HomeMy WebLinkAboutBLD1989-00531 BUIING ' ERMIT APPLICATION
III
Jefferson County Building Department*P .O . Box 1220•Port Townsend. WA 98368
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LOCATION
Al) /(1 (J C) C�
SPECIFIC LOCATION SITE ADDRES.: �'' .
POSTAL DISTRICT J /SUBD I V I ION .e - c `7-' !
LEGAL DESCRIPTION LOT BLOCK 7 DIVISION TA NUMBER
PARCEL NUMBER; 4��( - 40`l3 1 / 4 SECTION
PLANNING AREA_ SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
MOBILE HOME ❑ ADDITION 2ND FLOOR
MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING , 'INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES /' ,-{{,
❑ COMMERCIAL SIZE / ._.,,_y� q@ $3 5
❑ INDUSTRIAL YEAR A @ $ 16
' ❑ HOTEL/MOTEL/DORMITORY {
1� NUMBER OF UNITS MAKE y1 @ $g
' ! ❑ OTHER SPECIFY ESTIMATED COST OF @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU sr
$ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
, r- 0 WOOD FRAME []''(ELECTRICITY ❑ COLLECTIVE SOLAR
4 NIXMANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS 24%4,�
•....2 ❑ OTHER NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HE LT DEPARTMENT TYPE OF SEWAGE D I SPOSAj BER OF PROPOSED BEDROOMS 4
6�2 �y C19 ❑ ,PUBLIC OR PRIVATE y NUMBER OF EXISTING BEDROOMS
W2 4J I ND I V I DUAL ( SEPTIC ) 1C1T5 NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY //��
`;PUBLIC ( NAME OF WATER SUPPLY) '-)M.
APPROVED DATE ' ❑ PRIVATE ( NAME OF WATER SUPPLY (
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLI WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
(, 1 NAME OF PUBLIC ROAD
�v NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
JAI
/ MAILING�/ , ADDRESS ZIP TEL NO/
OWNER
JO•/// al �/h uL /7be'5D GP 1P4348- f"SSeT
Ivey
CONT
S I ATTE LICENSE NO
ARCH t
"1
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA RE OF PPLJCANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
Gti 5 2. ?�r-7c-,, 417
1 AP ✓ ----PERMIT FEES
751 CAD BASE FEE INSPECTION
�J 7 �
�ic0 BLDG SURCHARGE PLAN CHECK
i
JEFFER COUNTYlI
PLANNING&BLDG DEPT ENERGY SURCHARGE $7
TOTAL
911 NUMBER 1 REFUND DATE I 6:>77/ II�
+-- SS
BUILDING OFFICIAL lT
/ /a 1 J I1ir3 3_ $ O7 'Y
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account #
DATE 5 -23 - ff
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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 lirtque"nt State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP OCCUPANT DATA
Name(s) 4/'. rf /1Ir3 . �i`ia 4
Street or Box //G5t 11,64e, 2 D
City / P J1 /dw/t S€tc..( 1iJ. State/Zip /el/ lift.?6&
Home phone `��,j—��7�� Work phone
Best time to call 711.'
(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) 1117 Width 24 Model Year rYf
Make ,Ytr , oa — Model Oz««i4c ,.,
Serial number if id-03 /23Ys 33 V tf
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MOBILE HOME LOCATION - IN PARK
Park name
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
S
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land h 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) .
Agy/-- SOO -- o p3
What is the street address of this land?
Street 40 e77/Ae 1--h#4
City
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 $ld, e
Purchase price ` /l� ,j oo . O O
How did this mobile home get to its present location:
Moved into Jefferson County from Sr',.e.&i. .
(County or State)
Delivered by dealer (name) Lji/l �t/oek.. ( wrole 7' .�•we. 41 /loz,e/ep cc
Moved from another Jefferson County location? YES o N0. If yes, please give
previous address/location.
Didn't move - purchased in place. Yes or NO
Name of previous owner
Address
City State/Zip
, wsff Ze
If moved, was advance tax paid? 6E-S or NO. If yes, to which County /Lc 4 r)
Does the mobile home replace a previous mobile home at this new location. YES r 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
10
The map is for your information. It is not intond J to -- / _
express your exact GJU;il1af185 nor is it intended 10 dr'�iCt � ,,,///��� eee the actual location of existing easements,streets,roads acid )/ -r"
highways. The Company assumes NO LIABILITY for any I ��v �j� '�.
LOSS occuring by reason of reliance thereon. �:
JEFFERSON TITLE COMPANY ps. JOh" - InA4"�I"_. •� Z�`"C `
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