HomeMy WebLinkAboutBLD1989-00097 w•
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Jefferson County Building Department'T.Q . Box 122001,t Townsend, WA 98368
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LocATIo „.N
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTICT__ __/SUBDIVISION
LEGAL DESCRIPTION LOT_ BLOCK DIVISION TAX NUMBEV4-5
. -- . ,-,04; . --------
PARCEL NUMBER. Tr-75 e)07 I / 4 SECTION
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PLANNING AREA SECTION te TOWNSH I P 3- ?A). NORTH RANGE / We 5 7 WM
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1 i fu A BUILDING INFORMATION
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BUILDING TYRE TYPE OF IMPROVEMENT (WARE FOOTAGE
•/ ortt. 0 SINGLE FAMILY 0 NEW BUILDING IN FLOOR
11. * V/MOMILE HOME 0 ADDITION 2140 FLOOR
0 MODULAR HOME 0 ALTERATION BAS ENT
W
Al 04 0 DETACHED/ATTACHED 0 REPAIR CARROT
-f fl GARAGE 0 REPLACEMENT GARAGE
a_a
0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCI ' L
0 b C
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
N.-.
C NUMBER OF UNITS
MOBILE HOMES
0 COMMERCIAL
SIZE ---2.•-•:5? ''', (:; I.:,' 0 a 14 ' 5
0 INDUSTRIAL
i 0 YEAR 4!i --_
M I $ 16
0 -.. S 0 HOTEL/MOTEL/DORITORY
0.... NUMBER OF UNITS MAKE LF-7‘.e-c r i...i e o p 0
04: ...e''
0 OTHER - SPECIFY .. r 2 $8
.- TED COST --
0 1-1 ----" IMPROVE71F,.
CS 4k1 TA, AL FAIR MARKET VA UE
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UBC OCCUPANCY GROUP 3 11/ Q S
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SELECTED CHARACTERISTICS OF BUILDING '
- -
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
0 WOli FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR .
P ANUFACTURED 0 wOoDSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE , 0 07L 0 OTHER - SPECIFY
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0 MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES----[ TOTAL LAND AREA "4-
-
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAG7 DISPOSAL NUMBER OF FROrOSED BEDROOMS
t ! I 1 ( C:\, 0 'PURL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS..3
q- , . •, 1, (49 INDIVIDUAL ( SEPT I C ) /IUM S ER OF PROPOSED BATHROOM -
A P P Ft 0 V E D PATE 0 INDI y II)D A I_ 1717.1,7_. NUN 17.ER OF EX.I 9T!!‘49 BATHROOM
PUB TYPE Or WATER SUPPLY --,---
/ /,---- 2-)-.—V7 XPUBLIC ( NAME OF WATER SUPPLY.
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF rDJACENT WATER BODY
If NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD /r,,,vpi/ .4-72-7/40-'
NAME OF PRIVATE ROAD
APPROVED DATE TIAD ACCESS PERMIT REQUIRED p_YES 0 140 /e/.77
IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO:
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OWNER 7 „...-
Y' I-51:-/ Z-C- KP
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CONT IA,/,'"- */./ ,36 •)--- _ _
1-
1
ARCH
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THE OWNER or THIS BUILDING AND THE ump-7:n5IGnED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
----- ---------- , -
SIGNATURE OF APPLICANT APPLIBAT,107TE RECEIPT IJ,B 7 CHECK NUMBER OR CASH
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ArPROVED BY PEFflIT FM-:S
P P . al V D
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DECj
,,„ FEE
BLDG SURCHARGE INSPECTION
PLAN CHECK
r RSON CGUNT' Et4r7ZGI" SURCHARGE $ ,...
PLANNING&BLDG • f k, TOTAL
911 rlumBril REFUND DATE DATE ISSUED
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BUILDING OFFICIAL / i
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N0 •,. ®,,AOi 5,,,,e777,A "- Y.9 Br9SF0 U/?N .�N .1-Ci'V4L CIVIL ENGINEERS OB MADRON
,S✓.C1/EY; 7 -�,4i r/-/c covRs, 75 AND D/sTANct•� 4,eC
c.//2lN// cORREcT4i N 6N., 7;144,rALL REE9U/Rw"O • LAND SURVEYORS BAINBRIDGE
—. A.,./-)///hti: --1/r_c )IRE C'ED ON THE G,Q.Gt'.WO P L^ N N E R (2 0 6) 842A
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account II
PP Account 4/DATE iv1//4 //
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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 permit permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA T�
Name(s)
Street or
Box f`r , r =cri"'
City State/Zip
Home phone �$7 3 3 $ ', Work phone yx? `{Y,S 6
Best time to call („,(7O/f f'_ /- /flit1
(specify home or work)
NOTE: If you rent the mobile ho give name, address, and telephone number of
owner here \
*****************
MOBILE HOME DATA:
Length (exclude hitch) O Width L(p 3 „ Model Year /` 9 lJ
MakeCe ,rlfrrr Model
Serial number / 0
*****************
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) OWN BUYING
RE
Assessor's Real Property account (parcel) number (The 9 digit number on the tax .
statement or valuation notice) .
( C) 3Geq
What is the street address of this land?
Street
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
Date you purchased l / / ---- 3 /
Purchase price 3 7 6 /Z
How did this mobile home get to its present location:
Moved into Jefferson County from
(County or State)
Delivered by dealer (name) D25 i 6-,ve-/ f10,-14 e.S
Moved from another Jefferson County location? YES o NO. If yes, please give
previous address/location.
Didn't move - purchased 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 o(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
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I NOV 1 5 89 I
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