HomeMy WebLinkAboutBLD1989-00546 _DING . .
1
L31 'ERMIT APPLICATION iii
Jefferson County Building Departmennt•P .O . Box 1220sPort Townsend. WA 98368
•
LOCATION a t �t
vouuLA_
SPECIFIC LOCATION SITE ADDRESS X1 02 () t)0 !
POSTAL DISTRACT /SUBDIVISION
„LEGAL ^
DESCRIPTION LOT BLOCK In DIVISION TAX NUMBER
?I' PARCEL NUM ER C/(Q ”d o )O c`7k�'pt / 4 SECTION
PLA NING AREA SECTION 3 TOWNSHIP ? � NORTH RANGE WM
BUILDING INFORMATION
BUl ING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ INGLE FAMILY 0 NEW BUILDING MAIN FLOOR
MOn I LE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 2 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS '
❑ COMMERCIAL MOBILE H ME
SIZE \/C $35
❑ INDUSTRIAL YEAR ( 0a $ 16
�n7 ^^
❑ HOTEL/MOTEL/DORMITORY MAKE J�rr^l „ J a7 $g
NUMBER OF UNITS
O OTHER - SPECIFY ESTIMATED COST OF a $8
j IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP)1 '.> $ $
SELECTED CHARACTERISTICS OF BUILDING
`
PRINCIPLE TYPE OF FRAME PR CIPLE TYPE OF HEATING FUEL
co.A../
O OD FRAME ECTRIC TY ❑ COLLECTIVE SOLAR
''S MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
N...) 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS /Q
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
5744—'
( DEPARTMENTAL REVIEW
CrI HEALTH DEPARTMENT TYPE SEWAGE D I SPOSAL NUMBER OF PROF'OSF_D BEDROOM? 2,
W ❑ P BLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
APPROVED DATE
V INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM /)/`3/�
0 INDIVIDUAL WELL NUMBER OF EXISTING BATE¢2OOM___
PUD TYP OF WATER SUPPLY
_.,2 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLYLammorirwrrwanna
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YE NAME OF ADJACENT WATER BODY
O
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
��-• NNAME MAILING ADDRESS ZIP IP��/'�/ TEL
NO
OWNER
/1 `�� �. �� �J �tJ! a ' 9(�3/ ��� 7
�1 111
CONT
STATE LICENSE NO ' t
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
S TU APPLICANT APPLICATI DATE RECEIPT NUMBER CHECK NUMBER OR CASH ts.1
APP'ROVE'D BY PERMIT FEES
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A PI' \D(v E4 BASE FEE INSPECTION
��! BLDG SURCHARGE PLAN CHECK
MAY 1 6 1989
ENERGY SURCHARGE 2
JEFFERSON COUNTY P TOTAL
M. PLANNING&BLDG DEFT 9 I I NUMBER REFUND DATE DAT1E�J /I
� 1 SSUED I
BUILDING OFFICIAL
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account 1/
PP Account #
DATE 5/7S-17s�
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 Delinquent State transfer
by sale for title taxes report
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MOBILE HOME OWNERSHIP/OCCUPANT DATA •
Name(s) Nv i\ 69
Street or ToY�0 7
City State/Zip 9 S-.3�
Home phone 3 53 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 Pct Ti /C f
*****************
MOBILE HOME DATA:
Length (exclude hitch) 4 ��-" Width � z Model Year
Make (3 ,7) (/2'\2 Model
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name 0 //9
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 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).
What is the street address of this 'lnd?
Street :,q ° W ; mod
City
If you rent the land what is the name and mailing address of the land owner?
Name I ,i (.4 V. ICI R btlyij r(A'Y1 LIL.Ju,
Street or Box PP 6(.4 7 l
City F State/Zip ` ,' 7
Telephone number -- 3 3 3 7
***********
MOBILE HOME HISTORY
Date you purchased lcr:2c _,.
Purchase price / c! QO lJ
How did this mobile home get to its present location.
Moved into Jefferson County from q ii4A.A.rort
(Count r Sta e)
D1
ff
Delivered by dealer (name) C� 9),L4x_-t-- �t tit • .._
Moved from another Jefferson County location? YES N0. i yes, please give
previous address/location.
Didn't move - purchased in place. Yes or NO
Name of previous owner Y ,(,.,/-1 \I J10 ,
Address
City State/Zip
If moved, was advance tax paid? or NO. If yes, to which County
` C Does the mobile home replace a previous mobile home at this new locatio ? E or NO
If this is a replacement t whom and where did the previous mobile home go?
a ar = / /-(
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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