HomeMy WebLinkAboutBLD1989-00128 , ..
BWING 0.'1ERMIT APPLICATION
Jefferson County Building Department-P .O . Box 122l1T7Irrt Townsend, WA 98368
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LOCAT' ION - ,
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SPECIFIC LOCATION SITE ADDRESS__ ---
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POSTAL DISTRICT " - . , /SUBDIVISION
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LEGAL DESCRIPTION LOT BLOCK DIIVISION TAX NUMBER:; /
PARCEL NUM ER HI .- --/i4 c?"c' 1 / 4 SECTION .c.,..
PLANNING AREA SECTION , TOWNSHIP ]? tr NORTH RANGE t-- WM
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BUILDING INFORMATION .
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BUILDING TYPE TYP OF IMPROVEMENT SQUARE FOOTAGE // /
O SINGLE FAMILY NEW BUILDING MAIN FLOOR
/7
VMOBILE HOME 0 ADDITION 2ND FLOOR
/
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
l
GARAGE 0 REPLACEMENT ' GARAGE
/
O WOODSTOVE 0 WRECK/ NG/DMOLITION ' COMMERCIAL/
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIA
NUMBER OF UNITS _
MOBILE HOMES /
O COMMERCIAL
O INDUSTRIAL i
YEAR /' _______/ @ SI6
O HOTEL/MOTEL/DORMITORY
MAKE Oaci'?"
NUMBER OF UNITS ,
O OTHER - SPECIFY
ESTIMATED COST OF
P22".r IMPROVEMENTS
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/OTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU
/$
SELECTED CHARACTERISTICS OF BUILDING
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PRIN,E PLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
O WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
%ANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) I DIMEN5IONS
0 OTHER - -I NUMBER OF STRIE5 TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEA TH DEP MENT TYPE OF SEWAGE DIS1,05A1, 7MBER OF PROPOSED BEDROOM
10 a(0 0 P BLIC OR FEIV,,xE
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE E4VDIVIDUAL TELL NUMBER OF EXISTING BATH
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- PUD TYPE OF WATER SUPPLY __
---___ 0 PUBLIC ( NAME OF WATER SUPP
APPROVED DATE i 'RIVATE ( NAME OF WAT - ,urpLY1
PLANNING DEPT . WITHIN ..0E SLIME ISDICTION
0 YES NAME , JACENT WATER BODY
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,
APPROVED DATE --- BANK HEIGHT SETBAC
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PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
--E NAME OF PUBLIC ROAD --,
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NAME OF PRIVATE ROAD
EE
EEAPPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
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IDENTIFICATION
----r- ,
NAME MAILING ADDRESS , ZIP TEL NO
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(
OWNER r.J. ,•- ,• ,- C__, ri:,- A' < r.•) : ' 7"."-(7 ' . _)
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"-g :: E.'1'(.- - 1 C.'''Z' 7:7-7-t Z.7-1 4-101.1111,111111111M., . 10611.1111111111
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t, . (i ( t.i \. I I 11,--WriratairlIALL .2.•A .W-?
ARCH 5fa • 4- 7-
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIJOOP-FUR_ OF',AP IC
sp ICATION DATE RESF!PT IpIDER ICHECKNUMBER OR CASH
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/ APPROVED BY P EMIT FEES
...._2,...-- -.---- BASEFEE
:' E 0 7 ! i E 7 ' — INSPECTION
--f-±5 BLDG SURCIWZGE. PLAN CHECK
OCT 27 .: ) s b
ENERGY SURCHARGE $
—
r —_FFfRc:,, . TOTAL.
911 NUMBER REFUND DATE DATE ISSUED)r1,„
BLI 1 LD I NG OFF I C I AL 10 c;Z-i? v
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l'aili4' oecw-ii * Ti 10069
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account 1/
DATE /61 l -Di "
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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.
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REASON FOR INQUIRY:
Field visit Excise tax Building Moving
by deputy affidavit ; -rmit , permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) Wjtibrizt)
Jt� Pc
Street or Box � Cy � � V� Me.
City5497-) State/Zip
Home phone -/3`7 9/3 Work phone
Best time to call
(specify home or work)
NOTE: you renty%fthe mobile home give name, address, and telephone number of
owner here
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MOBILE HOME DATA:
Length (exclude hitch) 1741,0. Width (9 1 Model Year 774
---32
Makeax '
Model
Serial number
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MOBILE HOME LOCATION - IN PARK
Park name
Space # XINDate peace in park
(PLEASE COMPLETE REVERSE SIDE)
Pr
MOBILE HOME LOCATION - NOT IN A PARK.
Do you own (or are buying) land -Vaal mobile home is located
edNor do you
rent the land? (CIRCLE) OWN BUYING
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
pc.,z/
What is street a. .ress of this la d?
-T_� 7 j7 1%2
Street
City
If yo rent the land what is t name and mailing address of the land owner?
Name 7 /V U , 4
Street or Box )
City
State/Zip
���/Telephone number a 7 �`3
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MOBILE HOME HISTORY
Date you purchased
Purchase price
How did this mobile home get to its present location:
Moved into Jefferson County from k';' 7(3"; :t
(County or State)
Delivered by dealer (name) b 16 , r f' '
Moved from another Jefferson County location? YES or b. If yes, please give
previous address/location.
Didn't move - pruchased in place. Yes or0 '
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? or NO. If yes, to which County k'itc/Zip
Does the mobile home replace a previous mobile home at this new location? i or
NO
If this is a replacement, to whom and where did the previous mobile home go?_1_
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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