HomeMy WebLinkAboutBLD1989-00107 40VILDING HERMIT APPLICATIOt
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Jefferson County Building DepartmentGP .O . Box 122 Port Townsend. WA 98368
) ++ LOCATION
SPECIFIC LOCATIONSITE ADDRESSP v
POSTAL DISTRICT ,.,/S DIVI ION
LEGAL DESCRIPTION LOT BLO 'DIVISION TAX NUMBER
PARCEL N R `7 2c;, 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
MOLD I LE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ MOB111 0 S
COMMERCIAL SIZE t @ ,. 3 5 -.n-,
0 INDUSTRIAL
YEAR 1[J r $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE Al FA @ $8
)
NUMBER OF UNITS (`❑ OTHER SPECIFY ESTIMATED COST OF V1 $8
IMPROVEMENTS To 'AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR 1
O STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
o
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 2
�1 ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROLM
APPROVED DATE INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
ilw
A) in7UD TYPE OF WATER SUPPLY M ..._
❑ PUBLIC ( NAME OF WATER SUPPLY a
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLA^NN NG DEPT . WITHIN SHORELINE JURISDICTION
(Y3 ❑ YES NAME OF ADJACENT WATER BODY
/ � ❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
(j /FT NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME ' v . MA I L I G ADDRESS ZIP TEL NO
OWNER l�t / Fy' Q" S % g J�/ : p)1. 4A_
1--d tPAJUP/(-
n -V
CONT
ETATE LILEN5E R25- ,.......-
ARCH
I
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
/ /\S I G/N' `RE OF ` ANT APPLICATION DATE I E 1 PT2NIJMBER CHECK NVM R OR CASH
✓/ \�A'P ','VED BY PEMIT FEES ((%�l`ff/� I ///(n'(//
.CAD BASE FEE INSPECTION
A P + .` Itiv
,S ,51D BLDG SURCHARGE PL CHECK
JUL 5 1989 \ ENERGY SURCHARGE ;..:7 ,Sr) OTAL
&BLDG DEPT
IfFFEN COUNTY
PLANNING9 1 1 NUMBER REFUND DA . ` I sou
t/{
BUILDING OFFICIAL
MOIsILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) lan ich mobile home is located or do you
rent the land? (CIRCLE) 0 BUYING RENT
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
2 ( IY3al0
What is the street address of this land?
Street L(L4 e?-42-1G--0iC gc['
City Po v 1,AX0 J t Q,, ct ?.3 G_Ss
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 / b O 7
-c A. v0
Purchase price d ►
How did this mobile home get to its present location:
/16Moved into Jefferson County from Q- � t"
(County or State ,1 �� '
t
Delivered by dealer (name) j..-Aja,v,„„Llin,p16,-TAIALAvLe,
Moved from another Jefferson County location? YES or NO. If yes, please give
previous address/location.
L.1\C‘ ---CYv--e___ ..--\- S .,,,,,y,c_, --‘..,s1,4 s.-- --Ec-. at,
\--\ _c)..\,,kiekk,,,\_.\?s uq
Didn't move - purchased in place. Yes or NO
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? YES orc If yes, to which County
Does the mobile home replace a previous mobile home at this new location? YES orla
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 #
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. perms permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) 5Q W\
�^
Street or Box �� 13 I. �4— '
State/Zip 11�.1 Q
__Z_City !
Home phone 3)—4 — 059 (4C�1 Work phone i 3 ` v
Best time to call q 4.km
^�� � Q � '
(specify home or work) v
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here
*****************
MOBILE HOME DATA: (16'
Length (exclude hitch) / Width CI Model Year ✓j
Make Ar-cyakrvncie\-()„___ Model
Serial number
*****************
MOBILE HOME LOCATION — IN PARK
•
Park name
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
•
..� r r+ r .r-c- C7)TNT c:� R p T' T V -Fs'TT T. T.,iD T 1\ t=�. NT 71'
Jefferson County Planning and Hui ding Department
Courthouse; 3rd Floor
PO Fox 1 2 2 0
Port Townsend , WA 98368
206-385-91441
RM.T T # • BLD90-Ori74 DATE TSSI'IED. : 1 O i"0.3 /90
TF: Ai7i)rrE,SS : 44 P LFRAGF. Kf
: PORT LUiDLOW, WA 98365
NF.R • SAM RREWr.R PHONE: 824-0597
•TLT1_NG ADDR : 20 i 35 i 4TH AVF SOUTH
: SFATTLF WA 98198
iV T RACTO;R . . : NO CONTRACTOR "PHONE :
NTR . L T C #: RXP T RATTON DATE •
RCF.L NO. . . : 821183010
CAT, DF.SC . . : STR 1 8-28-01. RWM. TAX #
FLOCK
SCETPTTON OF TMPROVEMENT : new manufactured barn
) Footing/Setbacks (Shoreline Sethack) /Mohiie Home Blocking:
F00-271U //6
) Foundation :
1 Underground l umb i mg/Underground insulation :
Framing/Piumbing/Ch.i.mney:
i insulation :
} Sheetrock:
Sewage Disposal. System Final :
Final/Occupancy Approval : •
•
CALL 385-9 1 41. 24 HOURS TN ADVANCE TO SCHEDULr, INSPEC TTONS . •
•
Office Hours 9 a . m. to 5 p. m.
Inspector ' s Hours 9 - 10 a.m.
24 Four Recorder for Tnsnectinns .
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APPROVE
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JEFFERSON DUNI{
?TANNING&BLDG DEPT
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