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HomeMy WebLinkAboutBLD1989-00410 L _DING 'ERMIT APPLICTION Jefferson County Building DepartrnentOP .O . Box 1220c rt Townsend. WA 98368 OCAT O �...�.�,e SPECIFIC LOCATION SITE ADDRESS �� POSTAL DISTRICT - /SUBDIVISION LEGAL DESCRIPTION LOT 2- BLOCK DIVISION 2--- TAX NUMBER PARCEL NUMBER 37007 a SECTION PLANNING AREA SECTION <&eD TOWNSHIP _2„.55 NORTH RANGE cA WM BUILDING INFORMATION / v BUIL NG TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE f'f / ❑ INGLE FAMILY ❑ NEW BUILDING MAIN FLOOR dj MOBILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME 0 ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR . CARPORT GARAGE ❑ REPLACEMENT GARAGE ____/__ 7/._( ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY ELOCATION/MOVING 4INDUSTRIAL NUMBED OF UNITS 0 COMMERCIAL SIZE ,MOBILE HOMES 2 S a. M. ❑ INDUSTRIAL ' -". ❑ HOTEL/MOTEL/DORMITORY' YEAR ! �] $ 16 MAKE NUMBER OF UNITS p� � 0 OTHER - SPECIFY ESTIMATED COST OF 1 $8 IMPROVEMENTS T AL FAIR MARKET VALUE UBC OCCUPANCY GROU . $ 1 SELECTED CHARACTERI TICS OF BUILDING PRINCIPLE TYPE OF FRAME PRR NCIPLE TYPE OF HEATING FUEL ❑ OD FRAME pa' ELECTRICITY 0 COLLECTIVE SOLAR MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR O STRUCTURAL STEEL 0 GAS ❑ COAL O REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS • 0 OTHER NUMB R—OP-5fORIES TOTAL LAND AREA w DEPARTMENTAL REVIEW •w. HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS_ ❑ P L I C OR PR 1 VAT NUMBER OF EXISTING BEDROOMS �/� I ND I V I DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM. f' , APPROV.�-..D D ATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHE O0M _ PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY CJ a APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY 1,� ten PLANNING DEPT . WITHIN SHORELINE JURISDICTION `.,,,,,, 0 YES NAME OF ADJACENT WATER BODY NO APPROVED DATE BANK HEIGHT SETBACK "Q PUBLIC WORKS DEPT JROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD 0 APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO IDENTIFICATION 9 NAMES (y,���/� F/, MAILING ADDRESS ZIP TEL NO O W N E R 2.70)0401 1 ) 'v J J' "ci`-X ), _ ,.. ,� '4 .- �° \l11 '00\ e-/ / 5 Ate_ CONT /V7/2_ NE ?- -€. xiC STAT-L L I OkNSE` tr f -{ ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. SI ttATURE OF A��P�i.l C_A� AP��AT I DATE �RECE!� NUIvtBER J CHEm Ctc NUMBERoR CASH s APPROVED BY PERMIT FEES /6 BASE FEE INSPECTION APPROVED Asa .`" r-- BLDG SURCHARGE PLAN CHECK AUG 7 1989 ENERGY SURCHARGE _, TOTAL JEFFERSON COUNTY: PIAN`,1IN!i&8LOG DEPT /..0 9 1 I NUMBER REFUND DATE SUED BUILDING OFFICIAL . ..OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account # PP Account 11 DATE ********************************************************************************** Please read the entire form and provide as much information as possible. This will us identifythe unit correctlyand avoid double assessm nts. It will also aid help in placing a correct value on your property. ******************************* REASON FOR INQUIRY: Field visit Excise tax uilding 7 Moving by deputy affidavit. permit r permit Dealer report Application Delinquent State transfer by sale for title taxes report ******************************* MOBILE HOME OWNERSHIP/OCCUPANT DATA Name(s) .JvCLL y- / BooT,e./ • Street or Box / 420 / S,j. ' `G CT� ��- City Y,9- /1/4/ 'eV State/Zip �//9 O o 11/ Home phone p?Olo'o?5 51 -1.6 6- Work phone Best time to call g.`Q© - /a:4 D nit /h (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) 1.52> Width 1:32-- Model Year / /74 Make S i l / AJ6s Model Serial number 0/9 44 74, ,7 1 ***************** MOBILE HOME LOCATION - IN PARK Park name Space 11 Date placed in park (PLEASE COMPLETE REVERSE SIDE) MOBILE HOME LOCATION - NOT IN A PARK Y Do you own (or are buying) land on.. hich 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) . �/ (:ou4 %1.,� :) "76 ®©/o - 0m/- oa ( Ewf'$ p What is the street address of this land? Street . !//S/0 �/i/ WA/7- -;4 --- s City /Y iVO � .9�Sf/i,c%i ai . 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 /0 - 'jl— g C% c�v Purchase price 4/O� How did this mobile home get to its present location: Moved into Jefferson County from (County or State) Delivered by dealer (name) __ Moved from another Jefferson County ,location? YES o N If yes, please give previous address/location. Didn't move - purchased in place. Ye or NO Name of previous owner L(,e_C 19.4 G k (C.-I Address -Le D (P a lc.I) S 1'it2_%"% /G City C.6,0"fTLA--% A- State/Zip e.', 4.P. 572 6� / 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? YES 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 vaion 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 - • . r ) ) • r, � _ 7�r r(G duo V WIIPP-411211.111111111111101A I- MIIIIMPIP" ...r r r r/ 0 ;130E-r _ --.4110A11%. _ ) 1 SePo K Ted • ,( 9 go 1_1 - ,. ,. APPROVED Auc 7 14,141 JEFFERSON COUNTY pt+NN I NC !BLOC OPT 7i7(?-e:_l'f\'‘.-- 6CH1/4-1-.'--' 7.: 4tcv CG , a ck5-ev- , - 7-- a 04-f