HomeMy WebLinkAboutBLD1989-00032 t3UILD• PERMIT APPLICATIONIII
Jefferson County Building DepartmentSP .O . Box 1220+Port 1ownsend , WA 98368,
LOCATION �V^C�(�7.S�F7�Y1 P, 0�'t
SPECIFIC LOCATION SITE ADDRESS SUBDIVISION
.......120
POSTAL DISTRICT /
BLOCK DIVISION TAX NUMBERS/
LEGAL, DESCRIPTION LOT --
PARCEL NUMBERRatncp.o2.-LI) -co[[ 1 / a SECTION
4 SECTION TOWNSHIP I NORTH RANGE___(
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PLANNING AREA "
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
NEW BUILDING MAIN FLOOR
❑ SINGLE FAMILY 2ND FLOOR --
MOPILE HOME 0 ADDITION
❑ MODULAR HOME ❑ ALTERATION BASEMENT
CARPORT
❑ DETACHED/ATTACHED 0 REPAIR
GARAGE
❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES 41r) _____JA @ $35
❑ COMMERCIAL SIZE 1y X
❑ INDUSTRIAL YEAR ()F--)P 4 p@ $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE Nn pur-C rj_ced rt, 0 @ $8
NUMBER OF UNITS�� ,� $8
❑ OTHER SPECIFY ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUPz), . $ $
SELECTED CHARACTERISTICSZZ OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
❑ WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
MANUFACTURED !!!❑ WOODSTOVE ❑ PASSIVE SOLAR
0 GAS ❑ COAL
/K'STRUCTURAL STEEL ❑ OIL ❑ OTHER SPECIFY
❑ REINFORCED CONCRETE
O MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D 1 SPOSALr NUMBER OF PROPOSED BEDROOMS
s ❑ PUBL I C OR PR IV AT E vo.kjr NUMBER OF EXISTING BEDROOMS
;� �/ c )4 1 ND I V I DUAL ( SEPT I C )N(e'r NUMBER OF PROPOSED BATHROOM a�
APPROVED DATE 1 ND I V 1 DUAL WELL O�k-� 1e' NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY')
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY, S«.. ., �,.,,,
PLANNING DEFT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
XNO
APPROVED DATE
ANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUI*,RE\Dc�❑ YES ❑ NO
IDENTIFICATION ( I/ M CAA A./O �l J--�1�V�-' j Zi\--/I'P T E L N o
NAME l MAILING ADDRESS
OWNER Z _... t41_
� _ ,�61(,),C`J ,
CONT
STATE L IrEN5E ND
1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
GNATURE OF A P SCANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPR V Di
PERM[ J9
T FE
E
A P V\, �``� s�() BASE FEE INSPECTION
c3 •5O BLDG SURCHARGE —,, PLAN CHECK
198 ' `--
ENERGY SURCHARGE „�� TOTAL
►fFFERSON COUNTY $
PLANNING&BLDG DEP7 1 O , ( C) 8 1 1 NUMBER REFUND DATE DA;5_, Ij SSUED /
BUILDING OFFICIAL (/ /��
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
•
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account 1/
DATE 5/ /18
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
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) M1kt rt) E
Street or Box rq,)34.0
City �{._.)
,o l State/Zip ��
��� 11�
San
Home phone 711 6`4/?,r) Work phone
Best time to call
(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) 6(2) Width 1 Model Year
Make C��i'Vl,� Model
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
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) O N.--- BUYING RENT
Assessor's Real Property accoun arcel umber (The 9 digit number on the tax
statement or valuation notice) .
09 o ( 4 !
What is the street address of this land?
Street l../a
City (0, 1,7317-04/1
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 /'' -,ffurell(91-°
Purchase price
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.
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
x
,
b
Jefferson County P i ann i ncg and Building Department
Courthouse, :3rd Floor
•
PC) Box 1220
Port Townsend, WA 9836B
2O -3Fs5-9 1 4 i
PF.RMT T- # •BLD89-7ti3 2 DATF. TSSUFD. - C)5/C)2 n9
S T TF AIJDRF.SS • h5 1 F MARROWSTONR RD '
:NORDT,AN, WA yrs.sn s
OWNER •DTiANF. HAGF.RTV PHONE. •
MA T T,TNU ADDR : 65 i F. MARROWSTONF Rn
. NORDT,ANT) WA 95:355
CONTRACTOR . . :NO CONTRACTOR PHONE
MATs,TNU ADDR :
•
CONTR . T,T C ;If: FXP T RATTON T)ATF. -
PARC:F.T, NO. . . : 92 1 092024
LEGAL TW..SC. . : S T-R 09-29-0 i FWM• TAX #
LOT BLOCK
T)F.SC RTPTTON OF TMPROVFMENT : mohile home installation
) Fonting7%Sethacks (Shoreline Sethac %MIohi le Home Rinck ina:
1 Foundation :
i Underground PlumhingiTinderoround insulation :
i Framing/PiumhinciChimnev:
) Insulation :
i Sheetrock:
i Sewage Disposal System Final :
i Final /Occupancy Approval :
CALL 355-9 1 4 1 24 HOURS TN AT)VANCR TO SCHFDULF TNSPFCT T ONS .
Office Hours q a .m. to 5 p.m .
Inspector ' s Hours q - 10 a .m.
24 Hour Recorder for Tnsnections.