HomeMy WebLinkAboutBLD1989-00485 DUI: -NG i;ERMIT APPLICATION
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Jefferson County Building Departnlerit 0 Box 1220 P Po m . * rt Townsend. WA 98368
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LOCATION ) _
SPECIFIC LOCATION SITE ADDRESS CJ
060-.------
POSTAL DISTRICT_ /E ' R IVISION
r ,
LEGAL, DESCR I PT I ON-0-)LOT.rwA BLOCK DI ISI N TAX NUMBER
PARCEL NUMBER 0 / 4 SECTION
PLANNING AREA SECTIONTOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
— —
BUILDING TYPE TYPE F IMPROVEMENT SQUARE FOOTAGE
O INGLE FAMILY
WIK
0 I, W BUILDING MAIN FLOOR
MOBILE HOME
/ ADDITION 11/40TYn 2ND FLOOR 4 i
O MODULAR HOME 0 ALTERATION BASEMENT ,-2i-he,5 co
O DETACHED/ATTACHED 0 REPAIR CARr-TRT
GARAGE D REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
D MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS AD
mOBILE HOM s ,ei/ 0411
0 COmMERCIAL
SIZE 01* -01t_ 57a3-6 @ $35
0 INDUSTRIAL r
YEAR @ $ 16
0 HOTEL/MOTEL/DORM I TORY -
MAKE Li t"-e -a NUMBER OF UNITS '
0 OTHER - SPECIFY 0 @ $8 ESTIMATED COST OF
IMPROVEMENTS TOTAL FA I P MARKET VALUE
UBC OCCUPANCY GRO / / s S_
—....L. 7 '
_ -
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SELECTED CHARACTERISTICS OF BUILDING
PRII IPLE TYPE OF HEATING FUEL
7INCIPLE TYPE OF FRAME
OD FRAME ELEcTRICITY 0 COLLECTIVE SOLAR
"MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE D OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING )
0 OTHER - DIMENSIONS
NUMBER OF sTorilEsr2 TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
(*, .
0 P IC OR PRIVATE
. 61VIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
____
, INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLYA_
APPROVED DATE 0 PRIVATE ( NAME OF WATER pUPPLY)____________
.,..c.,
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
itiv. /VE ii NO S NAME OF ADJACENT WATER BODY
_I t:
.
AP OVED 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 0 YES 0 NO
-.. ----
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
----."-^*WNER ,000 m. 0 /i•k/22Z____
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CONT I -7 0_,Oh&On. LIV )
_ 571--klm LrecTIT Tia4, __
ii1110.0 ..),A--*Am
ARCH
THE OWNER OF THIS BUILDING ND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
''SIGNAT/bREPPAy'l ANT
.s<
1/1 /
fif/6-1/-14\ )
'P ICATII" " TE nr ' 7. T N 1 2 CHECK NUMBER OR CASH
APPROVED B PE MIT E S ,:... 6°'-7
INSPECTINSPECTION
(
nLoG suncuARGE PLAN C.HECK
P 8 1989
ENERGY SURCHARGE $ c2g0_......._
.47 /50
JEFFERSON COUNTY TOTAL
0-060Fpi 9/ 1 NUMBER REFUND DATE
BUILDING OFFICIAL.__,...,.....A.A, ... —
-fr) PM r3, /3 1
.... .
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
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MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account 1E
DATE "_;::-Vii? /
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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.
*******************************
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 DAT
Name(s)
Street or Box , 1 1
-7a City State/Zip LIL)4
Home phone4'�7 c2141 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
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MOBILE HOME DATA:
Length (exclude hitch) Width c7C2 Model Year
IN(�/;� Model 'L` I $��l�
Make — _
Serial number
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MOBILE HOME LOCATION - IN PARK .
Park name
Space If 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 oor do you
rent the land? (CIRCLE) OWN BUYING
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
8Q1 533 d3
PD
What is the street faddddress of this land?
Street av
City ,
If you rent the land what is a name and mailing address of the land owner?
Name 021
Street or Box
City 5'tate/Zip 7p 37) lc�
Telephone umber 37
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MOBILE HOME HISTORY I
Date you purchased
Purchase price //i 0 G O
1
How did this mobile home get to its present location:
I '
Moved into Jefferson County from �i
( ou ty orGate)
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 or NO �j
74
Name of previous owner 1'
Address c90 /
(i?
City �(GC-afrr't1
L/k State/Zip / 0 2
If moved d?' YES or NO. If yes, to which County
was advance tax pa ��
Does the mobile home replace a previous mobile home at this new location? Y S o 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
9861 Jagwa3ea 21,
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