HomeMy WebLinkAboutBLD1989-00470 [AWING i, 'ERMIT APPLICATION ..
Jefferson County Building Department7P .O . Box 1220. Townsend.. WA 98368
4LOCATEION .
SPECIFIC LOCATION1 SITE ADDRESS ' n...„ 1 rtA lA i2C.2
POSTAL DISTRICT / A/SUBDIVISION _r () etC
li.„. ../
L._.6 iL) 1c\_)
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LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER91p5-1006Q01 1 / 4 SECTION .
PLANNING AREA_ SECTION_ TOWNSHIP ,AD NORTH RANGE Ik .4 WM
BUILDING INFORMATION
---- .
BUILDING TYPE ! TYPE OF IMPROVEMENT :SQUARE FOOTAGE
O SINGLE FAMILY ri NEW BUILDING MAIN FLOOR
4ZDILE HOME 0 ADDITIOE! 2ND FLOOR
0 M DULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT 1GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING, INDUSTRIAL
NUMBER OF UNITS * --
MOBILE HOMES SIZE
O COMMERCIAL )CL1. rill a 3
0 INDUSTRIAL
YEAR A $ ! 6
O HOTEL/MOTEL/DORMITORY , , _A- ----0
4... ° @
NUMBER OF UNITS ----------
- ---_, MAKE y $O ----
---
0 OTHER - SPECIFY ESTIMATEL COST OF @ "
(Th IMPROVEMENTS T TAL FAIR MARKET VALUE
'. ! UDC OCCUPANCY GROU
--- -- —
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME ----
PRINCIPLE TYPE or HEATING FUEL
az - -
O WOOD FRAME Li.,CIR
, ' ICITY 0 COLLECTIVE SOLAR
(--- - C < ANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
,_•
--- 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) _ NUMBER
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
41Q DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWA;:: : DI SPOSAL NW,DER OF PROPOSED BEDROOMS
CIA48Ciaj A 0 ' If'UBLIC OR PRIVATE ,FR OF EXISTING BEDROOMS
UN: I NO I I DUAL ( SEPT I NUMBER OF PROPOSED BATHROOM - - ._
APPROVED DATE--_____
q.,,. .IID I V I DUAL WELL J9 NumB ER op Ex'ST NG EATHnoom
- ,...,_,.„...,....._ ,,,.s._ .....6.0-
.A• PUD TYP,E OF WATER SURELY
e cc-3J
7-a%-pD0 q nsi 0 pbriLIC ( NAME or WATER SUPPLY
APPROVED DATE 0,,,, PRIVATE ( NAM7 OF WATER SUPPLI) C)-
PLANNING .P.--T-r- WITHIN SHORELINE JURISDICTION
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O YES NAME OF ADJACENT WATER BODY
O NO
APPROVED DATE BANK HE SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
0PP A 07
ROVED DATE NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD . ...
ROAD ACCESS PERMIT REQUIRED 0 YES D NO
--- ---- . ,
IDENTIFICATION
,.....,
----
NAme mAiLirAG ADURESS A ZIP TEL'.3 NO
OWNER e - -
,
11 ,CONT
17. A:7, Li
=1,79
ARCH
THE OWNER OF THIS BUILDING AND THE UND77:Rn7GNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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711 G,A uRE OF APPL I C AT P..PI:1_l(fri- I ' ,Trz L-7F27 I PCUNBER CHECK NUM3BERi OR CASH
,
1 . . .
-; - - — ° I
A R41 ED I. PERMIT FEES
AP14 , , l' .. . :7 .0_2, CASE FEE INSPECTION
Iv , ---.....---- _ , rq,s a B LUG SURCHARGE ,.. ._...,\PLAN CHECK
\ISA' 2 6 989 _
ENERGY SUL7C-1/sLRGE E
JEFFERSON COUNTY , TOTAL
PLANNING&BLDG OW „ ,
IIIIL).. 9 1 1 NUMBER , 'REFUND DATE rIE _ 7
BUILDING OFFICIAL
toos.....
40 ,4L ci• iifflcic
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account I
PP Account ll I
DATE l v( N7
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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.
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REASON FOR INQUIRY:
Field visit Excise tax Buildi g Moving
by deputy affidavit permit permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
r / ;
Name(s)
Street or Box C : ac i)
City / / State/Zip
Home phone ? ' 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 /V /4�
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MOBILE HOME DATA: C/
Length (exclude hitch) q (''T Width Model Year l C ?'
Make Model
7
Serial numbe
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MOBILE HOME LOCATION - IN PARK
Park name kl6t)
Space 11 Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
III ilk`
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which mobile home is locatedNT or do you
rent the land? (CIRCLE)
OWN BUYING
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
What is the street address of this land?
Street 1-4:10)\Ot'""' v
c QQ
City )
If you rent the lan what is the name and mailing address of the land owner?
Name /v
fr-
Street or Box
State/Zip
City
Telephone number
***********
MOBILE HOME HISTORY 7
Date you purcha d
Purchase pric qDv 1
How did this mobile home get to its present location:
Moved into Jefferson County from 2_..2/1/1..
(County or S e)
Delivered by dealer (name) V
Moved from another Jefferson County to ation? E o NO. If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes o NO
Name of previous owner
Address
State/Zip
City
If moved, was advance tax pai . YES, r NO. If yes, to which County
D oes- the mobile home replace a previous mobile home at this new location? Y NO
If this is a replacement, to whom and wh re did the previous mobile home go?
you (9
foryour assistance. If you need help or information about the assessment
Thank Questions about taxes
of your mobile homescOfficeeats385S9150,s Office at 385-9105.
call the Treasurer
(NOTE: If mobile home is new to this county
ma vatluation notice will be mailed to
you when it's valued and added to the
ll.)
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
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