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Home My WebLink AboutBLD1989-00396 it VEDt `.:.� BUILDING � 'ERMIT APPLICATION J f .n n Coutry .Burt'ding DepartmentwP -° - Box 12200Port Townsend ' WA 98368 \i* . -. 0 /'� rn t n �/ �+�Ly,OCAT I ON ( V� ►le�I l!i- ��Z\ �F. C ''1 F I C LOCATION SITE ADDRESS ti, ALTH DEPL POSTAL DISTRICT -� /SUED 1 V I S 1 ON DIVISION TAX NUl.1BER( J LEGAL DESCRIPTION LOT BLOCK WM PARCEL N MBER <7('):,,.2 1-'j1 0'�5`4 1 / 4 SECTION- NORTH RANGE_ - _ PLANNING AREA, ' SECTION �) TOWNSHIP �`7 -+- BUILDING INFORMATION J� BUILDING TYPE TYPE OF IMPROVEMENT / SQUARE FOOTAGE ❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR MOBILE HOME ❑ ADDITION 2ND FLOOR MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLA .1ENT GARAGE ❑ WOODSTOVE ❑ WR 1NG/DEMOLITION COMMERCIAL % ❑ MULTI - FAMILY ❑ ELOCAT I ON/MOV I FIG ! NDUSTR I AL/ NUMBER OF UNITS / MOBILE HOMES �/ n�/ ❑ COMMERCIAL V� a $ 3 5 SIZE 3 . ❑ INDUSTRIAL YEAR (/��, @ $ 16 ❑ HOTEL/MOTEL/ DORMITORY MAKE V� $ 8 NUMBER OF UNITS ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $ 8 IMPROVEMENTS TOTAL s`A i R MARKET VALUE UBC OCCUPANCY GROUP $ �I $ SELECTED CHARACTERISTICS OF BUILDING l/ � PRINCIPLE/ TYPE OF HEATING FUEL PRINCIPLE TYPE OF FRAME ��❑ WOOD FRAME ( P9 ELECTRICITY 0 COLLECTIVE SOLAR C1��1ANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL 0 GAS ❑ COAL 1 ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) ` DIMENSIONS /� 1 ❑ OTHER - NUMBER OF STORIES I TOTAL LAND AREA-1 70A DEPARTMENTAL REVIEW • HEALTH DEPART?AENT TYPE OF SEWAGE DISPOSAL. 1MQ1ER OF PROPOSED BEDROOMS -_ at- " •1-2-- 1)4.7. -�(7�, P� UBLIC OR PR I VATE )JO +CJ ;'� UMBER OF EXISTING BEDROOMS )�-k,". i 4 1�. 0 s)zkvC_}_1_ND I V I DUAL ( SEPT I C )11 NUMBER OF PROPOSED BATHROOM i APPROVED DATE C✓'i ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM ..r... cG'i7G.%' PUD • TYPE 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 \\, L-19— ❑ NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC 17ORKS DEPT ROAD RIGHT-OF -WAY WIDTH Or NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO IDENTIFICATION NAME - MAILING ADDRESS ZIP T E L NO OWNER V r3C/ ./ .�/.. C1 16 C_�_ 1 C O N T _._-r.- --- STA1 E L. Ft-EftSE Nu [ AR CH t THE OWNER O!F THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. 1 N TU E OF APPL 1 CANT1 17 1 CAT 1p DATE_ ' RECEIPT NyT4,!:R [CHEE - oR CASH APPROVED BY PERMIT FEES BASE FEE INSPECTION t/1 ( i3LDG SURCHARGE PLAN CHECK �ENERGY SURCHARGE $ 7 9! r ) TOTAL 911 NUMBER REFUND DATE 1 DATE ISSUED BUILDING OFFICIAL To 1--W 1 O II la 7/ ? r BUIo:NG , 'ERMIT APPLICATION • Jefferson County Building Department*P .O . Box 1220'Port Townsend . WA 98368 LOCATION ' SPECIFIC LOCATION SITE ADDRESS 1 ( allanteMEMAMINIIIIII POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCKrr tt DIVISION TAX NUMBER /' PARCEL N MMBER 7(15,2 I31 ( 1 / 4 SECTION PLANNING AREA I?) SECTION TOWNSHIP NORTH RANGE 4 WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑//SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR CMODILE HOME ❑ ADDITION 2ND FLOOR MODULAR HOME ❑ ALTERATION BASEMENT .411111111111 ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE ❑ REPLAC ENT GARAGE ❑ WOODSTOVE ❑ WR ING/DEMOLITION ( COMMERCIAL Atall.1111111111111 ❑ MULTI - FAMILY ❑ ELOCATION/MOVING INDUSTRIAL;' NUMBER OF UNITS - ' MOBILE HOME/ 1 ❑ COMMERC I AL S I ZE 3 7-101,Li _,wit a' $3 5 ❑ INDUSTRIAL YEAR )( � ❑ HOTEL/MOTEL/DORMITORY / � �� $ 16 MAKE l.Vll "'lll��(((, K 0 @ $g NUMBER OF UNITS J ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROU • $ $' SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAMEELECTRICITY ❑ COLLECTIVE SOLAR MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS 0 COAL ❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS /� ❑ OTHER - NUMBER OF STORIES I TOTAL LAND AREA ,I- DEPARTMENTAL REVIEW HEALTH DE-ARTM : NT TYPE OF SEWAGE DISPOSAL(" ER OF PROPOSED BEDROOMS t�_."