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HomeMy WebLinkAboutBLD1989-00123 L3WING , 'FRMIT APPLICATION 4 Jefferson County Building DepartmentSP .O . Box 1220.Port Townsend . WA 98368 r LOCATION SPECIFIC LOCATION SITE ADDRESS ' POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER %PARCEL NUMBER 7.,, -7c7O -30 1 1 / 4 SECTION /' PLANNING AREA SECTION !J TOWNSHIP 7- / NORTH RANGE /a / WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ S4NGLE FAMILY ❑ NEW BUILDING MAIN FLOOR DMOfILE HOME ❑ ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION ICOMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE OMES ❑ COMMERCIAL �- ` Il $3 5 SIZE O p ❑ INDUSTRIAL YEAR /�( © _p 0 @ $ 16 ❑ HOTEL/MOTEL/DORMITORY MAKE ! 'Li,4(YYt-1 4 NUMBER OF UNITS - $8 ❑ OTHER SPECIFY ESTIMATED COST OF a7 $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUF $ SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WQ0D FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR ❑-MANUFACTURED ^❑ W0ODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL O''GAS ❑ COAL ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) j DIMENSIONS k ? X)?,-/T ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH •EPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ! , R RIVATE MR OF TING BEDROOMS `% �� �� INDIVIDUALP( SEPTIC ) NUMABER OF PROP POSED BATHROOM " APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUD TYP '`OF WATER SUPPLY PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ 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 ❑ NO IDENTIFICATION — NAME MAILING ADDRESS .ND TEL NO OWNER 3!/� II / / �PK</g -_� s " &\goAkr [<C ��Tff CONT ... STATE LTtENSE NO 1 4, I ARCH , THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. s l r TYRE,1wY7/XI\O A PL I C ,/T� ,/'f/�J/J PP !CATION} /l,1J DATE RECEIPT NUMBER CHECK /NUMBER OR CASH //'��G/ .1 i� `1/ "�/ � 3// �! I ,20 / /cam L�'C / APPRO PERMIT FEES A P 7 5 BASE FEE INSPECTION I $ 19 '`7> BLDG SURCHARGE PLAN CHECK JE riNkr'r i ENERGY SURCHARGE $ Jg aNS€1t` ,g6 TOTAL 911 NUMBER REFUND DATE [ "lY SSUED BUILDING OFFICIAL /- j ' 8 J /r OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account II 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 assessw-unts. 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 Name(s) Kok R� {'l., S/y Gj,, T' m, jrj Street or Box 3 City X;)d'_r'X ' V 0 //1J/J-4F'A/I State/Zip WAL Home phone ��;.� f' Work phone ,A---)a A) 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) S ' Width 2- Model Year 5' 2' Make Cek-S -6 Model Serial number ***************** MOBILE HOME LOCATION - IN PARK .. Park name Space li Date placed in park (PLEASE COMPLETE REVERSE SIDE) 11 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) dip BUYING RENT Assessor's Real Property account (parcel) number (The 9 digit number on the tax statement or valuation notice) . What is the street address of this land? Street fr4':1,20. 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 �,',A7.433 Purchase price '2f 9 e How did this mobile home get to its present location: Moved into Jefferson County from nre__ (Cou ty or State) ,t Delivered by dealer (name) !�P Ce �� r I �1' A4[42_ 2 6?'5 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 toe countymanvat luation notice will be mailed to you when it's valued and added to .) Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE PO Box 1220 PORT TOWNSEND, WA 98368 • . • - _. ... .... • ' .-•.1...."'7.-IL•s. ••: . . . . ..., .1 . ---.14 •....1 \ . ,.. •,.. . I 01;43 • , ..›..' 11 . ,c-• . . . ‘t ,Q . .• ...• .. . i ..„ I . . Cs- .... .. ... . . -a . .. .. .... . , .n. -. , , co 1 i 1 ;01 0 1 ,5 , . _. ,.....______. . ..:. ..-... Ks. .,m, •e, st. , • . ,„..-- ... 's... -J- . ,,:•.'4 : _ • i!W 01 -- '11 - i sr- ' A. .. •= ... .s... ....,.,- -...! -i ----- C ''' . ..:.--.. -.._ —...__. . , ..-.. , t . T•C\ ... 2,-1 1 , .. .....;•** . . . _. 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