HomeMy WebLinkAboutBLD1989-00543 •LDING 'ERMIT APPLICATION A
Jefferson County Building DepartmenteP ,O . Box 1220'.-ort Townsend. WA 98368
'LOCATION �//
SPECIFIC LOCATION SITE ADDRESS / /9.2f?hi(_/f�-.,-4 POSTALL ISTRIC r /SUBDIVISION
LEGAL DESCRIPTION LOT I BLOCK/ DIVISION TAX NUMBER
PARCEL NUMBER ') 7040 1 a SECT 1 ON �n �` _
PLANNING AREA SECTION TOWNSHIP NORTH RANGEfV M
BUILDING INFORMATION
BUIL NG TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ NGLE FAMILY [ %NEW BUILDING MAIN FLOOR
MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
iX) GARAGE 0 REPLACEMENT GARAGE
‘it.4 ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
COMMERCIAL MOBILE //'�
O ( _
SIZE )HOMES
V �\_C' i1, $3 5
0 INDUSTRIAL YEAR -% 7 N CU l $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE
NUMBER OF UNITS $6
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
''"' IMPROVEMENTS
OTAL FAIR MARKET VALUE
„^ UBC OCCUPANCY GROU2:5 $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
_,<D ❑ WO D FRAME 0 ELECTRICITY ❑ COLLECTIVE SOLAR
ANUFACTURED ❑ WOODSTOVE ❑ PASSI E SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ C
0 REINFORCED CONCRETE 0 OIL OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS:
❑ PU C OR PRIVATE NUMBER OF EXISTING BEDROOMS
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED 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 ❑ YES 0 NO
IDENTIFICATION
_ram NAME ^ MAILING ADDRESS ZIP TEL NO
OWNER
me r);lc " t .yR - -f ` i -
. ihrti
CONT NJ�J
STATE LTCtfTSEr NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S! NA URZ F_APP� , AP i,.1l CAT 1 Oc DATE I RECE 1 PT�R CHECKB�R�R CASH
APPROV D BY PERMIT IF�OJ{EES `--L}- ! ^✓�_J`y
A P P ' BASE FEE INSPECTION
, BLDG SURCHARGE PLAN CHECK
J N t 9 1 $ !
ENERGY SURCHARGE �'? TOTAL
AfFEPOINIAW
INLAMAti t tatt it $ 9 1 1 NUMBER REFUND DATE AT I SSU
BUILDING OFFICIAL 2
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account #
PP Account #
.`a .`i"'"/
DATE (
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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 l 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) ref, r I e m es : .
Street or Box /9 /'
City ' , G in c.f k," 1 '# State/Zip '",
Home phone Work phone ' _'
Best time to call j')'1
(specify home or o
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here
***************** .
MOBILE HOME DATA:
Length (exclude hitch) 4/ .r
Width :2 ' Model Year ' k" '
Make IC? ? a jr/if Do"1/" Model µ • ,,,, '
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name
Space # 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 locate do you
rent the land? (CIRCLE) OWN BUYING RE
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
What is the street address of this land?
Street / 3 / I Gz t s t' L.
City / a.,7
If you rent the land what is the name and mailing address of the land owner?
Name Narh' , i /'F
Street or Box
City Lt�� ( C' `- `/ State/Zip
Telephone number
***********
MOBILE HOME HISTORY
Date you purchased "- / 3 w
Purchase price / , 0 0
How did this mobile home get to its present location:
Moved into Jefferson County from ''i` .5 :2,�
(Counfjt)or State)
Delivered by dealer (name)
Moved from another Jefferson County location? YES orn ) If yes, please give
previous address/location.
Didn't move - purchased in place. .Yes or NO
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? /ES? 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
theoase sessment
of your mobile home call the Assessor's Office at 385-9105. Questions
call the Treasurer's Office at 385-9150.
(NOTE: If mobile home is new to this caounty
manvatluation notice will be mailed to
you when it's valued and added tothe
.)
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
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