HomeMy WebLinkAboutBLD1989-00001r
[31110ING , 'ERIIIT APPLICATION
Jefferson County Building DepartmentcP .O . Box 12200Frt Townsend , WA 98368
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LOCATJON, ___ _
,-,
SPECIFIC LOCATION SITE ADDRESS
.-..i 2:-.7 U::::-V& 7-_- . / / .. 2iL/ -
POSTAL DISTRICT I ,/ /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DI,VISION TAX NUMBER
- 1 PARCEL NUMBER f(9533(Az", 1 / 4 SECTION
PLANNING AREA SECTION _TOWNSHIP 0> C1 NORTH RANGE lbj WM
BUILDING INFORMATION --
f
BUILDING TYPE TYRE OF IMPROVEMENT SQUARE FOOTAGE
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O "INGLE FAMILY 0,'NEW BUILDING MAIN FLOOR
Ei MOBILE HOME 0 ADDITION 2ND FLOOR
O o;.ULAR HOME 0 ALTERATION BASEMENT
-, DETACHD A E ATTCHED -
0 REPAIR CARPORT ---' C- ;
-./ iC
GARAGE - (- ( C>4(- - 3C0/: 0 REPLACEMENT 1GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION / COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL
SIZE
O INDUSTRIAL I
YEAR . 0' 2 $ 1-8-
O HOTEL/MOTEL/DORMITORY
MAKE .2p(J1)
NUmBER OF UNITS
O OTHER - SPECIFY
ESTIMATED COST OF
A4rIMPROvEBLENTS 1116T F MARKET VALUE
UBC OCCUPANCY 0.;FRUP $
SELECTED CHARACTERISTICS or BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O ,,WOOD FRAME [" 'ELECTRICITY D COLLECTIVE SOLAR
' MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
AD STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
•
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
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DEPARTMENTAL REVIEW
- ......---
HEALTH DEP rimENT TYPE OF SEWAGE DISPOSAL- BER OF PROPOSED BEDROOMS '-- -
, ,.
d/&._ , •/fq 04, / $ 1 i 0 PUBLIC OR PRIVATE cN MBER. OF EXISTING BEDROOMS
'>('INDIVIDUAL ( SEPTIC K‘:,)- NUMBER OF PROPOSED r3ATHROOM-
APPROVED DATE 0 ,,,,,INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF 'HATER SUPPLY)APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPpLY),.
- ..ICIM'SMZ- ^r.Z.M11wItr==r,,r,,,7T,r,
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
0 O.
ONO
APPROVED DATE BANK HEIGHT SETBACK___
PUB
I\IC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
I -
ZikAhh : IOFF ZO7NL/ I/k(T:ERZDAD.)\)
APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES 0 NO
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IDENTIFICATION
. _
NAME MAILING ADDRESS ZIP TEL NO
OWNER '--r
C . . .-1-1 C—i -S',> 3 . :--
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CONT
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Ili , A
VI E OWNER 0 IS 'sli1i1—DING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICADLETAWS.
b...
S GNA E OFIVLIIVANT APPLICATkON DATE IRNCEIPT TRAMDER CHECK NURSER OR CASH
.. '• —
I S 6114. :
L8LILI _'"
APPRO4. ' , PERMIT FEES tgtv
ASE FEE INSPECTION
A c „
) V*4' '4` - (... L2(11 _- • BLDG SURCHARGE _. PLAN CHECK
_
JAN 3 usa \ ENERGY SURCHARGE (
$1 9'ctTh
TOTAL
JEFFE8SON .COUNI? -
PLANNING&fagi OF,1-'' ;/6) (4 911 NUMBER REFUND DATE DAT IS UE. .
BUILDING OFFICIAL . •S. .
. .
7 0 (1 tin /7Z,/(Ci 0
•
Manufactured Home:
Year �990 Make Glen River „ Width 27' Length 52'
Vehicle Identification Number Serial No. # GR-3673—X'1
Registered Owners:
Names Signatures'
Legal Owners:
Names BOMBARDIER CAPITAL INC. Signatures'
'SIGNATURES OF OWNERS INDICATE TERMINATION OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 48.12 RCW AND
INDICATE INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY OWN AND TO WHICH IT IS/IS
BEING AFFIXED.
Land to Which Manufactured Home is Being Affixed: 7 Gi/ek' y ree A Z.O.de ,ir+'#addfocc---
Property Tax Parcel Number 998 300 oii
Legal Description Tamarack Villa, Tot 19, Hardl n-'k, Wa_ , 98339
Owners' Names Harvey J. Minnihan Co. Signatures2
'SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED TO THE REAL PROPERTY LISTED ABOVE.
Building Permit Office Certification:
I certify that the manufactured home has been affixed to the real property as described above and/or building-permit
number has been issued for the purpose of affixing the manufactured home to the land and will be
inspected upon completion.
(P NAME SIGNATURE BLDG.PERMIT OFFICE DATE. PHONE NUMBER
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application app ars be n p tE ectly, and that the appPlicant has sufficient
documentation to proceed with the re rdin ofP this orm.
V l C i-1/4.12... ' •N X
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NAME SIGNATURE - OFFICE P OPERATOR NUMBER DATE
Jefferson Caunty Planning
& Bonding Department
Recording Office:
I certify that this form has been recorded in the county records.
NAME SIGNATURE COUNTY DATE RECORDING NUMBER
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishable In accordance with RCW 9A.20.021.
TD•420.730 MFG HOME TITLE EUM(N/1/901 Page 2 of 2
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Jefferson County Planning and Building Department
Courthouse, 3rcd Floor
PO Box 1220
Port Townsend , WA 98368
206-385-9 14 1
PFRMTT # • RT,Dri9-C)001 DATF. T SStiF.D. ! 01 i 03 i 90
STTF. ADDRESS - 72 FVFR( RF.FN T,iv
:PORT WADTflCK, WA 98339
OWNFR •F.VAN RTCF PHC)NF. ' 634-0 7 25
MATT,TNC ADTR-4555 5TH NE
SFATTT,F. WA 98105
CONTRACTOR . -NO CONTRACTOR PhONF
MA I T,TNC AIIDR '
CONTR. T,T C #! F.XPTRATTON DATF.
PARCF T, NO. . . 7 9983(IC)C)1 9
T,F.CAT, DF.SC. . ! STR 02-29-01 WtniM, TAX #
LOT 19 RT,cO( K
um:-c;rcTrTTON OF T MPROVFMFNT? mobile home with detached rrarane
) Font i nczj Sethacks (Shoreline SetHack) i Mnh l i e Home R i nck i nu
) rFnundationr
) Underground Piumbinrritindercyrround Tnsu1atinn
( ) Framincgr/PlumhinaiChimney.
) insulation -
) Sheptrnck
) Sewarre Disposal System Final !
) Final /Occupancy Approval !
CALL 385-91 41 24 HOURS TN ADVANCF. TO SCHFflUT.F T NSPFCTTONS .
Office Hours 9 a .m. to 5 p.m.
inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Tnsnectinns.
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