HomeMy WebLinkAboutBLD1989-00586 BIDDING '.y'.'ERMIT APPLICATION 0 .. .
Jefferson County Building DepartmentTP .O . Box 12200Port Townsend. WA 98368
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OCAT 0
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT 1--(Cs.DI- C'-SUBDIVISION
2 LI ewit*fimgrage .:Hat_.44 .-1 c Z
LEGAL DESCRIPTION LOT BLOCK 7-0 DIVISION TAX NUMBER
I_ PARCEL NUMBER 9V2-q(12.. -00V 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIPL_NORTH RANGE_ / 60 WM
BUILDING INFORMATION
---- --- ,_
( ILDING TYPE
10
MOBILE HOME
ZT PE OF IMPROVEMENT
I. NEW BUILDING
0 ADDITION
• 0 ALTERATION SQUARE FOOTAGE
SINGLE FAMILY
MAIN FLOOR
. 214D FLOOR
MODULAR HOME
BASEMENT
O DETACHED/ATTACHED 0 REPAIR ICARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ° COMMERCI
..-...--...... ---
O MULTI - FAMILY 0 RELOCATION/MOVING J INDU IAL
—
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL
SIZE itt, V a $35
O INDUSTRIAL
YEAR— trrr ag 4 c)._ 0 @ $ 16 -../
O HOTEL/MOTEL/DORMITORY
MAKE . 0 @ $
NUMBER OF UNITS
MATED OST OF
O OTHER - SPECIFY 0 8
8
ESTI
-,..S — ---
UBC OCCUPANCY GROU7 IMPROVEM__ENTS
$ ITO L FAIR MARKET VALUE
. _ L ______
. _
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
O WOOD FRAME PRINCIPLE TYPE OF HEATING FUEL
0 ELECTRICITY 0 COLLECTIVEQJR
1
cY- MANUFACTURED 0 WOODSTOVE 0 PAS SOLAR
0 STRUCTURAL STEEL 0 GAS COAL
Cr- 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
—
O mASONRY ( WALL BEARING ) DIMENSIONS
O OTHER - ---- NUMB - STORIES. TOTAL LAND AREA
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DEPARTMENTAL REVIEW .
- -HEALTH DEPARTMENT T T- -E OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 2.
CO 1/4161. ak, .,,. PURL I C OR PR I VAT E NUMBER OF EXI STING BEDROOMS
P.: I ND IV I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM /
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
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PUD TYPE OF WATER SUPPLY
XPUBLIC ( NAflE OF WATER SUPPLY1
APPROVED DATE 0 PRIwATE ( NAME OF WATER SUPPI2),, ,,,,,
_
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 n--- 0 YES NAME OF ADJACENT WATER BODY
. . _ -
0 NO -
...,,
APPROVED DATE BANK HEIGHT SETBACK
st PUBLI YORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
-----
NAME OF PRIVATE ROAD
.**i.-. APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES ONO
s,.
7--/- IDENTIFICATION
'44... NAME M A I 1...! N G D D R E S S ZIP TEL NO
OWNER (Ai
/6(4v1 4. PC • .3Y/ e^ /G0 . — ?)3 2 S 38
... ,
0 CONT— I&Y?
CN( -=7CTE L I Cr:ffSt-711.9 '
_ — -.....
RCH
1
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
.- I ., Tti•ApF APPLI 'NT APPLIT ON 7TE, R,ECEIPT NUMBER CHECK NUMBER OR CASH
/ A • 6,7 () 0 2,
A
APPROV-D Y P E R ii/T FEES
A P P Tt (41-.g D
0 I BASE FEE INSPECTION
S 1 i 91) 1,/c3', BLDG SURCHARGE .,i PLAN CHECK
I_
F -
_
PLANNIN &liDG DEPT ENERGY SURCHARGE $ r g - - TOTAL,
91 I NUMBER REFUND DATE ' D E I SUED
BUILDING OFFICIAL /
........---.-- • .
....,..0
0
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account I
PP Account 4I DATE C7( -ii 6r)(
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
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MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s) W//it Q in
Street or Box LJ 1U 3 C�
City k,L4n 0 .a/2Y\-.- State/Zip
Home phone J4211 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 /n---
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MOBILE HOME DATA: /
Length (exclude hitch) ��
Width / 0 Model Year 19lp
Make 1 C-4. Model
Serial number
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MOBILE HOME LOCATION - IN PARK
Park name
Space Ii 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 ordo 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) .
y -C/oa_CC(`-/
What is the street address of thisland?
Street 14
City Pep di ec)(
If you rent the land what is the name and mailing address of the land owner?
Name 4.) i
Street or Box
City State/Zip
Telephone number
***********
MOBILE HOME HISTORY
Date you purchased / t-
Purchase price v( J( J ,(S/=-7)
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
qJ
Name of previous owner 43k Q�� � V ,��1A fy
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 o NO
If this is a replacement, to whom and where did the previous mobile home go?
l
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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