HomeMy WebLinkAboutBLD2018-00489 - 02A MANUFACTURED HOME,
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DEPARTMENT OF COMMLINITY DEVELO
621 Sheridan Street, Port'Iownsend, WA 98368
Tel. 360.37 9.4450 | Fax: 360.379.4451
Web : www.co.ieffetson.wa. us /communitydevelopment
E-mail: dcd@co.iefferson.wa.us
SUPPLEMENTAL APPLICATION
MOBILE OR MANUFACTURED HOME
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For Department Use Only
Related Application #s:
Receipt #Date:
Payment #:
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Submittal Documents
Permit Application, Supplemental Applications and Fees; 3 copies Completed and signed.
Each building permit requires a separate application, signed and dated by property owner.
Water Completed and signed permit application. Please submit 2 copies.
You must provide all information necessary to prove potable water prior to submitting
yourbldgpermit. Well -mustincludewell logsandlabanalysisatthetimeof application.
Public Water - have a completed & signed Water Availability Notification from water purveyor,
Septic Septic Permit Number
A septic permit applicatio
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ding application.n must be on file prior to submitting your buil
O&M Form First page of Current O&M lnspection paperwork. Please submit 2 copies.
Site Plan We cannot accept a site plan larger than 11" x 17". Please submit 5 copies.
See Site Plan checklist to ensure your site plan is complete at time of application
Floor Plan We cannot accept a floor plan larger than !!" x L7" . Please submit3 copies./
All rooms to be labeled on the site plan, show any, including garage, that are unheated.
lf this is a remodel provide a before and after floor plan with all rooms labeled.
Stormwater 2 copies of the stormwater calculation worksheet is required for all building applications.
All stormwater plans must comply with the current Stormwater Management Manual for
Western Washin gton : http ://www.ecy.wa.gov/programs/wq/stormwater/man ual. html
Access Road Approach Permit Application. An approved access is required for all County roads
if approach has not been previously approved.
Existing - Permit Number RAP OR
Private Road (no permit required); OR State Road (permit from WSDOT)
Address Address Application required for all construction projects, if no address is currently assigned.
Existing Address & Red fire sign showing your current address on site
ManufacturedHomes-reguirenoplansattimeofsubmittal. Howeverattimeofall inspections,therequiredset
up manual must be on site with permit or no inspection will be performed, and a re-inspection fee assessed.
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All Existing Buildings on Property
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Home Data:
Make:
Length
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Your Purchase Price Don't include sales tax): S Purchase Date:
Yea r:
Serial #
Model:
width:
Was manufactured home assessed in Jefferson County last year:
lf yes, Previous address of manufactured home:
No}(YES
Previous Owner/Location of Home (if new move to question next question):
lf no, what County was M/H assessed in last r:
Where is the manufactured home to be located:
Willthe home be in a mobile home park?
lf located in a mobile home park: Name and address of park:
lf not located in a mobile home park: Name of land owner:
Location address:
Assessor tax parcel #
NoxYES
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Property Owner Name:Assessor Tax Parcel #:
Replacement Moved Demolition
Pa rk On a Lot Tem pora ry Construction Living Qua rters
X
Type of Manufactured Home:
Check One:
New
Check One:
.g
Sq/Ft:
lb0
Type of Heating:(\ u,lri
Number of Bedrooms:
Number of Bathrooms
Sq/Ft: c-- GarageDeck: N
Proposed Buildi ng/Project:
Square Footage:
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Contractors License #
Address, City, State, Zip:
lnstaller Email:
lnsta ller
Phone:
By signing this application form, the owner/agent attests that the information provided herein, and in any attachments, is
true and correct to the best of his, her or its knowledge. Any material falsehood or any omission of a material fact made
by the owner/agent with respect to this application packet may result in making any issued permit null and void.
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Assessor lnformation
From whom did you purchase your manufactured home:
Address
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