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HomeMy WebLinkAboutBLD1988-00054 OILDING ` 'ERMIT APPLICATION Jefferson County Building Department•P .O . Box 1220. 'ort Townsend. WA 98368, O AT ON 1 {/ L C i , SPECIFIC LOCATION SITE ADDRESS -- "` /� `" POSTAL DISTRICT - /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIYV SION TAX NUMBER PARCEL NU E'ER .7f /`..2,JOO 1 / 4 SECTION � / SECTION y. -. TOWNSHIP • NORTH RANGE / Li( ,i WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑,.SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR `` MOF3ILE HOME 0 ADDITION END FLOOR ❑ MODULAR HOME 0 ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL _777/ ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE OME / ❑ COMMERCIAL SIZE 1 (O.)GP C @. $3'5 ❑ INDUSTRIAL YEAR ! . w,0FF�� C�/�$ I s ❑ HOTEL/MOTEL/DORMITORY MAKE , 2C.'ICAC)60C../ VIA $8 NUMBER OF UNITS j'' ❑ OTHER - SPECIFY ESTIMATED COST OF _____ @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUPS $ SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME P NCIPLE TYPE OF HEATING FUEL ❑ WOOD_FRAME LECTRICITY 0 COLLECTIVE SOLAR 'MANUFACTURED OODSTOVE 0 PASSIVE SOLAR ❑ STRUCTURAL STEEL 0 GAS 0 COAL ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS J 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM..J_ APPROVED DATE INDIVIDUAL W E L L NUMBER OF EXISTING BATHROOM��� UD TYPE OF WATER SUPPLY APPRO� � 0 PUBLIC ( NAME OF WATER SUPPLY) VED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY) _ .mmm® PLANNING DEPT . WITHIN SHORELINE JURISDICTION /AL ) \ (76T ❑ YES NAME OF ADJACENT WATER BODY 0 NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME: OF PUBLIC ROAD A)/ fl}- NAME: OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO IDENTIFICATION "---'^— MAILING ADDRESS ZIP P TEL N Ems` U r C l p--„Alxkiy CONT '"S'f W'I'E' -LICENSE NO ARCH ------a— 1 THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. ,IG TURE OF APP 'ANT- APPLIC T►ON ATE RECEIPT NUMB„lR CHECK NUMBER OR CASH . ,7:.,/,(e9",„..,..77... ,ovi.e--:...-2 ---- p- --5(c.'). 3 6 . _ (77 APPR`:2- Y PERMIT� FEES jI� v/w'\ BASE FEE INSPECTION � � � > BLDG SURCHARGE PLAN CHECK ' C 1 3 1988 ENERGY SURCHARGE $ N7S2 I¶L ) TOTAL JEFFERSO�N COUNTY REIF UNPD DATE DATE 1 SSU D PINNING&BLDG DEPT 9 I I NUMBER BUILDING OFFICIAL 1 �kg 1 °� ryi,Ism �( l C T w / [J ij.)-7// c-4s 3, , • RETURN ADDRESS FIRST AMER ICAN TITLE INSIRANCE CO. P.O. BOX 598 PORT TOWNSEND, WA 98368 ElL7STA=astTEm OFrntWofASHINGTON MANUFACTURED HOME -L AS CH CK ONE ID TITLE ELIMINATION ICEflSIflG APPLICATION OTRANSFER IN LOCATION Anyone who knowingly makes a false statement of a material fact Is guilty ['REMOVAL FROM REAL PROPERTY of a felony, and upon conviction may be punished by a fine,imprisonment,or both.