� % 1, " ., ■ PUBLIC OR PRIVATE VY�,eUMBER OF EXISTING BEDROOMS I. % I; l eg ND I V I D UAL ( SEPTIC )l I NUMBER OF PROPOSED BATHROOM MO APPROVED DAT - ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY) „_ l[ / APPROVED DATE ►: PRIVATE ( NAME OF WATER SUPPLY '�� ABC A � sil Ai, PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY0.-ft ❑ NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH O NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO IDENTIFICATION 1112223111111111111 MAILING NG ADDRESS ZIP TEL NO g. O W N E R , %........,... ,7 7 "" �� .r. �' ' ir CONT • RC 111111111111111111111 A I HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; 271 ,N TUrE OF APPL I CAN'1? )PP I CAT I • DATE RECEIPT NUMBER CHECIS �{t�Ityip7 OR CASH APP-OVED BY PERMIT FEES , 1- ,' - ' ' 41Y BASE FEE INSPECTION A P P ',' *ig D k-ir 5 BLDG SURCHARGE PLAN CHECK 1-:IViv ENERGY SURCHARGE $ 79 9 ) TOTAL AI•FE&ON COUNTY REFUND DATEDAT t SSUED PLANNING &BLOG DEPT 8 I I NUMBER BUILDING OFFICIAL � '/ ` '9 ( o i //3 /Ec • 111 OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account 4/ PP Account 41 DATE (I(-WSY 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. ******************************* 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) OUR Street or Box '2 , 3 City �.� State/Zip ( 83 7 (,-, 'R Home phone S - Work phone Best time to call 6Z-1N (specify home or work) NOTE: If you rent the mobile home give name, address, and telephone number of � l owner here < ***************** MOBILE HOME DATA: Length (exclude hitch) Width T ? Model Year Make Model Serial number ***************** MOBILE HOME LOCATION - IN PARK Park name k.) //9-- Space # Date placed in park (PLEASE COMPLETE REVERSE SIDE) i • MOBILE HOME LOCATION - NOT IN A PARK or do you Do you own (or are buying) land on which mobi is locatedRENT rent the land? (CIRCLE) OWN BUYING Assessor's Real Property account (parcel) number (The 9 digit number on the tax statement or valuation notice) . 7 O 1 / ° What is the street addres ,4-, a_____ s of this land? Street Street � �( City ` . L'.' If you rent the land what is the name and mailing address of the land owner? Name k)` ' Street or Box City State/Zip Telephone number MOBILE HOME HISTORY �1 Date you purchased I v 6 NI r Purchase price `r"/ Sj r) l "' How did this mobile home get to its present location: A.)6--ef . Moved into Jefferson County from 1 ,-. (County or S ate) Delivered by dealer (name) Moved from another Jefferson County location? YES o NO. If yes, please give previous address/location. Didn't move - pruchased in place. .Yes o0_,' Name of previous owner (I- Address City State/Zip If moved, was advance tax paid? YES or NO. If yes, to which County mobile home replace a previous mobile home at this new location? YES o- NOD Does the P If this is a replacement, to whom and where did the previous mobile home go? G'O/fl 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 1 A _ A 7n ca LQTY Izt) i II r\ ' I rt 4 II LOT L Pou)Ee a (Ir a 11 . . VA---1 , P • Possidt- H canal (D a U� '/ ' --. SURE GW PARCEL Do�),l��vAR� A A. IN ALL b/ Cr/o,V3 F/oM G>��0 SOIL LoG I. RUE"SLOPE y AT PurtP lo�.1h� A —� - - - - - - 1 N s/` 1 A A OUNIlS17E COWERS FLAGGED S�ZY Ls,s/�,�I a SCALE I o I ov' /.2941' NIAAEZO u SRESERVE 'C i TES � v�2Q,g� a j1 Pfrt AuD ha L DR£5 1-1A ID c.y PARCEL 70,2 --/3 i-03 7 DEs-14/uEz) 6Y .77W ET WELCH, iK ) - < o o' > AP P ° ED tsz 1. a MON C NTY P1A-NNING e.t BLDG DEP1 a lie C-/— ,