HomeMy WebLinkAboutBLD1989-00533 . -
AIDING ERMIT APPLICATION
Jefferson County Building Department-P .0 . Box 1220,11,rt Townsend, WA 98368
,
LocATIoN
SPECIFIC LOCATION SITE ADDRESS . 0 MaP
POSTAL DISTRICT , iSUBDIVISION
'A
LEGAL DESCRIPTION LOT LOC"- DIVISION TAX NUMBER
1- PARCEL NUMBE - D ,1 / 4 SECTION
PLANNINGAREASECII3N ----
TOWNSHIP .4,2 NORTH RANGE 6(17 WM
___
N...,
'A .• BUILDING INFORMATION /
r BUILDING TYPE TYE, OF IMPROVEMENT SQUARE FOOTAGE
N,
'
WONGLE FAMILY EW BUILDING MAIN FLOOR
/.
N., DILE HOME 0 ADDITION 2ND FLOOR
.C: 0 MODULAR HOME 0 ALTERATION BASEMENT
0 DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE . •
Ni .,p 0 WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBIL,Eg)NEp
O COMMERCIAL - , -
O INDUSTRIAL ---
R .0 d
O HOTEL/MOTEL/DORMITORY YEA _ $ 16
MAKE V @ $8
NUMBER OF UNITS —
O OTHER - SPECIFY VJ @ $6
ESTIMATED COST 0
impnovvi i • TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROIJ,72 - $ -----
--- --
SELECTED CHARACTERISTICS OF BUILDING
----- — .
PRIM" rLrz TYPE OF HEATING FUEL
PRINCI„IPLE TYPE OF FRAME
O W D FRAME E1tECT1ICITY D COLLECTIVE SOLARE %j
ANUFACTURED U WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL E4,-'6THER - SPECIFY
0 MASONRY ( WALL BEARING )
DIMENSIONS
I 0 OTHER - ---- NUMBER OF STORIES TOTAL LAND AREA_
, ---- )
DEPARTMENTAL REVIEW / Air e.I.' 1 I II
HEAIITH p PAR TM ENT TYPE OF SEWAGE D 1 SPOS A L 4 NUMBER OF PROPOSED r3EDROomr.i _
01 I i il 7 U r13Lic OR rRivATE NUMBER OF EXISTING BEDROOMS
k\O WINDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM ---APPROVED DATE
PUD 0 INDI IDUAL WELL NUMBER
TYp- OF WATER SUPPLY
E OF EXISTINC.; Buvrtirm>cm
—,......—....---------........,m,
L PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE U PRIVATE ( MARE OF WATER SULEIL1
---
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
j 0 YES AME OF ADJACENT WATER BODY
i 0
APPROVED DATE BANK HEIGHT SETBACK
_ __ ----
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH —
NAME OF PUBLIC ROAD
.
NAME OF PRIVATE ROAD
--:2 APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
--- -
NAME
MAILING ADDRESS --...
Zip TEL NO
OWNER —77.---- JIZ.L.,_______ IV ",i0P....e4111
• , - _ AP-04MM
••••••••••••••}1M* .
,.........
r .
CONT T44A42._ _
---.--- --
ARCH
_
A ---- ---
THE OWNER OF THIS BUILDING AND THE UND77RSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
)(,
S NATuRE 0 ArZ CAT CHECK 3 CASH
)(5*
Ap A ' to PERMIT FEES
DV "0.." BASE FEE
INSPECTION
_ A/JEFFERSON BLDG SURCHARGE PLAN CHECK
POINfivi3 , „- UNTy c_.!• ,.;
uti6LOG DEpT N t-,I( '
EERGY SURCIBVTGE $ — ,
TOTAL
911 PUMUER REFUND DATE DATE ISS D
..----,--,--.*---.
BUILDING OFFICIAL 1 I
4andeewa*_..+4-7). ii/8 le
! 4
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account I6
PP Account 1l
DATE // g sCI
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
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) CLQQA1\
Street or Box 0• V C
\A)-(1--
City State/Zip
Home phone Work phone
Best time to call
(specify home or work)
NOTE: If you rent t mobile ome give name, address, and telephone number of
owner here
*****************
MOBILE HOME DATA:
Length (exclude hitch) Width Model Year
y
Make (r) Model 4)(1.0
Serial number jD LI C 1 7), I l c2 J v
*****************
MOBILE HOME LOCATION - IN PARK
Park name
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
O i
MOBILE HOME LOCATION - NOT IN A PARK _�
Do you own (or are buying) land on which mobile home is 1 ated 0 r do you
rent the land? (CIRCLE) OWI�.-_ ______,,BUYING
Assessor's Real Property accoun (parcel) gtilmber (The 9 digit number on the tax
statement or valuation notice) . `----"
What is the street address of i� -�
s land?
Street
City .---IE 41)(7 PpC
,Q a_0� `'� C
If you rent the land wtrat-,s the nam an mailing address of the land owner?
-4"-C
\,_2) ,
Name 6:4„),)_,
„C?
c- 1
IZ V ,,,,,,
Street or Box "'`
, A
City .---R State/Zip
Telephone number , ) ' (: )
** ********
MOBILE HOME HISTORY09
Date you purchased //NCI
/
Purchase4)
price rice " lV (/ #2r)
How did this mobile home get to its present location:
•
Moved into Jefferson County from '-----(301(76 - �
(County or State)
Delivered by dealer (name)
Moved from another Jefferson Cou y
location? YES o N" 0• If yes, please give
previous address/loc tion. 7
Didn't move - pruchased in pla . .Yes 4/- -/
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 o NO
If this is a replacement, to whom an 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 Assesso 's Office at 385-9105. Questions about taxes
call the Treasurer's Office at
(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
,.PAy
•
GG '
t
�J 5'
v
F 7 X �',3
A
SGAt-L. " a o,
v e 0
A P 17 ,
0 t -----,
.-----
3E S°
1,1 tN^±1,0 fl BI-0 F-131
r
2s All ,
/I 7 e 7 ,' ._- _2„7
,
/
,.....--%" ,„e,i /
7 ,____/-de/ , . A. ,,,,A,
cdc,,<
.0/
Abh.,
'------------„....:,.........
1 \
irii"- i 7 0 r i
i (1/1
((7IS773q
f ----
-72-_-,c,,,y _
----..----:__ ---,
----__
I I / s /9 0 ..1-4-1,-- -
II
ip_e_.47/