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HomeMy WebLinkAboutBLD1989-00580 BUILDS '`'ERMIT APPLICATION11, Jefferson County Building Department*P .O . Box 12201Port Townsend . WA 98368 LOCATION ____ SPECIFIC LOCATION SITE ADDRESS " POSTAL DISTRICT /SUBDIVISION (/��I S,Lryryry? /W 1 ,1 LEGAL DESCRIPTION LOT BLOCK �1 /D) �IVIS ON TAX NUMBER PARCEL NU BER (Y7 .�1c.'✓ c- 1 / a SECTION PLANNING AREA SECTION TOWNSHIP tx- NORTH RANGE WM f `V BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ S NGLE FAMILY ❑ NEW BUILDING MAIN FLOOR U44OnILE HOME ❑ ADDITION 2ND FLOOR O MODULAR HgME ❑ ALTERATION BASEMENT k``---� 0 DETACHED/ATTACHED 0 REPAIR CARPORT ///...± GARAGE ❑ REPLACEMENT GARAGE 0 WOODSTOVE ❑ W ECKING/DEMOLITION ( COMMERCIAL ❑ MULTI - FAMILY RELOCATION/MOVING INDUSTRIAL / NUMBER OF UNITS MOBILE H OMES ❑ COMMERCIAL SIZE YEAR -.A $35 ❑ INDUSTRIAL O HOTEL/MOTEL/DORMITORY MAKE 86 NUMBER OF UNITS k- ❑ OTHER =-SPECIFY ESTIMATED COST OF -7/- 440 @ $8 } IMPROVEMENTS // OTAL FAIR MARKET VALUE UBC OCCUPANCY`GROUP� $ !!//t� a �. ' SELECTED CHARACTERISTICS OF BUILDING ' PRINCIPLE TYPE OF FRAME PRI CIPLE TYPE OF HEATING FUEL "'' rOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR NUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR 0 STRUCTURAL STEEL 0 GAS ❑ COAL .-'-' 0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY sL ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL 'REVIEW HEATH PEPRATMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDR MS { /( ' 0 PMB LIC OR PRIVATE NUMBER OF EXI ST I HG BEDROO eV. ( ( � Lf INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM D A T E NUMBER OF EXISTING BATHROOM APPROVEDDIVIDUAL WELL 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 ❑ NO — (7. IDENTIFICATION '" — - w MAILING ADDRESS ZIP TEL NO NAME F' OWNER f ,,,glQ✓J)` /' `lam' I Y 1 'k CONT :- - � STA7'E L1Dr - A- _ ARCH rL THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. SIGN TURF OF APP! CANT APP 1 CATJ1 O DATE 1757 NUMBER I CHECK NUMBER R CASH -i L C ._ �t.-tc1 ---- GK�) t APPROVED BY P RMITEES BASE FEE INSPECTION gNCP S� PLAN CHECK . BLDG SURCHARGE IRIe9 78 s $ ENERGY SURCHARGE TOTAL JEFFF C'.P�courgTy �� ii m `'rr3T 9 1 1 NUMBER ' REFUND DATE DA I S U 1 BUILDING OFFICIAL :IA418 OFFICE OF THE ASSESSOR, JEFFERSON COUNTY MOBILE HOME QUESTIONNAIRE RP Account # PP Account # DATE ********************************************************************************** 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) e----)11)11-) V 4/AC K0 Street o, lox 07(P City State/Zip /'V)//- 9(9_3oZ5 Home phone .3 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 ***************** MOBILE HOME DATA: �j� / Length (exclude hitch) 4k1 Width Model Year Make Model Serial number ***************** MOBILE HOME LOCATION - IN PARK Park name Space It Date placed in park (PLEASE COMPLETE REVERSE SIDE) MOBILE HOME LOCATION - NOT IN A PARK Do you own (or are buying) land on whi 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) . 975 7 / What is the street address of this land? Street 44 )/ City LL/ TJ ) 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 - purchased 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 0 ., �� n y t o ° ` ,f. • `ti ,. i tft Q ''..t),`:"' *.\ i m > Q. '` .,.. — _1) ,,,,, ,.. i ( j i 1 1 srDo #s J �� r43i,z, '1.3 4 4 = t .) / i--- (3, r. \s„ --- 5-?)i o1 .4431.7 ///),, r, , ,----:*•;,,,,. - ' , ,i lJimm.I® - .-ee_. •.Kt - -,.v: ...a•wAkdo`F ...e...s.�-.. - .... ..._L .,,,. ,. . ... ..a.-._........ ��z .„ , ,,. ,.,......... : , ,_ . . . ....„... . ,„ 1 , , • .� of Let a A 4 'AS. 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