HomeMy WebLinkAboutBLD1989-00469 I 4-
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lfrDINGERMIT APPLICATION 410
Jefferson County Building Depattment'TP .O . Box
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1220ePort Townsend. WA 98368 , 1
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LOCATION _ * , ,464evAida(7-n
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SPECIFIC LOCATION .--4-ITE ADDRESS ,,- '- \
POSTAL DISTRICT /SUBDIVISION
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LEGAL DESCRIPTION LOTS 4'4 BLOCK ?... IVISION4(0066,MX' N M R
i'N\ t..-15ARCEL NUTT? 955. -Stode,l,o,IV-)W 1 / 4 SECTION
PLANNING AREA L L,..SECTION e%, TOWNSHIP 77N NORTH RANGE WM
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BUILDING INFORMATION kblkik
BUILDING TYPE T PE F IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY EW BUILDING MAIN FLOOR
7.MODILE HOME 0\ADDITION 2ND FLOOR
MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 ,WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY (RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
--- MOBILE Homg.sV
0 COMMERCIAL
SIZE /61 1 X 601 —0 I:' $3 5
0 INDUSTRIAL
YEAR tWoq 0 @ $ 16
0 HOTEL/MOTEL/DORMITORY
MAKE FLAW/ @ $B
NUMBER OF UNITS
(-----
0 OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TaTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP
--7---
SELECTED CHARACTERISTICS OF BUILDING if
PRINCIPLE TYPE OF FRAME PRI IPLE TYPE OF HEATING FUEL
i 0 WOOD RAME ELECTRICITY 0 COLLECTIVE SOLAR
ANUFACTURED [7] WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
0
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
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--. DEPARTMENTAL REVIEW
HEA TH DEPARTMENT TYPE OFSEWAGEIDISPOSAL NUMBER OF PROT(7;TEDT-ETTDROOMS------
4 aCi q>
lI' VIDUAL ( SEPTIC )
1/17 C
VATIC ) NUMBER OF EXISTING BEDROOMS
NUMBER or PROMISED BATHROOM /
A OVED AT
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM . ,
PUD TY-E OF WATER SUPPLY I ',_ - .(3Y1,1111Q101'ri (4414S
GI, ,
10iZ PUBLIC ( NAME OF WATER S PPL j.„_;,_ Sr41.Te- •
APPROVED DATE 0 RIVATE ( NAME OF WATER SUPPLY,,
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
0 1) }
0
APPROVED DATE BANK HEIGHT SETBACK
PUBI? DEPT IC WORKS ROAD RIGHT-OF -WAY WIDTH
). a NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
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IDENTIFICATION
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NAME MAIL / NG ADDRESS ZIP TEL NO
awrIER
iMI Kg-41V, . LA ,
rYlli/upleij a frklibqA4. ' 9576 3(e31
CONT 1(3)
,"'S-T7CTLE-T7TUTZTTETr—Rtr" ,
iL
1
ARCH
-----,
THE OWNER OF THIS BUILDING AND THE UNUERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
NATURE OF APPLICANT f -.1/A61DA E RECEIPT NV BEn CHEC NUMB R OR CASH
i PERMIT FEES
/- - BASE FEE INSPECTION
, ‘........,,, '''. '577
Au 24 tgi -_ 4 BLDG SURCHARGE PLAN CHECK
-----....
40T!°. . .0
40TERSOttammry ENERGY SURCHARGE $ i ,,
p.._ 0Awasm00, - TOTAL
/0(00 911 NUMBER REFUND DATE I DAT ISS E
BUILDING OFFICIAL,...._
2T5 1 -/(113 /6 q
A
OFFICE OF THE ASSESSOR, JEFFERSON, COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account # C ,
PP Account # l l 6/cicQo Q.0
DATE 7/(0
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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 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) DA-Al rnv2?EfY 4' 84-43/KA CA ND ne ri ,42I0 •
Street or Box ( , 6 , eO X 732
City ( lA(/CQ)4.. State/Zip (JQ . (i837b
Home phone 3 6 S I Work phone
Best time to call ,_i\/2y1,15
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here
/ er--
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MOBILE HOME DATA:
Length (exclude hitch) /P./ X (00 ' Width Model Year 194,
Make Model 19 9
Serial number cJ
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MOBILE HOME LOCATIO - IN PARK
Park name i79--
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
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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 ` BUYIN RENT
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
q 5?-90o 2 )-oc
What is the street address of this land?
Street p03 Ni ooL( i((dcpea,da-(.y,_ r/loSS ' 4e,")
City CPt,{,[t C,E
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 , 1 (� ,° 7/ ( f f
Purchase price
How did this mobile home get to its presentloccat on:
Moved into Jefferson County from J
)(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 /n Mq Kt Lifo.E
Address (r1(n73 1 i hwaj 1 o 1
City 01Alktfl P State/Zip 01, gn-37�
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 wh and where did the previous mobile home go?
4
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
i PO Box 1220
PORT TOWNSEND, WA 98368
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