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HomeMy WebLinkAboutBLD1989-00474 l3UIL G 'ERMIT APPLIGATION Jefferson CountyBuilding Department0P .O . Box i2200Porkownsend . WA 98368, LOCATION <.J"=27 SPECIFIC LOCATION SITE ADDRESS POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIVISION/ TAX NUMBER PARCEL NUMBER —AO, c . 24 - P 1 / 4 SECTION \ } PLANNING AREA SECTIONc��` TOWNSHIP �7 NORTH RANGE � VV WM BUILDING INFORMATION BUIL ING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ INGLE FAMILY ❑ NEW BUILDING MAIN FLOOR MOTILE HOME ❑ ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL ❑ MULTI - FAMILY NAELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOfyIES ❑ COMMERCIAL SIZE iO `X/ *1.5 A 2 $35 ❑ INDUSTRIAL YEAR 4 $ 1 6 ❑ HOTEL/MOTEL/DORMITORY MAKE � t--0©4 0 @ $8 NUMBER OF UNITS ❑ OTHER SPECIFY ESTIMATED COST OF $8 f'. IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUPS/' ," $ $ SELECTED CHARACTERISTICS OF BUILDING , PRINCIPLE TYPE OF FRAME PRI IPLE TYPE OF HEATING FUEL ELECTRICITY ❑ COLLECTIVE SOLAR ❑ OD FRAME MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW , HEA TH 7ARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOM ., 9 ❑ P B L I C OR PR I V AT E NUMBER OF EXI ST I IJG BEDROOMS 1 . ^ D t V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM Ls� A PROVED DA E INDIVIDUAL WELL 1. NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)m�MweTmm 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 0 NO ___ IDENTIFICATION IDENTIFICATION ��^ NAME MAILING ADDRESS ZIP T E L NO OWNER --- v_04L,1,_ - D r-Sc)-i( 0-4 (--- R7(,) '7&, -)-- CONT , $'TATE LICENSE NO I .- ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS, SIG ATURE?OF APPLICANT APPLICATIONRECEIPT U r BER L HECK NUMBER OR CASH ,�``����GGpp((/ 6/; 189I 77 ,_ - APPROVED BY DATE PERMIT FEES A PP O V E ® 76 BASE FEE INSPECTION BLDG SURCHARGE PLAN CHECK S P 2 89 ENERGY SURCHARGE $ %� 5`---_ _^ TOTAL JEFFERSON COUNTY MANNINO&BLDG DEPT I REFUND DATE A E 1 S D C� 9 1 1 NUMBER 1��� �1� C� BUILDING OFFICIAL I ( . 4 4111• OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account # PP Account # 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) ,ScorT Z,i il(C(20 F. 1 r Street or Box ,c), � ,ZQ(-{City QuILCJI State/Zip W 737 Home phone 765 S C' Work phone 3 8S ` V 7 Q Best time to call A �,[ T\ 1\A (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) L'1S Width ICE Model Year 6 S Make l` (-Er-T (,oOO Model Serial number 5,3 3 c.($ ***************** MOBILE HOME LOCATION - IN PARK Park name Space # Date placed in park (PLEASE COMPLETE REVERSE SIDE) a 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) (O1. 1) BUYING RENT 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 f ii i4t� /0/ --o ?H City 4u 14 eiti ' If you rent the land what is the name and mailing address of the land owner? Name Street or Box City State/Zip Telephone number *********** MOBILE HOME HISTORY Date you purchased ATQl L. 2-6 8 t Purchase price Akt MO,o Q 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. nu, 1, LceMC I,JP, , Didn't move - purchased 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 i i Vj'in ff\\� el < -� x r 1- Bpi. rook drcr ray Fi. H, JAytvr Pi iltif 1o1