HomeMy WebLinkAboutBLD1989-00429 BUSING `'ERMIT APPLICATION
ferson County Building p .
De artmentSP .O . Box 1220' t Townsend . WA 98368�
LOCATION
SPECIFIC LOCATION SITE
I TE ADDRESS
I STRICT �, �y ai/ UB�(V L- in ,
a I
P
L
N
LEGAL DESCRIPTION LOT
BLOCK DIVISION TAX NUMBER
PARCEL NUMB R 1 / 4 SECTION
PLANNING AREA SECTION +4._. ) TOWNSH 1 P r
J NORTH RANGE . ';? WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY `19"`NEW BUILDING
MAIN FLOOR
MOflILE HOME 0 ADDITION 2ND FLOOR
; '''
O MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES. „
O COMMERCIAL SIZE I (�iX(_✓t} 0 @ $35
p
❑ INDUSTRIAL YEAR 19 �R
4
@ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 1 f "1PV` ky 0 a@ $8
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
0///WOOD FRAME -0,,ELECTRICITY 0 COLLECTIVE SOLAR
' MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
STRUCTURAL STEEL 0 GAS ❑ COAL
/2`,, 0 REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
'3 --_0 MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER NUMBER OF STORIES TOTAL LAND AREA
' DEPARTMENTAL REVIEW
C HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
O, I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPO`-QED BATHROOM
APPROVED DATE 1 ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD YPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
( \ ) PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO ___
IDENTIFICATION
MAILING ADDRESS ZIP TEL NO
NAME 0.. C1
----a „(Tef(-->rc-,nn Cr,
-." CO N T\ oac-e- ez -P VC
!SPATE L1cENSE NII
(ARCH I
r
�n
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
J SIV U,REOF ,APPL)& JQ
T OH 103i APPLICATIODATE RECEIPT NUMBER CHECK NUOER OR CASH
3-7 8 �� ^ S8
APPROVieDBY PERMIT FEES
A P P 0 rE Or-,' /n(LA
.' BASE FEE INSPECTION
5�`1989
`13 . X_) BLDG SURCHARGE PLAN CHECK
_
ENERGY SURCHARGE Q
JEF4WIN couraV �� TOTAL
? ANNINO &8LD6 DEPT 9 1 1 NUMBER REFUND DATE DATE SSUE
/f
BUILDIN
G �--OFFICIAL I f! (. /
7-(13 t (,per
411
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account #
DATE
**********************************************************************************
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 permi permit
Dealer report Application Delinquent State transfer
by sale for title taxes report
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) C.` )e J4 ee
Street or Box 1— /
City u,1 J State/Zip VJ l.V
Home phone 73:2 4('7). Work phone
Best time to call
(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) Width f Model Year 86-5)
Make Li Y+1 Model
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name �) /1Or
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
411 4
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) .
What is the street address of this land?
Street q6?8 '1''"(LuL/ Jo)
If you rent the land what is the name and mailing address of the land owner?
Name , 46-71fIK-C
Ci
Street or Box
City State/Zip
Telephone number
***********
MOBILE HOME HISTORY
Date you purchased
Purchase price
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 or NO. If yes, please give
previous address/location.
Didn't move - purchased in place. Yes or NO
Name of previous owner
Address
City 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? 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 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
. '
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APPROVED
MAY 5 689
JFFFEMN COUNTY
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