HomeMy WebLinkAboutBLD1989-00554 .
BUSING ,, 'ERMIT APPLICATION0
Jefferson County Building DepartmenteP .O . Box 1220*Port Townsend . WA 98368
LOCATION _ rr��
SPECIFIC LOCATION SITE ADDRESS 1'2 McL'vit-ttN, j ?city Tsf7.,N1,4i.t.r)
POSTAL DISTRICT _/SUBDIVISION
LEGAL DESCRIPTION LOT _BLOCK DIVISION,� J TAX NUMBER
.
PARCEL NUMBER , 1/ 00 11 / A SECTION
PLANNING AREA SECTION ' TOWNSHIP - e' NORTH RANGE 11L , WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
jMODILE HOME ❑ ADDITION 2ND FLOOR 4
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL SIZE 2-1 ,'( a' ---- 1 C>). $35
❑ INDUSTRIAL
YEAR /5 7'-' 4 @ $ 1 6
`�.l ❑ HOTEL/MOTEL/DORMITORY
rNUMBER OF UNITS MAKEd� $ 8
0 OTHER SPECIFY ESTIMATED COST OF /- -----0 @ $8
IMPROVEMENTS--....-----
•_ TOTAL FAIR MARKET VALUE
t UBC OCCUPANCY GROUT? $ ��,./ $
:4:, —
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
*.,I
^ ❑ WOOD FRAME 2/ELECTRICITY ❑ COLLECTIVE SOLAR
_,,,i EEi MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
("� 0 STRUCTURAL STEEL 0 GAS ❑ COAL
`ape 0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
�- 0 MASONRY ( WALL BEARING ) DIMENSIONS•
//"��
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA�`i. )L-j,.
DEPARTMENTAL REVIEW
r , HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
it 101E9
�y '� ❑ P�L I C OR PR I VAT E NUMBER OF EXISTING BEDROOMS
(s` ❑ I,NP I V 1 DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD ��//IIyy, TYPE OF WATER SUPPLY
(/t/ ❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
l/
//'I
,_ NAME OF PUBLIC ROAD
"/ NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP T E L NO
L
CONT
STATE LTt NSE ND
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
`/ �f$F1/yOF�\A ITy APP L I �TN_DATE REIF�NUMBF_IR I CttECI$�' 1 ER OR CASH
, /
'" APPROVED BY PERMIT FEES
A P P R P E ! ` BASE FEE I NSPECT I ON
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BLDG SURCHARGE PLAN CHECK
3cFFVRSCN COUNTY ENERGY SURCHARGE
PLANNING &8l1),DEPT TOTAL
9 1 I NUMBER REFUND DATE DAT ISSUE
BUILDING OFFICIAL .I I UJ(9
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account 1/
PP Account 41
DATE /J//7 /8 1
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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 Building Moving
by deputy affidavit permit permit
Dealer report Application nquent State transfer
by sale for title taxes report
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) 11---MAL/LJ J T,7"C,
Street or Box Mc Minn
City t c 101L3 State/Zip Ll.-2(k--
Home phone ` 3 Work phone
Best time to call
(specify home or work)
NOTE: If you rent the mob'le home e name, address, and telephone number of
owner here
*****************
MOBILE HOME DATA:
Length (exclude hitch) :Y Width E Model Year72_.
Make Model
Serial number
*****************
MOBILE HOME LOCATION - N ARK
Park name
Space # ate placed in park
(PLEASE COMPLETE REVERSE SIDE)
.
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which mob e homers 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) .
0/4 cc-7
What is the street address off this land?
Street / 7 (rmnn
City �Y`-i- -A
5y)c„,Q_N\a
If you rent the land what s the name a,d mailing address of the land owner?
Name
Street or Box
City State/Zip
Telephone number
***********
MOBILE HOME HISTORY m'"
Date you purchased t'` A I J
(
Purchase price ) 4041(0(2 ,
How did this mobile home get to its present location:
Moved into Jefferson County from
(County or State)
Delivered by dealer (name) s�c
Moved from another Jefferson County location?YES or NO. If yes, please give
previous address/location.
Fg, P ati2-e3 a'n4
Didn't move - pruchased in place. .Yes o(t..0----)
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
Ato I., V *,.., .....
Nov 2 8 1989 I el-F-- )F.' c.,( Peit.thk .
_.
JEFFERSON COUNTY
PLANVNG&BLOC DFPT
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.60
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