HomeMy WebLinkAboutBLD1989-00376 ,t-
B i DING 'ERMIT APPLICATION
. .
Jefferson County Building DepartmenteP .O . Box 1220.00kt Townsend. WA 98368
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LOCATION
SPEC
IFIC LOCATION SITE ADDRESSX ,c ,,-411 :fr1'44k2/./;(7:/• / 12)(
' A.dc.,) ,
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4
POSTAL DISTRICT N ./SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBE ---77-- '1 ooS114 SECTION
PLANNING AREA SECTION - TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY NEW BUILDING MAIN FLOOR
MOL1ILE HOME 1.
0 DDITION
0 ODULAR HOME
0 ALTERATION 2ND FLOOR
BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HomF ,
O COMMERCIAL i
siz% . AI) 0 ,,. $35
0 INDUSTRIAL
YEA- •Millillill V @ $ 16
O HOTEL/MOTEL/DORMITORY
W-) NUMBER OF UNITS MAKOMPArr 401111
-----
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP/ 37
\,..) $ -
;
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0 OOD FRAME XELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O RUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING )
...,,,. 0 DIMENSIONS
OTHER -
NUMBER OF STORIES
TOTAL LAND AREk
DEPARTMENTAL REVIEW A ' (On t
HEA TH EPARTMENT TYPE OF SEWAGE I SPOS NUMBER OF morosEo BEDROOMS
(' ' (V
l VED DATE 0 PUBLIC OR PRIVATE NOW. PROPOSED
OF EXISTING BEDROOMS
INDIVIDUAL ( SEPTId ) 4UMBER OF cwosEn BATHROOM
i 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM_L.
TYPE OF WATER SUPPLY
Tr 0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE X PR I VATE ( NAME OF WATER SUPPLY ) /4
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
1 ,
0 NO
APPROVED DATE DANK HEIGHT SETBACK
PUB41q WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
0 fl NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED ATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO t,
37-147 / d 1 - , C
- I rm/ g ritni ET (._ .
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MX: __,
CONT It
C3
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDEPSIGNED Af7=REE TO CONFORM TO ALL APPLICABLE LAWS.
IG ATURE OF APPLICANT
i liATot, ' (--- i A PLICATIOU DATE RECEIPT NUMB-R CHECt NUMB OR CASH
(s-it L L
C- ' -lr 0
APPROVED BY ' PERMIT FEES
k , 3
A P i: 04,01)s'y E 0 BASE FEE INSPECTION
_ BLDG SURCHARGE PLAN CHECK
Util' 2—e' 71-989 \
\ ENERGY SURCHARGE
JEFFERSON COUNTY ' .t
p 7 '----'b TOTAL
PLANNING&BLDG OEPT
911 NUMBER IREFUND DATE E IS
BUILDING OFFICIAL
11,
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MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land o. h mobile home is locat do you
rent the land? (CIRCLE) 0 ► BUYING R
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice).
&a/ O7c cx:5
What is the street -ddress of this land? �f��J�
Street __32V atii` ,� �.J- 0 '124 P-1)1
City AV Z6.' OCC) G )G L .
If you rent e Lan. w at is the name and mailing address of the land owner?
Name /i// i/
Street or Box ,S lar 4'4
City 0(1 ZtA A State/Zip � > .4
Telephone number 4(25?. — 9/2 /UPI
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MOBILE HOME HISTORY
Date you purchased //_5(>�//
Purchase price !)7 cep . e)0
How did this mobile home get to its present location:Moved into Jefferson County from _ktt/q //C1 Q
f L--
(County or `State)
Delivered by dealer (name) , ?4'/7L /0 /4 A4If
Moved from another Jefferson County location? YES or NO. If yes, please give
previous address/location.
/t
Didn't move - purchased in place. :Yes or '0 -
Name of previous owner `)/1( ,PGe--
Address 4/%4/ 171/) a //? /'/
City / C�G/r,/' z 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? ES 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 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
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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 assessm2.nts. It will also aid
in placing a correct value on your property.
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REASON FOR INQUIRY: (-Building Moving
Excise tax
Field visit by deputy affidavit, ..permit permit
Dealer report Application Delinquent State transfer
re ort
by sale for title taxes p
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
iri-/3/ice
Names) r���� " �
Street or Box /9. (6k/ 2(A
City ! 1
l0C( State/Zip �i{/
G
Home phone
y(17-71/// Work phone , �/ - 44/0!2
Best time to call /--
(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:
�~- /f/72
Model Year
Length (exclude hitch) . 6, ' Width
Make &,4,(4--we Model
Serial number �J 6 2 5132- � /� ��
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MOBILE HOME LOCATION - IN PARK
Park name
Space I Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
+': ar
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A P P;11 BE
143
JEFPERSDN COUNTY
PLANNING&BLDG DEPT