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HomeMy WebLinkAboutBLD1989-00018r (3UL' .NG *'ERMIT APPLICATION e fferson County Building Department*P .O . Box 1220IPorC Townsend . WA 98368e LOCATION / ) SPECIFIC LOCATION SITE ADDRESS /( POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER C ION PARCEL NUMBER IU ()Y? 1 / 4SECT PLANNING AREA SECTION ��a� TOWNSHIR NORTH RANGE / WM BUILDING INFORMATION BUI DING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ INGLE FAMILY ❑ NEW BUILDING MAIN FLOOR MOP. ILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE ❑ WOODSTOVE ❑ CKING/DEMOLITION ( COMMERCIAL ❑ MULTI - FAMILY RELOCATION/MOVING INDUSTRIAL .. NUMBER OF UNITS MOBILE HOME ' f ❑ COMMERCIAL SIZE3 `'S�' , @ $3 5 ❑ INDUSTRIAL YEAR r — 0 q@ $ 1 6 ❑ HOTEL/MOTEL/DORMITORY MAKE `�/Inehe/1-�'ama/y, A @ $a NUMBER OF UNITS ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUPV $ $ SELECTED CHARACTERISTICS OF BUILDING PRI IPLE TYPE OF HEATING FUEL PRINCIPLE TYPE OF FRAME ❑ W D FRAME ELECTRICITY 0 COLLECTIVE SOLAR MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR O STRUCTURAL STEEL 0 GAS 0 COAL O REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY O MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - 0 NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW 1 1 ALP-in �i- HEALTH DEP R:TMhENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM O(( c-% 114 31 P B L I C OR PRIVATE NUMBER OF EXIST I NG BEDROOMS D I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE - ❑ 1 ND I V 1 DUAL WELL NUMBER OF EXISTING BATHROOM '"` _( w PUD TY OF WATER SUPPLY PUBLIC ( NAME OF WATER SUPPLY)I . APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION 0 YES NAME OF ADJACENT WATER BODY [217N4:/: 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 0 YES 0 NO IDENTIFICATION MAILING ADDRESS ZIP T E L NO NAME^ OWNER 2.(^1 V _.. '_ D�',J,�1d� �'''+ (�Q /� P r9 D Y_ . ' _ue/ dd�-yl/r° !� 1d<LS b(- W f& v r CONT '` 'S T/ATE LICENSE NU I 1 -, ARCH r M THAil NER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. r S RE F P ICANT AP LICATIO DATE I RE AMBER ( CHECK N MBER OR CASH ✓ C26) APPR V)!BY P RM I T FEE 378s A�'���C 4I--) A p i '� BASE FEE INSPECTION ° BLDG SURCHARGE PLAN CHECK �J PR 1gQg `I ENERGY SURCHARGE $ �1-l) < �� TOTAL .IIFFEASUN COUNTY' �} } / FIANNING a iflG /0 ,,O 9 1 1 NUMBER REFUND DATE { 71 1 DEP! l BUILDING OFFICIAL OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account 1/ 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) Street or Box liv ,e-f T /,-t.4A''- City /'c2 </42L- 4741_,i State/Zip Lii.4f` 9, 3 .5.- Home phone2 --64ZS—//O e€ Work phone 2Odg — to S S - 3 02_9 Best time to call 4y (specify home or work) NOTE: If you rent the mobile home give name, address, and telephone number of owner here Al/ ***************** MOBILE HOME DATA: Length (exclude hitch) Width Z 8 Model Year 8 -9 Make J'/L V, i—EJ'7 Model /3 -'C Serial number ***************** MOBILE HOME LOCATION - IN PARK Park name /t /4 Space I / ///q Date placed in park /`A) (PLEASE COMPLETE REVERSE SIDE) MOBILE HOME LOCATION - NOT IN A PARK Do you wn (or are buying) land on which mobile home is located or do you rent the and? (CIRCLE) c%T)WN BUYING RENT Assessor's Real Property account (parcel) number (The 9 digit number on the tax statement or valuation notice) . Age. - C7ao -.