HomeMy WebLinkAboutBLD1989-00534 LIDDING , 'ERMIT APPLICATION 411
Jefferson County Building DepartmentrT .O . Box 12201Port Townsend. WA 98368
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LOCATION . ;_
SPECIFIC LOCATION' SITE ADDRES. WIEIMELT il4fd3/4,4- 44„
POSTAL DISTRICT 44/1,- / ./SUBDIVISION .
1 .52 A.,, fy•r .6"'ex.,-, e:/a0%4461. Av/1-6-7,v o4 rA4.9 95;igeo- e)3
LEGAL DESCRIPTION ...L-4,.‘r EIL CK DIVISION TAX /NUMBER 3(5,7/-
PARCEL NUMBE4? 528(n 1 / 4 SECTION
PLANNING AREA (-1 SECTION A TOWNSHIP , 14/ NORTH RANGEoM/Olpe Wm
BUILDING INFORMATION
BUILDING TYPE TYPE OF ;mrROVEMENT SQUARE FOOTAGE !
0 SINGLE FAMILY 0 NE w BUILDING MAIN FLOOR
VZBILE HOME 0 ADDITION 2ND FLOOR
n DuLAR HOME 0 ALTERATION BASEMENT
O DETAcHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT IGARAGE
tZ>c)
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
c-N1
\_ NUMBER OF UNITS
MOBILE HOMES
N ) 0 COMMERCIAL @
0 INDUSTRIAL $35
( Th S I Z E...F2/ ...4.21)
O HOTEL/MOTEL/DORm I TORY YEAR AK ...Lig y ,,_. _
$8
vj . $ i 6
, ‘ .1,6 fr.egz_el, ._.:,-..kr-s-5 , @
NUMBER OF UNITS A , _ . .0 OTHER - SPECIFY ... rij @ $8
ESTIMATED COST OF
IMPROVEMENT T6TAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP — At
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
'fl‘sKMANUFACTURED WOODSTOvE 0 PASSIVE SOLAR
TRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
VI 0 MASONRY ( WALL BEARING )
DIMENSIONE
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
c'4< HEALTH EPARTMENT :TYRE OF sEWAGE DISROSAL NumBER OF PROPOSED BEDROOms
0 PUBLIC OR PRIVATE NUMBER OF EX I ST I HG
A BEDROOMS ---
1
-(-- 1,71E/“r INDIVIDUAL ( SEPTIC ) IUmBER OF PROPOSED BA1 HROOM
PUD TYPE OF WATER SUPPLY
04 P U IP ,
BLIC ( NAME OF WATER SUPPLY)PXt0044 I —
APPROVED DATE tri PRIVATE ( NANE OF WATER SUPPLY)
PLANNING DEPT . EITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
0 NO
‹) APPROVED DATE BANK HEIGHT SETBACK ...
----
PUBLIC WORKS DEPT ROAD RIGHT- WAY WIDTH
NAME OF PUBLIC ROAD ...... ,
____
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
---
g IDENTIFICATION
_ —
NAME. - MAILING ADDRESS ZIP ..TEL NO
• -, --,
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OWNE Apar ,
/e-s x(40( -__5( - Aid . ' E.07 .) -L ./C oc
rq.5-37 .14es,,. .e
,
Ar.of dr- ‘\r-Qc cD,c. .
CONT IA-5c— q 2.._.S
—,17-777r i Lit..71TM ITT,_1
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
. - - -----------------.-,--, ---- . . - ..--.---,-,----
SA GNAT E OF APPLICANT APPLICATION,DATE RECEIPT NUMBER CHECK DUMBER OR CASH
-
oq / 2_189° j i/Lao3 I Calt-)h I
____,.. _____-_,_
t.
XP:iv\r:: ake D r PERMIT FEES
r ,._0(;) BASE F E ,
c 50 BE CG s un CHARGE PI N.SLANPECCHTEIOCKN
, ‘ ' ji , --------- -
JEFFERSON COUNTY ENERGY SUPC r,s-D TOTAL
PLANNING&BLDG DEPT HARGE $7
v-----
1 1 NUMBER REFUND DATE 1 or I SS
--, ,
NLDING OFFICIAL
___ _
-To 1-1 0
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account (I
PP Account If
DATE********7/6 //218911?
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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
Dealer report Application Delinquent State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) i 6/1 i
Street or Box TO `,P44 C7. 7-0
City '^U State/Zip V/41 ClC I/k%
Home phone 4? 7 4;77p2 (/nAd3
o
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) v Width // Model Year
__8_!/____Mak / 7�a�?_��- et' odel
Serial num
ber •�
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MOBILE HO LOCATION - IN PARK
Park name
Space Il 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 or 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) .
2 800 3-e) '" )
What is the street address of this land?
Street di
/ / '11111FRIM
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
Purchase price
How did this mobile home get to its present location:
Moved into Jefferson County from
(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 - pruchased in place. Yes or 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 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 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
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