HomeMy WebLinkAboutBLD1984-00134{?e so
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BUI LDING PERMIT APPLICATION
Jefferson County Building Department. County Courthouse . Port Townsend, Wash.98368 . 385-1310
Tax Number
h,
H
Block
%
N 7
?AA,t*,O€S,t e-*<rlTEfsrw
srDE oF
other specific location or landmark
LEGAL DESCRIPTION
FRoM rNrERsEcnoN or SQROC. E-RoADAND N A6ilo L I,A ROAD
ROAD Lo FEETl. LOCATIONi geographic name
NE
SW
t,^t 4
Lot
ucF
II. TYPE AND COST OF BUILDING
MOBILITY
fl Ne* County Resident
ls this structure to serve the residential
or commercial needs of those employed
at either the U.S. Navv's Trident or
lndian lsland Facilities?
E yEs .Eruo
TYPE OF IMPROVEMENT
D Ne* building
n Addition
! Alteration
D Repair, replacement
=
il:T:fi",.ca,ion) o$ .&l {"
E rornau,ion oniy \r ot'(-'
BUILDING TYPE
lngle Family
n Mutti-Family
number of units _
f] Hotel, Motel, Dormitory
(Mobite Home
E Otner - Speiity
OWNERSHIP
I Private (individual, corporation,
nonprofit institution, etc.)
D PrUti" (Federal, State or local gov't.)UBC OCCUPANCY GROUP:
-
E Frll-tint" Residence
E Second Home: Recreation Cabin, etc.
E Second Home: Future conversion to
permanent residence
USE
(Omit cents)
$ 21, {oOCost of improrcment.. .. . .. . .
To be installed but not included
in the above cost
a. Electrical,
b. Plumbing.
c. Heating,airconditroning ......
d. Other (elevator, etc.). . .
TOTAL COST OF IMPROVEMENTa
cosT
a
$
Nonresidential - Describe in detail proposed use of buildings, e.9., food
processing plant, rnachine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
lf use of existing building is being changed, enter proposed use.
III. SELECTED CHABACTERISTICS OF BUILDING -
O /t/€'"'*'t'f#iffi*k"
.b ooo si,
DIMENSIONS
rlJumber of StorresIt)' .Total square feet of lloor area,
all floors, based on exterior
d imensions .
.Total land area, sq. ft
PRINCIPAL TYPE OF FRAME
I Masonry (wall bearing]
p Wood Frame
! Structural steel
! Reinforced concrete
E Other - Specify
TYPE OF WATER SUPPLY
[} Puotlc or private company
E lndividual (well, cistern)NUMBER OF OFF.STREET
PARKING SPACES
Enclosed
Outdoors
TYPE OF FIREPLACE
tl o rdF
PRINCIPAL TYPE OF HEATING FUEL
E Gas
E oit
E Ete"tricity
D coat
f) otner - Specify
TYPE OF MECHANICAL
I
I
RESIDENTIAL BUI LDINGS ONLY
Number of bedrooms
Full. .
Part ial
Number of
bathrooms
IV. IDENTIFICATION.
Name Mailing Address - Number, street, city and State ZIP code Tel. No
*rt R0{460& PogT Ltotot<t %a6f,ufl-aq1l
Owner
CI-EA.*-
2.
Contractor State Licerrse No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant
C./ t'y'.t-,ta -
Address 4t3CS-
tlT t Bo/{toQ ?fit,|-uN-ctq)
Application date
\
o
tot\
oa-
I\
o
q-
o
l-
PLANNING AREA WATE ICTFIRE DISTRICT SCHOO
BY Kr
J2/?-a
APPROVED BY
ING OFFICIAL
PERMIT FEE ISSUE DATE
t3t1
PERMIT NUMBER
Subdivision
Section Township Ranqe
SPnocF 57.
