HomeMy WebLinkAboutBLD1989-00373 illUILDING , 'ERMIT APPLICATIO ' .
Jefferson County Building Department'P .O . Box 122OsPort Townsend. WA 9E368
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LOCATION
SPEC I F I C LOCATION S I TE ADDRESS 13ERVEf' \J L.
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r / 6 f "� POSTAL DISTRICT 7�I 'OLOttl /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER , h . 1 )2) 015 1 / 4 SECTION
PLANNING AREA SECTION I ^ TOWNSHIP 26 NORTH RANGE PH Al WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
//��❑�SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
CMOrIILE HOME 0 ADDITION 2ND FLOOR
lam❑ ODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLA ENT GARAGE
❑ WOODSTOVE ❑ WR ING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL SIZE IA X J4 . $35
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY YEAR { ( I 9 ''flit- ( $ 1 6
NUMBER OF UNITS MAKE 11/t/?cto. Llne, ( n tin khVtt'n 1--!/,, @ $8
❑ OTHER - SPECIFY ESTIMATED COST OF w @ $8
/� IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUT $
, SELECTED CHARACTERISTICS OF BUILDING
\
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
(\ ❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
N } MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
0 STRUCTURAL STEEL ❑ GAS ❑ COAL
" 0 REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) ` DIMENSIONS
V ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
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DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑
/.. C_. PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS . ;4
C J � � 4 INDIVIDUAL ( SEPTIC ) I NUMBER OF PROPOSED BATHROOM -&- ,+C
APPROVED DATE
, INDIVIDUAL WELLNUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
J ❑ PUBLIC ( NAME OF WATER SUPPLY ) —____
(,APPRO D DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
r ❑ YES NAME OF ADJACENT WATER BODY
Gj{fl ) (6 ❑ NO
A��VPPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
1
NAME OF PUBLIC ROAD
tJ ( r NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
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NAME MAILING ADDRESS ZIP T E L NO
OWNER
.LF1WSorl iiin r , `v. 575o be EKAV VAlLI. y r u, t'o, u i' L0Low q83&. .3 Z t
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CONT
I' STATE LICENSE NO I
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ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIG ATURE -F APPL CANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
%r ( 1 I LP 2431-j-��'
AP f2 VED B PERMIT FEES
Ze1 ( )
. BASE FEE INSPECTION
, S( / BLDG SURCHARGE PLAN CHECK
JUNI 9 ing � ENERGY SURCHARGE
/r� [, L,�/ TOTAL
JEEFERSON BLDG
DE / v, (1.1) REFUND DATE DAT I SS PLANNING&BIDG DEPT 9 1 1 NUMBER I � � ��'
BUILDING OFFICIAL
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account #
DATE
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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. permit .�' permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) LL ► Am, D (\O1 ED L. AVNiSot •
Street or Box 575o BEAVER. ✓ALLE tY R0/10
City PO ,2T )._U'D 1--O State/Zip (AYA , [ 8310
Home phone Work phone
Best time to call gowt t - CI:30 A+\ --- ) : 3 v i°M 02 /W FT EA O P/'1
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here
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MOBILE HOME DATA:
Length (exclude hitch) 54, Width l 1- Model Year g J4
Make MpoL,LL... /rC Model COOINT I ►4
Serial number q(p 8 92
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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 mobil- lime 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) .
Sol 10- 1 0i .5-
What is the street address of this land?
Street 575-rf,z, BEAvE°R VAI-LEt? 'oAD
City 1okT LL DLoi
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 #400A s141.6 No7- Ili ET' CLos
Purchase price Ia) 7V0
How did this mobile home get to its present location:
Moved into Jefferson County from V 1 T S A P a o .
(County or State)
Delivered by dealer (name) Q—A rA t c= kdzE L 1 S k Y •
Moved from another Jefferson County location? YES or CP If yes, please give
previous address/location.
Didn't move - purchased in place. .Yes or N�O
Name of previous owner
Address
City State/Zip
W t L I,- 13L f-7 C10,5206-- of SAL. -
If moved, was advance tax paid? YES or NO. If yes, to which County k►TS A P 0 o
Does the mobile home replace a previous mobile home at this new location? YES arc)
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
AP
JEFFERSOliCOU1tY
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