HomeMy WebLinkAboutBLD198-00389 .f
(3DING 'ERMIT APPLICATION
Jefferson County Building DepartmentoP .O . Box- 122O rt Townsend. WA 98368
LOCATION{
SPECIFIC LOCATION SITE ADDRESS i
POSTAL�y rDISTRICT, /SUBDIVISION
LEGAL DESCRIPTION LOTe "' (F BLO(C'yK �,n, D I V I S 1QN TAX NUMBER
•
PARCEL NU�iMBER'? 7,3SOrE CGS 1 / 4 SECTION '�
PLANNING AREA SECTIONc --/ TOWNSHIP 9 NORTH RANGE / �"V WM
BUILDING INFORMATION
BUILDING TYPE TY E OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILYEW BUILDING MAIN FLOOR
..) OF' I LE HOME ❑ ADDITION 2ND FLOOR
❑ ODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED ❑ REPAIR CARPORT
' GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
\ , ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
9 NUMBER OF UNITS
`t ❑ COMMERCIAL MOBILE H o c $35
� ❑ INDUSTRIAL SIZE
` YEAR UJ
❑ HOTEL/MOTEL/DORMITORY , $ 1 �
NUMBER OF UNITS MAKE ( /. @ $g
Cam'-'-' 0 OTHER - SPECIFY f ESTIMATED COST OF /A @ $8
\� IMPROVEMENTS T. AL FAIR MARKET VALUE
UBC OCCUPANCY GROIy �/ $ $
SELECTED CHARACTE ISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME ^�P/RINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME t yQ ELECTRICITY ❑ COLLECTIVE SOLAR
MANUFACTURED v❑`-WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL ❑ GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING )4 DIMENSIONS
❑ OTHER
NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL* NN MBER OF PROPOSED BEDROOMS
'O I �Y ti 0 PUBLIC OR PR I VATEJ" o JJQ CMBER OF EXISTING BEDROOMS
Dj C APPROVED DATE l ND 1 V I DUAL ( SEPT 1 C )( C NUMBER OF PROPOSED BATHROOM
❑ INDIVIDUAL WELL NUMBER OF EN ST I NdG BATHROOM
PUD TY E OF WATER SUPPLY
BLIC ( NAME OF WATER SUPPLY
4i APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
16 /i9\
.>' ❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLICJ WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
I1 NAME OF PUBLIC ROAD
/} VtO NAME OF PRIVATE ROAD
/ APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
--z IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER ®. _._, _.... .. .. .: f
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CONT
FARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
.fit
ATURE 0 PO NT APf L I AT! DD;A RE
yTE CEIPT TER CHECK NUMBER OR CASH
s1./6l.' ,L ( �l Sic
APPRO PERMIT FEES
�lOA P p [ BASE FEE INSPECTION
JUM 1Q 3, ) BLDG SURCHARGE PLAN CHECK
89 JEFFERSON C ENERGY SURCHARGE $ l �`� ) TOTAL
OUNTY ,1)
PLANNING .BLOC DEPT-
911 NUMBER REFUND DATE .: t UED
BUILDING OFFICIAL
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account #
DATE (0/(5/0F)
**********************************************************************************
Please read the entire form and provide as much information as possible. This will
help us identify the unit correctly and avoid double assessor.nts. 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
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) Q cj •
Street or Box rj( (00 3
City \�`9 C Uj State/Zip .% �Jj
Home phone (Qc79 Work phone 6 c 7?
Best time to call (CAD ` A ,i/ ` '
(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) LWidth All( Model Year / 30)3
Make ‘A Model
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name A) In
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 mobile home 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) .
973s'Oo 90
What is the street address of this land?
Street Ic 1 ej. 1
City 14a 10,1
If you rent the land hat is the name and mailing address of the land owner?
Name 0
Street or Box
City State/Zip
Telephone number
***********
MOBILE HOME HISTORY Date you purchased may 0S7Purchase price (g���IJC,.�. �rt J�-�
How did this mobile home get to its present location:
Moved into Jefferson County from i\Gl y, qc,
rh,r CV?"
(County r State)
Delivered by dealer (name)
Moved from another Jefferson County location? YES o NO. If yes, please give
previous address/location.
Didn't move - purchased in place. ��Ye//s or NO
Name of previous owner � C�'rvi .- 0
Address
City State/ZipWi l ,ct� h)
paid? YES or NO. If yes, to which County r a ..----)
. he mobile home replace a previous mobile home at this new location? YES o NO
If moved, was advance tax
Does t
If this is a replacement, to whom and where did the previous mobile home go?
' k.) /n— .
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
A P P\ III 0
JEEFER&.;,,LuLiNTY
PLANNING et OLDG DEPT
36c..424,47
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