-Z o What is the street address of this land? Street Gl/ (S' - /74-4-- 1 City /0U.e7- G ve,GaA.) / w f W. If you rent the land what is theme name and mailing address of the land owner? Name / "/4- Street or Box W/4- City /tG/i4 State/Zip AZ/,..9- Telephone number /(//� *********** MOBILE HOME HISTORY Date you purchased / -G/ 2 S/ / 9 8 9 Purchase price /l ' O 2 CY How did this mobile home get to its present location: Moved into Jefferson County from e--C. ,',JE'X/ ©.�� 0X/ (County or State)' j, Delivered by dealer (name) A2 c'4i `1 r '/L..4.: Ala AI J' - /76)'e-7- 'z2DU rye Moved from another Jefferson County location? YES or NO. If yes, please give previous address/location. N O We Didn't move - purchased in place. .Yes o NO Name of previous owner ft Address /U/4. City /VAL State/Zip ///4 If moved, was advance tax paid? YES or NO. If yes, to which County /'v'//9- 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 a ti • .-T T:WW r.1?F-; C)T\T CT 5177T4 T'Y F tTT i. V)T T'ic; 1r r'?Tv1T 'T' Jefferson County Planning and Building Department Courthouse, 3rd Fl nor PO Box 1220 Port Townsend, WA 98388 206-385-9141 PFRMTT # -RT.fl89-0C 1 S DA-i F. T SSTIFD. • ()4/04/89 STTF AT)T)RF.SS - 1 60 WEST MAPT,F ST PORT LUDLOW. WA 98365 OWNER JEAN MARSH PHONE- 385-110A MATT.TN(; ACT)R , 3C 1C1 SF. 395TH FNTiMCLAW WA 98022 CONTRACTOR. . :NO CONTRACTOR PHONF. MATT.TNC f'il')i)R - CONTR. T,TC #: FXPTRATTON T)ATF. - PARCF.T. NO. . . : 984f 00520 T.FGA+'. T)F.SC. . ! STR 22-28-i FWM. TAX # LOT 20 , BLOCK DFSCR T PTTON OF TMPROVFMF.NT: mobile home i nsta l i aton permit ( ) Fontina/Sethacks (Shoreline Setback) /Mobile Home Rinckinc-r- ( ) Foundation ! ( ) Underground P1umhing/iindercrrnund Insulation ! ( ) Framing/Plumhincr/Chimney. ! 1 Insulation - ( ) Sheetrock: ( ) Sewage Disposal System Final : ( ) Final /Occupancy Annrn is i - CALL 385-9141 24 HOURS TN ADVANCF TO SCHEDULE. TNSPF.CTIONS . Office Hours 9 a .m. to 5 p.m. Tnsnector ' s Hours 9 - 10 a . m. 24 Hour Recorder for Inspections. 4. . f D,--,./,,, \NJQ •war Pole !� ' U. � S j��Yt . ao " . i(� — n7ot, ; I� ��a.-k;, e,w, ,E,p� K' D 6p(1 rooks, Nl 2 64 C ��q (o c, r G I -3G I( tO a�0„A i , `-ao1,0) has r.. /0i �L or c r o ci fTs v C/ Ja• „ f ri✓ipn t o ~ ^I+f y G t rr .w ) 0Y , SC2 �YvpGP cz eSCYVe W Ali'J [(• . .u Y-.•f cc„, 6- rU ( Y4. p /—t-- ‘( ,k r� — _ / ., i---- a,uoy t Q y a5 41\ o� �_o [Y P Ji C , ,4 i, ix Y. �,P, �Pci 6) �Yo,r r `. to Fr: _A w ra _ c� ,°. ,N goo Z+ Y 0w 7 ----. ,� _ _ Is c -1 1`. r 1��1M-/ J 1 1�V J lJ G ^'1�Ja Y 1 V- 6 Q ;a lid --1 1 C viva G `(1' f �` �''� rca �� ,bv l � L �'.�(, C F, . J v.,4.. / '{ ;I) r C., -f C C, ; w l t r I-a) I _ _ _ _ /_______ o LI--": LI , CC r- c j