HomeMy WebLinkAboutBLD1989-00022 Bl DING '` 'ERMIT APPLICATION
Jefferson County Building Department•P .O . Box 1220'Port Townsend. WA 98368
LOCATION s ��� i/J J •
SPECIFIC LOCATION SITE ADDRESS Iw::, /-1 ( I 1 �J/POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK/t D VISION TAX NUMBER 6/2
PARCEL NUMBER 7G ) 1 / 4 SECTION
PLANNING AREA,( SECTION (/ TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ INGLE FAMILY 0 NEW BUILDING MAIN FLOOR
MOI.? I LE HOME ❑ ADDITION 2ND FLOOR /
❑ ODULAR HOME 0 ALTERATION BASEMENT l!/
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE H ME
❑ INDUSTRIAL S I ZE3(...(2 A @, J 5
YEAR❑ HOTEL/MOTEL/DORMITORY MAKE illiID
(4) 0
$ 16
NUMBER OF UNITS ��� $B
❑ OTHER - SPECIFY ESTIMATED COST OFp7 $$
IMPROVEMENTS 74/ 0
AL FAIR MARKET VALUE
UBC OCCUPANCY GROUB f $
SELECTED CHARACTERISTICS..tt OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ QOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
ANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
STRUCTURAL STEEL ❑ GAS ❑ COAL
s
❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES I TOTAL LAND AREA�7
d
DEPARTMENTAL REVIEW
HEALTH D P TM ENT TY-E OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS �01
1,6 /�/"/ 1/ ',/ ', ' /PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMSaND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM I #A;CA APPROVED DATE . v:-.-"
/ ❑ 1 ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION .----
O 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
a
NAME MAILING ADDRESS ZIP TEL NO
OWNER C `�-mil/` / ' jX) / -C__
Ccf,"61 ��( 4hCL1i NNN l 37Y7 7
CONT
STATE LICENSE NO
A
ARCH
T-
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
N ¢N T E OF AP LO C(\��JA�(N/}T— c,, — 3 AP L C 1 TE I
RECE I T NUMBER OR CASH
j.��i �JsXX rfl��XX ! / �� ��Th J
AP RO BY PERMIT F S
"1 _
A P P E BASE FEE INSPECTION
S BLDG SURCHARGE PLAN CHECK
AR 4 9 _..
JEFFERSON COUNTY ENERGY SURCHARGE 2 ce)
.� TOTAL
P!r''A"N"&SLOG DEPT
911 NUMBER REFUND DATE I D Ti, ED
BUILDING OFFICIAL t_11
('�/f�
% Th 3&c,?„,
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account I
PP Account 4!
DATE
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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.
*******************************
REASON FOR INQUIRY:
Field visit Excise tax Building ' Moving
by deputy affidavit ermit permit
Dealer report Application Delinquent'. State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) 6- , 0 it a
Street or Box SW 3-D/
City Q 0 ) l State/Zip `? - 3 ? (7p
Home phone 76 ?---30 -27Y Work phone
Best time to call da y ,32.___,
(specify home or work)
NOTE: If you rent the mobile h me give name, address, and telephone number of
owner here 0 -ft-
*****************
MOBILE HOME DATA:
Length (exclude hitch) (2 4 Width , -5 Model Year
S<--E)
Make lt=. e G000c Model
Serial number t
*****************
MOBILE HOME LOCATION - IN PARK
Park name UV Fri—
Space 11 Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
MOBILE HOME LOCATION - NOT IN A PARK <
Do you own (or are buying) lan on-whli mobile home is located or do you
rent the land? (CIRCLE) OWN BUYING RENT
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
lea /)IO( Cf'
What is the street address of this land?
Street ' qc, --7 �J ,, I Y (0
l'
City C) v
If you rent the land wh t is the name and mailing address of the land owner?
Name /v79—
Street or Box
City
State/Zip
Telephone number
***********
MOBILE HOME HISTORY 1
Date you purchase r/�M I/9-- 1 n
. 7
Purchase price l 0))-
How did this mobile home get to its present location:
e. elcitie
Moved into Jefferson County from (County or Stt
Delivered by dealer (name) C?/te/j.O-1-4J 7\-
Moved from another Jefferson County location? YES or NO. If yes, please give
previous address/location.
Didn't move - purchased in place. :Yes or NO
Name of previous owner
Address
City State/Zip
AlbIf moved, was advanc zax pai or NO. If yes, to which County
Does the mobile home replace a previous mobile home at this new location? YES o NO
If this is a replacemen
to and where did the previous mobile home go?
�ht,) �w}�T►
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 valuation notice will be mailed to
you when it's valued and added to the assessment
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
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. FFcF°FRSC)i\i ( i)i7i\T r'Sr rsT3 e T.Ti i 1\rC 1=1T:RF'Trn
Jefferson County Pianninn and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-3R5-9 i 41
PERMIT # •RT,DR9-0022
STTE Ai�DRF.SS _ i �5275 HIcWWAY 101 DATE TSSURD. : 04iCi4,r89
OTT T T,CF.NF.; WA 9R376
OWNER •(ORFO CA LAHAN
MATT,T NO ADDR : PCi BOX 5i)i PHc7NF. 7ri5-;sCi7e1
:C)TTTT,CFNF WA yrs.s in
CONTRACTOR. . !NO CONTRACTOR
MAIL TNt ADDR : PHC)ivF.
CONTR . LTC #: FXPTRAT T ON DATE
PARCF.T, NO . : 702 1 1 1 O1 A
T,FOAT, DFSC. . - STR 1 1 -27-02 WWM. TAX #
LOT BLOCK
DFSCRTPTTON OF TMPROVFMFNTf mobile home installation
f i F not i nor/Sethacks (Shoreline Setback i j Moh i i e Home R i ock i nn
( ) Foundation -
) Underground PlumhingfTTnderground Insulation !
i Framing Piumhinfr/Chimney
) Insulation !
) Sheetrork
) Sewage Disposal System Final :
) Final /Occupancy Approval :
CALL 385-9141 24 HOURS TN ADVANCE TO SCHF.DTTT,F TNSPFCTIONS .
Orrice 'Furs 9 a .m. to 5 p.m.
Inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Inspections.
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