HomeMy WebLinkAboutBLD1989-00448 (SLDING "ERMIT APPLICATION 0
Jefferson County Building Department'P .O . Box 1220'rort Townsend. WA 98368
4.,O G A TJ O N j3/ /0.1, '" -4,-.4 Os g4.0
SPECIFIC LOCATION' Si `:ic: ADDRESS_,.
POSTAL DIS;RICT /T— /SJBDIVIS !ON
LEGAL DESCRIPTION LOT BLOCK DIVISION,/ TAX NUMBER
•
PARCEL NUMBER I_ ('O/ 333 67O 1 / 4 SECTION
PLANNING AREA SECTION 3 Z TOWNSHIP. 30 NORTH RANGE / WM
BUILDING INFORMATION '
BUILDING TYPE T £ OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR I
)4
MOBILE HOME ADDITION 2ND FLOOR �
❑ MODULAR HOME 0 ALTERATION BASEMENT i
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
/
GARAGE 0 REPLACEMENT ` GARAGE
❑ WOODSTOVE 0 W'RECK I NG/DEMOLITION " COM RC I AL
O MULTI - FAMILY 0 RELOCATION/MOVING 1 USTRIAL
NUMBER OF UNITS MOBILE HOMES❑ COMMERCIAL SIZE Cs; rZ SLJ 0 a $35
❑ INDUSTRIAL YEAR VI 16
t.J ❑ HOTEL/MOTEL/DORMITORY MAKE �1� n- d a $6
NUMBER OF UNITS
0 OTHER - SPECIFY ESTIMATED COST OF @ 58
UBC OCCUPANCY GROrIMPROVEMENT �OTAL FAIR MARKET VALUE
�J $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
0 WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE t
J 0 MANUFACTURED / 0 WOODSTOVE 0 PAS SOLAR
0 STRUCTURAL S L 0 GAS GOAL
O REINFOR CONCRETE 0 OIL 0 OTHER - SPECIFY
O MAS Y ( WALL BEARING ) ENSIONS
❑ HER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW ____
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER or PROPOSED BEDROOMS
Q //�/(� �� UBL 1 C OR PRIVATE NUMBER OF EXISTING BEDROOMS
1 / (v INDIVIDUAL ( SEPTIC ) NUMPER OF PROPOSED BATHROOM„I
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF.
EXISTING BATHROOM
PUD TY E OF WATER SUPPLY 0PUBLIC ( NAME OF WATER SUPPLY) I
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
"1J PLANNING DEPT , WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
01 el
❑ NO
Z APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
"® 'V�, 1 K NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
v APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
mm ------
NAVE MAILING ADDRESS gZ�I��P`�y,� TEL NO
OWNER /// O "� (��'"''-^ l 1 v 1�
_ /� !J/i/ZoL� �5��-0 �O //SGa
-
��4-Yip/ _
CONT
+ STATE LTEEF1SE NO I
1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIG ATURE OF APPLICANT APPLICAT ON DATE RECEIPT NUMBER CHECK NUMB R OR CASH
APPROV BY PERMIT FEES�^-
��� J "- BASE FEE INSPECTION
- 7q-_-
BLDG SURCHARGE PLAN CHECK
_1 b
ENERGY SURCHARGETOTAL
.JFF€Ei Gnu r r:Litef
PLANNIV 6 O AA OVT 8 1 1 NUMBER REFUND DATE T D
1*--
BUILDING OFFICIAL - _J
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account I1
DATE
**********************************************************************************
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 permit permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) YT ) 1/1- r 1170Y (Of
Street or Box
City State/Zip
Home phone ^6,0,3 Work phone
Best time to call
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here
*****************
MOBILE HOME DATA: r'
Length (exclude hitch) Width /? Model Year 7/
Make /�� Model -
Serial number
*****************
MOBILE HOME LOC ION - . N PARK
Park name
Space I1 Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which mobile home is located or do you
rent the land? (CIRCLE) OWN BUYING RENT
Assessor's Real Property account (parcel) number (The .9 digit number on the tax
statement or valuation notice) .
( O/ 333 a 10
What is the street address of this land?
Street / �/ ✓ ��� 0\711
City
c �
If you rent the lan what is the ame and mailing address of the land owner?
Name
Street or Box
City State/Zip
Telephone number
***********
MOBILE HOME HISTORY
Date you purchased
Purchase price
How did this mobile home get to its present location:
Moved into Jefferson County from
(County or State)
Delivered by dealer (name)
Moved from another Jefferson County location? YES or NO. If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes or NO
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 NO
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 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
IMMENNEMENME
i ToW Country_ Suite B • 16521 Hig 99 • Lynnwood. WA 98037-3161
'en" 1.11111.1MMII. STEEL UILDINGS Everett Line. (206) 258—,'71
ammiiiim Toll Free; 14300-824.9552
inintionsimsomoussa 1/ • Administrative 1' 'queftets: 206) 743-1555
Quality: Our Future Depends On It'
I.
Site Plan
PLEASE CHECK:
LtProperty dimensions NSeptic and drainfield EAccess to proposed building
CZ1Existing buildings ❑Sewer lines Vtot size
CXProposed building pSetbacks of proposed andElevation of property
Easements existing buildings 'Bodies of water
[(Main road with name LJFloorplan
Job name: P C{u, x, Ot''t ' -` Job Site Address: /37 V et3CIvdr, _ (
Legal Description f —-1.3 3 " 0 4f 0 J J t- s.'_; ,-
x
t
Cr,t . ------T----------, ,
. i
.,,
TA
I1:
r
t
I
rti
A r
R /7 fY'{r
()wnor has verified and approved the beaten of acc, .>:ories:, -..tentation of the building to the north,and verifies that afi item`specified in paragraph
B of the contract are shown on this drawing and vice versa. Customer signature: .�
a 4,.71984 PeranaBdt InOuatnes
1 CIA)
\,...." !
/2—A -./4 f — "'Si /V / r .
,
,
(---= lt 1
AA U S-7-- .k
C tT ILA.,J
kJ 1 V-AAL1----
,
1 -2(a=__)- A-kA-_ leD'•-u Cir- ak-NE- "ill br_____ !..ini '
0 ,.,"
// 2196 ill-
..w /Al,
V31 (CI! C 5,4,,j-3 Ce,t,-vv26
ilo iq.J
te) „. a I b r•igt I pti„ c.erktAkt PI
AQ r
' 2 , A)0 u4--,47-- ,,,,,,,
s- )_,,,,,,,,9,
- /
'3- 1-14 y ro763t, c)...ee4h.
tt ,- A) '
5-. A)0 stet...1, 0,44 IS-
/
/7 /49 il;C) ----
, r 4
cr
, .. ,/ )
_
5 /7 --- --
,
[
[
(L) '?)C
(..?:: ‘\'
3 ) --.....--- (...."..c......f.c2,14.4„,....„.._
L. ..,____............ LE vt..„..,..,....s 6....,.. st.,, ec,,,„..„,\
)
„.‘
[ ( so---
)!/_/a. ,.., 9-.z.) --
------ c .,,, ,m13,_c--\-, ..-3
A--\, - kc,
)5/4,r-
i I
kk?