(RCW 46.12.210) D MANUFACTURED HOME TPO P1LAT6NUMBER I YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 1,1988 iTNWnnTI 30 X 60 Serial No, 3191 0651 W AB © LAND LEGAL DESCRIPTION ON PAGE REAL PROPERTY TAX PARCEL NUMBER MANUFACTURED HOME WILL BE 13 AFFIXED 0 REMOVED 801 1.2.1 008 LOT BLOCK PLAT NAME SECTION/TOWNSHIP/RANGE PTN SW NE 12-28-1W © GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS Jefferson 1 1 NAME OF REGISTERED OWNER Arlon K. Johnson NAME OF ADDITIONAL REGISTERED OWNER ADDRESS CITY STATE ZIP CODE 553 Embody Street Port Ludlow WA 98365 NAME OF LEGAL OWNER COUNTRYWTD.E. HOME. LOANS-- NAME OF ADDITIONAL LEGAL OWNER ADDRESS CITY STATE ZIP CODE P.O. BOX 170, Sf8'IT ITALLEY CA 93093-5170 GRANTEE NAME I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: i Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE --- ' q,, A, YSFAWLR$TAMaar NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE ��'''(= REI® , state of Washington Signedorattested NOTARY ���� ( County of befor eon I STATE OF WASHINGTON ' ( Q J f ,- COMMISSION EXPIRE; 'y �'1.�1I i-^ O l'''.Y'' > Signature �J �l MARCH )9 ' RI T NAME OF REGISTB OWNER C NOTARY OR A Q.P C/ PRINT NAME OF REGISTERED OWNER PRINTED NAME OTARY ,, / County/Office No.OR f I 9 i, f ' Title ( AND: Dealer No.OR.) 0 DEALERSHIP POSITION/AGEN /NOTARY Notary Expiration Date 4 TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. 0 BUILDING PERMITOFFICE CERTIFICATION I certify that: the manufactured home has been affixed to the real property as described. a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(T ED OR PRINTED) BLDG PERMIT OFFICE/PHONE# BLDG PERMIT# (364 37q- 41150 SIGN.A't''T/L�`iE/P SITICN a VI�� AQ-kk, �\�.0 p TE TD-420-7IAN HOMEAPPL(R/ 8)OR Page 1 of 2 {{{ (_/ t .71F F'F'F'.RSC7T7 t'.:C)t7TTTV .RT7T T.T)T TJC4 1 1 T"TT 'T Jefferson County Planning and Building Department Courthouse, 3rd Floor PO Box 1220 Port Townsend, WA 98368 2O6-385-9141 PF.RMTT # •RLD88-0054 DATE TSSUED. : 12/13 88 SiTE ADDRESS : 553 EMBODY RD PORT LUDLOW, WA 98385 OWNER •ARLON JOHNSON PHONE: MAILING ADDR: 553 EMBODY RD -PORT LItnLOW WA 98385 CONTRACTOR. . -NO CONTRACTOR PHONE: MATLTNG ADDR CONTR. LTC #: EXPIRATION DATE- PARCEL NO. . . : 801121.-008 LEGAT, DF.SC. . :STR 12-28-01 WWM, TAX # T.OT , BLOCK DESCRIPTION OF TMPROVF.MENT: MOBILE HOME INSTALLATION ( ) Footing/Setbacks (Shoreline Sethack)/Mobile Home Blocking: ( ) Foundation - ( ) Underground Plumbing/Underground Insulation ( ) Framing/Plumbing/Chimney: ( ) Insulation : ( ) Sheetrnck ( ) Sewage Disposal System Final : ( ) Final /Occupancy Approval : CAT,T, 385-9141 24 HOURS TN ADVANCE TO SCHEDULE INSPECTIONS. Office Hours 9 a.m. to 5 p.m. inspector 's Hours 9 - 10 a.m. 24 Hour Recorder for Inspections. j!;11,-JA:10 "-'tiU6 'saj6trb. od ' • 06 DRAW AS-BUILT BELOW • -T&) rn ; d( e_ S 10 n • Sit 0 woo C - ldc )0 • Ip• • 111 Ti rrr l.._t N E `— �.�cv�J C C z— I CERTIFY THAT THIS SYSTEM WAS INSTALLED IN A MANNER APPROVED BY THE HEALTH DEPARTMENT: • . INSTALLERS SIGNATURE DATE DATE INSTALLED ' s % \C-.1 U 7 �? aN\ ., • ;a. • DEC I 3 ------- -S'-)'L;j_e_ _?----,„ c c", / -c11..144, ----':-'-----'-- JEFFERSON COUNTY Pt4NNING&BLOC DEPT 2/1 ,//65c /04ice._ S(( c(c4..yo /- r /2 L4e i44'1/7-----1 I--•-c.a p '/ --- --- - IX I I M 4-6G116-k '3 ( t9 q o / —(- 1 L -2Q. ,..4(.... 715—c-4k*z/F) _ /7 74-790 --- . - --i /44 7 ) /11 i (1"'il! 1 e7rt ) L /2- / /2--/ V) — — FT-4-a-P - /--L-0,--/- -,,ad - i 4 L4174 /1' --b6 'P.,S2j"-• , -?--- i 21// /17 - r_ 74,/A L / 2 /1/4) 1- //7 0 i' ( -:Z