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HomeMy WebLinkAboutBLD1989-00452 BUING PERMIT APPLICATION Jefferson County Building tepartrnent`P .O . Box 1220•Port Townsend, WA 98368 v LOCATION / SPECIFIC LOCATION SITE ADDRESS 4 POSTAL DISTRICT /SUBDIVISION oft IA4{j(+�J�f4 Iro LEGAL DESCRIPTION LOT( / A'f'[FkLOCK/ ( DIVIIO TAX 'A11. BE �� r PARCEL NUMB R sµC14 �Cn' (CD 1 1 / 4 SECT 1 ON SECT I ONr TOWNSH I PIc 2C) NORTH RANGE ' LI ) WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE!� FOOTAGE .., c"/ ❑ SINGLE FAMILY �(,i NEW BUILDING MAIN FLOOR [ /ro ..„'MOBILE HOME 0 ADDITION 2ND FLOOR E MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL • MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES 0 COMMERCIAL J. AS I ZE b C. 0 1 $35 ❑ INDUSTRIAL v �{y ❑ HOTEL/MOTEL/DORMITORY YEAR I79 W $ 16 MAKE )"J.a LA:,f> %W7 @ $8 NUMBER OF UNITS ., A1+14:21z1�,t, Ci+a ❑ OTHER SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROU l $ $ i SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL "-< 0 WOOD FRAME [( ELECTRICITY ❑ COLLECTIVE SOLAR .. %,MANUFACTURED /❑ WOODSTOVE ❑ PASSIVE SOLAR 0 STRUCTURAL STEEL 0 GAS 0 COAL 0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH D'f'PARTMENT ! TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS It t((e\.1��� r1 '(_ ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS / A INDIVIDUAL ( SEPTIC ) UMBER OF PROPOSED BATHROOM APPROVED DATE ❑ INDIVIDUAL WELL '+NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY , PUBLIC ( NAME OF WATER SUPPLY) -, r APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY 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 ❑ YES ❑ NO IDENTIFICATION NAME MAILING ADDRESS ZIP TEL NO OWNER ,* , &. Jlf4-"Y.X J VR�9O Ain Cye K /R11 qA �4� 9C333c 3 ?5- Y 3�--JC CONT ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; SIGNATURE OF APPLICANT AP L CAT10 DATE 1 RECEIfT P NpMBER ICHECKER OR CASH tl NUMBER A APPROV PERMIT (FEES , A P P 75, Cj ) BASE FEE I NSPECT I ON 0 3 0 � 89 BLDG SURCHARGE PLAN CHECK • ENERGY SURCHARGE $2R 5 O TOTAL JEFFERSON COUNTY PLANNING&SLOG DEPT �� ...:�L11.... . 9 1 1 NUMBER REFUND DATE DAT I SS D BUILDING OFFICIAL I ` `C/3O/ 70 1+0 /o/i 716 9-L OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account # PP Account I 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 ( 7. 7 ) Moving by deputy affidavit ermit permit Dealer report Application Delinquent State transfer by sale for title taxes report ******************************* MOBILE HOME OWNERSHIP/OCCUPANT DATA Name(s) / ® I a ie1'/ E ) 5 . Street or Box �� City AlC /C,°°.. _ State/Zip Q 5 3 Home phone .?g, 5 -I3 5 Work phone 3 5 r 3 .8 3 67/1/Y1 .- :1 )/V)i) Best time to call 6j©k-k- n7/ / �?j 130 Ac7�f 4 .1040A 07 (specify home or work) NOTE: If you rent the mobile home give name, address, and telephone number of owner here ***************** MOBILE HOME DATA: Length (exclude hitch) ‘ Width , 0 Model Year /99© Make Ai e 7 D OO Q/ Model a nda�['t»®Q '?/ F.6,3 Serial number ***************** MOBILE HOME LOCATION - IN PARK Park name Space Ii Date placed in park (PLEASE COMPLETE REVERSE SIDE) .111.111 MOBILE HOME LOCATION - NOT IN A PARK D0 ou own (or are buying) land on which mobile home is located or do you r y � CIRCLE) OWN BUYING rent the land. Assessor's Real Property account (parcel) number (The 9 digit number on the tax statement or valuation notice) . *I9S o 800 - (ooj What is the street address of this land? Street City If ou rent the land what is the name and mailing address of the land owner? Y Name • Street or Box State/Zip City Telephone number *********** MOBILE HOME HISTORY Date you purchased Purchase price /0 O How did this mobile home get to its present location: Moved into Jefferson County from (County or State) Delivered by dealer (name) ' 9 ✓ 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 State/Zip City If moved, was advance tax paid? YES or NO. If yes, to which County Does -themobile home replace a previous mobile home at this new location? YES ore) 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 A 385 sS9150,or's Office at 385-9105. uestions about taxes Q call the Treasurer's Office at (NOTE: If mobile home is new to this county avaluation notice will be mailed to youuwhen it's valued and added to the assessment se send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE Plea PO Box 1220 WA 98368 PORT TOWNSEND, '4 --- 1-1- ' n61--t try • I, s----t----,Q. \) Qh s-A-: ., . P 0o( (. , ( ..t ' a -_)- P\\N0Q, he , .,/ sly f . so I IRR .,Se_,(,---1,) e_., c \N e .