HomeMy WebLinkAboutBLD1989-00436 WILDING ERMIT APPLICATION •
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Jefferson County Building Departmentor" .0 . box 1211Vort Townsend, WA 98368 ,
LOCATION
SPECIFIC LOCATION SITE ADDRESS /2-7(_ __ . - '-
POSTAL DISTRICTE-14 _/SUBDIVISION
LEGAL, DESCRIPTION LOT O& BLOC, DIVISI •N TAX NUMBER
PARCEL NUMBER7 W -Y ) 40- d, 1 / 4 SECTION
PLANNING AREA SECTION 2-._ TOWNSHIP .e..2..7 NORTH RANGE /Lt/ WM
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BUILDING INFORMATION
- ——
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY N NEW BUILDING MAIN FLOOR
N MOD I LE HOME D ADDITION 2ND FLOOR
O MODULAR HOME 0 AL1EERATION 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 -
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MT HOMES
O COMMERCIAL
SIZE - 14
O INDUSTRIAL YEAR (910 0 @ S I 6
0 HOTEL/MOTEL/DORMITORY Ay ,„,,,,, ,,,,,, --
'
NUMBER OF UNITS
NO, ----
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
73..' IMPROVEMENTS TOTAIFAIR MARKET VALUE
S /)”
, a2
UBC OCCUPANCY G1117 .-1 S 1000
N \
\...) SELECTED CHARACTERISTICS OF BUILDING
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1 PRINCIPLE TYPE OF FRAME rn 1 IC I PLE TYPE OF HEATING FUEL
LA WOOD FRAME Y4 ELECTRICITY 0 COLLECTIVE SOLAR
YLMANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
*7f 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
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O MASONRY ( WALL BEARING )
0 OTHER -
REVIEW DIMENSIONS
R
NUMBER OF STORIES /
----- --- TOTAL LAND AREA
DEPARTMENTAL
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROpOS-E7D-E76-17-7-7-00NS
II/0 Igqq ( . 0 PUBLIC OR PRIVATE
INDIVIDUAL ( SEPTIC ) NUMBER CF EXISTING BEDROOMS
NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUB TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY), . _
— _ _
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD .5/4F/WL27/ Z9
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED DYES 0 NO
_ . .
IDENTIFICATION
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NAME
1----- MAILING ADDRESS ZIP TEL NO .
OWNER
'..." '
1 9m39
i7--- _gate2„ 053./Lt
CONT /6 6? /WaY I./Pj / SC08,01ill/ ‘
Of-'-Zr411/4 ., . .
L 71 I L.1. .. E
ARCH
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-.----/---- _ -- ---- ,
THE OWNER OF THIS BUILDING AND THE UNWHISIGN740 AGRE TO CONFORM TO ALL APPLICABLE LAWS:
-,.. ...---( .-----
Sej.GN) ' ,---*F PIP Cf...I / 40/ / A71 iCAT N VAT777, IFM571PT NRI:JZOMR CHECI5 NUMBER OR CASH
1jPs Ar - /7 i -1 .• ••--1) 7j
A 1911:\* PERMIT rs.IS
Apitt; . 1
' ' . 7..,5 f: o., BASE FEE
INSPECTION
* pttIh _ 13 LO7.; SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ ,
- --
TOTAL
AfFEASON COUPIIL.
PLANNIN6 SL BLDG OW
9 I I NUMBER REFUND DATE 1 DAT ISSUED
BUILDING OFFICIAL
ugft
_,.... _
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account Il
/l/C2r1
PP Account 4I
DATE / �9
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.
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REASON FOR INQUIRY:
Field visit Excise tax Building2) 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) //iU.V,A7 -t/
Street or Box /C.l� l7�� ,C4/f/F
City /4D ‘.4 State/Zip 4/4.? er•JeTz.
Home phone Work phone J 95 t /7rl .0 (' 2/"
Best time to call ff—t5 0
(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:
Length (exclude hitch) 459 Width Model Year
,�/� . ., I
Make /'�/®1' �/�ti'� Model -�r �'�s'✓,eF .
Serial number /"//pW
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MOBILE HOME LOCATION - IN PARK
Park name
• 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
dNor do you
rent the land? (CIRCLE) ) BUYING
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
9 300 1116 �a�
What is the street address of this land?
Street
city /'A V.�G J
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
J
Date you purchased /���,�f
Purchase price 'y �.��
How did this mobile home get to its present location:
a_Ar .
Moved into Jefferson County from
(County 'or State)
Delivered by dealer (name) /0:K0p/01- /6//4G- v &6I /
Moved from another Jefferson County location? YES o 4010 If yes, please give
previous address/location.
Didn't move - pruchased in place. 'Yes o
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? YES or NO. If yes, to which County AZ/�
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 toe
assessment valuation notice will be mailed to
you when it's valued and added to
l.)
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
i
1 & J SERVICES
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320 JC AN ST!,RORT WDLOW,WA 98365 (1
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