001-130-000 345.81.10 CAMPER CLUB FEES
001-130-000
HEALTH.:FUND
... . ...............................
. . . . .. ...........................
•
127-000-010 346.22.30.10 HTH523 WATER AVAILABILITY FEES .
127-000-010 346.22.30.10 HTH541 LIQUID WASTE FEES
127-000-010 346.22.30.10 HTH582 SHORT/LONG PLAT FEES
OTHER FUNDS
.. .. ...... ........................
.... . .. ...........................
626-000-010 239.10 PLNG TRUST ACCT
TOTAL REFUND 2 ,CZ)
•
Applicant signature /
Authorized person signatur her-
Treasurer's check# Date
Treasurer's signature
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