)_z 2Nru /€.w.rLt
number ol units
1
3 O. c>O
BETUBN ADDRESS
JOSEPH AND DEBRA MCDERMOTT
?57R)\HI,JY. 1 O 1
PORT A NGELES. I^]A 98362
t)
MANUFACTURED HOIVIE
APPLICATION
Anyone who knowlngly makes a false stEtoment ol a materlal lacl ls gullty
ol a felony, and upon convlctlon may be punlthed by a flne, lmprlsonment, or
Elrrle ELTMTNATToN
flrnlNsreR rN LocATtoN
ElRenaoval FRoM REAL pnopE
both. (RCW 46 .1 2,21 001''t,l1111,,
'fJ'9.S6y""YEAR1982 MAKE
BERKS
VEHICLE IOENTIFICA
WAFL2AC3
,TON
03 1 t7
MANUFACTUREO HOME
LANO LEGAL DESCBIPTION ON
MANUFACTUREO HOME W|LL BE ffi ArrrXeO ! neuoveo REAL ,AX
\:,N.py?;Fei i-t
22-t+BL?TK 'fdfl6aise View esrares
REGISTERED/LEGAL OWN AOOITIONAL NAMES ON PAGE
COUNTY NUMBES NUMBER OF REOISTEREO OWNERS
2
NUMEER OF TEGAL
JOSEPH MCDERMOTT
NAME OF FEGISTEREO OWNER
NAM€ OF AOOIIIONAL REGISIEREO OWNER
DEBRA MCDERMOTT
AOORESS CITY
', I{A 98362PORT A NGEI,E.S
STATE ZIP COOE
257 825 HI^IY. 101
FIRST FEDERAL SAVIANGS & LOAN
NAME OF LEGAL OWNER
NAME OF ADOITIONAL LEGAL OWNEN
AOOBESS CITY STATE ZIP COOE
GRANTEE
NAME
vEHICLE AND THIS INFORMATION lS ACCURATET
Signature of Registered Owner and Tifle, lF
owner and Titte, lF APPLICABLE
ov Cln" ,q ,n13o-<rr., ,,..*-
pBrNT NAME oF REGISTEREo owNEF phrxtEo NAME oF iroreey
AT a v
o2-15-2009
Fgggt0 PBINT NAME OF ABY OF AGENT
br
L-by Signature
Op
Tiile AND
\;\q2 Signsd or attested
betore me on
I StateolWashington
Countyol
NOTABIZATIO'.UCERTI FICATION FOR REGISTERED owNER(S)IGNA
County/Otfice
Oealer
and correct p€r the real
TITLE COMPANY / PHONE
is records.that the descriptlon of the land
NAME (TYPEO OR PFINTEO}
TITLE COMPANY CERTIFICATION
IURE / POSITION OATE
o, th€ dato1calendar R€presentatlveFlnallze thls
BU ILOING PERMIT OFFICE CERTIFICATION
manulactured home has been atfixed to the real property as described.
a building permit has been issued lor this purpose and the attachment will be inspectsd upon completion
I certify that:
SLDG PERMIT OFFICE/PHONE T
-Bb-\ a1q 4{5o
OR PRINTEO)NAME
|-
SLOG PENMIT T
UOg L.CIDIL
/ POSITION
PLEASE EHECK,ONE
I
2
"i,l,ilao**:l q'$s'
3
1
lt )e6-)
JOSPEH MCDERMOTT
No.
4
a
5
OFs
FBOM FEAL PROPERTYOF TITLE/TURE OF LEGAL OWNEB INOICATES CONSENT FOR
Signatur€ol Legal Owner and Tltle, lF APPLICABLE
and TitlE, I F APPLICABLESignature of
gOTA Qy
Exp. oe-r
Puguto
WA
a,-l
OF NOTARY
CLALLATI
Sighature
PFINTEOPRINT
Slgnad oranosted
me on
AND:
SIGNATUBEowNEF(S)LFORTIONFICAABIZATIOI.UCERTINOT
M)TARYTitle 'ABY Dato
Washinglon
County ol
County/Otlice No. OR
Dealer No. OR--
land can beDESC lrom untylega
Lots L2 t,hrough L4 , inclusiY. t Block. ttH" Paradise view Estates ,
according to it" Piat record;a in Volume 4 of Plats, Page 8,
records ;f Jefferson County, lJashington'
R'S AS
EEENT,
OATE OF SALEWA OEALEB NUMBER
OEALEB N^ME (TYPED OR PRINTEO)
OEALER'S AUTHOBIZEO SIGNATUNETAX JUFISOICTIOVTTJ( RA,TEPURCHASE PRICE
notarlzed statement ofthe resgrvatlonTribalCertifiedaSaletoEMPTEUSEXTAX
lor ueeAPPROVAL;A
the
corrsctly, and the aPPlicant has sutlicisnt documentation to proceed withhav'eioappears
.6tNAMEOR
{Aro aSIGNATUBE
r-s0
TITLE FEES
.:1:
USE TAXELIMINATION FEEMOBILE HOME FEEFILING FEE
IMPORTANT: Once the application has been approved by
For tull instructions on completing this ,orm for TitlE Elimination, Removal lrom Real Property
or Transfer in Location, see forrn-To-4zo-730, Manufactured Home Application lnstructions'
APPLICANTS:Once recorded,you must return to a Vehicle Licensing otfice to file the
Manufactured Home Application, paYing all
charge a service fee.
required fees.Vehicle
licensing subagents
,the County Recording Otfice'
Recording Otlico retains
the County Auditor / Vehicle
Office, take your application form toLicensing
of the recording lees Paid, lf theRotain proof
copy of the recorded torm'application form, oblain a certifiedyour original
70.420-729 MANUF FOME APPL (F/Ug8)OR PrgeZ ol 2
The Oeperlment ol Licensing has a policy ol providing equal accoss to ils services.
lyou nieed special accommodation, pleasecal (360) 902-3600orTDD (360) 6O4'8885.
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1 2-30-2005
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