HomeMy WebLinkAboutBLD1989-00093 BUDIONG , 'ERMIT APPLICATION
Jefferson COuntyBuilding- Department,P .O . Box 1220,PAIITownsend. -,, 98368
LocATLoN 1)0,0011L0 Oil t/t
SPECIFIC LOCATION SITE ADDRESS' hoc14(7 i30( 6-. / ii-----erex,5 Edi4-. <7si
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT /0 BLOCK DIVISION TAX NUMBER
)6PARCEL NUMBER 7/3-0,1/ - 0/5- 1 / 4 SECTION
PLANNING AREA SECTION__42 TOWNSHIP , 7A NORTH RANGE jR W WM
BUILDING INFORMATION
/7
BUILDING TYPE TYPE OF IMPROVEMENT -ouARE FOOTAGE
)(k,S4NGLE FAMILY NEW BUILDING M - N FLOOR /
monILE HOME 0 ADDITION 2711) FLOOR
O MODULAR HOME 0 ALTERATION BASE ENT
O DETACHED/ATTACHED 0 REPAIR CARROT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ICOmMERCI -L
O MULTI - FAMILY I RELOCATION/MOVING J INDUSTRIAL
NUMBER OF UNITS —
MOBILE HOMES
O COMMERCIAL
SIZE ;2 x 6 0 @ $35
O INDUSTRIAL
YEAR. i9917 0 . $ 16
O HOTEL/MOTEL/DORMITORY
MAKE c A @ $8
NUMBER oF UNITS
----
O OTHER - SPECIFY 0 @ $8
MATED COE F
IMPRO - NTS Tio AL FAIR MARKET VA UE
UBC OCCUPANCY GRO T $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
XMANUFACTUREDPW0Arra^e. 0 WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL U GAS 0 COAL
O REINFORCED CONCRETE , 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
L 51- Ch,
0 OTHER - NUMBER OF sTon t Es....j TOTAL LAND AREA /i iCol
DEPARTMENTAL REVIEW
HEALTH 7„EPARTMENT TYPE OF SEWAGE, r I SPOSAL 7”.,7-.4BER OF rdoposEn BEDROOMS „,3
S E: -
\
\I\ 1K.RD 9 „ PUBL I C OR PR I VAT
X I ND I V I DUAL ( SEPT I C ) NUMBER OF k,:)(I ST I I,, BEDROOMS, .-i
NUME11417 or PROPOSED BATHROOM a I
APPROVED DATE ........--,
O INDIVIDUAL WELL r_e, m3ER OF r x!sTy.nr; BATHROOM
--- J-----,,- - :
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY')
APPROVED DATE )4 PRIVATE ( NAME OF WATER SUPPLY) - .1
4
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
YE4, NO
NAME OF ADJACENT WATER BODY
/
..,.
APPROVED DATE BANK HEIGHT 84:) SETBACK ,.)0..0
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD —
NAME OF PRIVATE ROAD _
APPROVED DATE ROAD ACCESS PERMIT REQUIRED n YES KNO
. ———
IDENTIFICATION
-
NAME MAILING ADDRESS ZIP TEL NO
OWNER
tic eo eox L-4,t 1::-0.---.kS' Gs:,(7 _
W 3.5'i 32t'-at'l
CONT
BTKiC 1_ 1LE/1-sr-mu 1,---
....._
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF APPLICANT
pR VED BY APPLICATION DATE REC LT NUI CtECK NUMB OR CASH
q/..3,I f
A
-.....- -,,
PERMIT
‘....) .
BASE FEE
A INSPECTION
_ BLDG SURCHARGE PLAN CHECK
NOV 1 1989 ENERGY SURCHARGE $ 7 9,4,____"27
TOTAL
JEFFERSON COUNTY
NANNING&BLDG DEPT $11NU7IDERRE"-"IDDATEDATE Is u.TD.
BUILDING OFF I C I Al. h/4
) /
.., .
•
.TF.FFF.RSC)T\T C'�C-)t'TT'.T9 'Cr* TIT T T.T)T TT( 1P NT T
Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PC Box 122O
Port Townsend, WA 9R368
20A-3R5-9141
PERMIT # •RT,flR9-OO93 T)ATF. TSSTTF:fl. . 11 /iR/R9
STTF. ADDRESS : T)OWFNS CREEK RT)
:FORKS, WA 9R331
OWNER •DANTF.L ROSE. PHONE: 374-6R04
MATLTNC AT)T)R :HC RO BOX 5R1
:FORKS WA 9R331
CONTRACTOR . . :NO CONTRACTOR PHONE:
MATT,TNC ADDR:
•
CONTR. T,TC #: F.XPTRATTON DATE::
PARCEL NO. . . - 71 302 1 -01 5
LF.GAT, fF.SC. . :STR 02-27-13 WWM, TAX #
LOT 10 . BLOCK
T)FSCRTPTTON OF TMPROVEMF.NT: MORTT,F. HOME TNSTALT.ATTON
( ) Footing/Setbacks (Shoreline Sethack) /Mohiie Home Blocking:
( ) Foundation :
( ) Underground Plumbing/Underground Tnsulation :
( ) Framing/Plumbing/Chimney:
( ) Tnsulation :
( ) Sheetrock:
( ) Sewage Disposal System Finale a�
( ina F 1/Occupancy Approval ! �' /`'
CAT,T, 3R5-91 41 24 HOURS TN ADVANCE. TO SCHF.T)TTT,F. TNSPF.CTTONS .
Office Hors q a .m. to 5 n.m.
Tnsnectores Hours 9 - 10 a .m.
24 Hour Recorder for Tnspections.
5rrz PLAN t=D►2 t3UI LD%N& Pt=g+n%T ,.,
i
/ ,� A rce 1 #1
a. 70 y cv.:.--cs /
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SITE Ccpz SON OF `� !_
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Paree 1 /,2
1' 1,68-7 G Cie reS 4
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pGirc,l 3 In
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1, 73/L/ acres
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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) OWN BUYING RENT
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
C. / C/C=9
What is the street address of this la d?
C
Street W-6 '5
City
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
te.._you purchased Oawd
Jea0tir"
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 o NO. If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes o. 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
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account II
PP Account 11
DATE / 0/89
Please read the entire form and ctlav much
doubleinformation
assessments possible.
WillThis
alsowill
aid
help us identify the unit correctly and avoid
in placing a correct value on your property.
*******************************
REASON FOR INQUIRY:
Field visit Excise tax Building Moving
by deputy affidavit permit permit
State transferuent
Dealer report Application Delinquent report
by sale for title taxes re P
*******************************
MOBILE HOME OWNERSHIP/OCCUPIT DATA
Name(s)
1-- I'D
Street or Box 41C- / 5(47) (
City
�� State/Zip
��
Home phone 3 804 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) c)42._
Width Model Year
Make G A aM Model
W t(a/VIA
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name
• Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)