HomeMy WebLinkAboutBLD1989-00588 410ILDINO ERMIT APPLICATION .
Jefferson County Building Department*P .O . Box 1220*Port Townsend . WA 98368
LOCATION
• ( 2 -5 '7 4//,' ) I .4.>9,1
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT ./ /SUBDIVIS(L N ri?
LEGAL DESCRIPTION LOT BLOC DIVIS4N TAX NUMBER
PARCEL NUMBER ) ..]r - 1 / 4 SECTION
.../
t TOWNSHIP NORTH RANGE WM
PLANNING AREA SECTION ,
BUILDING INFORMATION /
......,,,
S• BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE /
O 7INGLE FAMILY 0 NEW BUILDING MAIN FLOOR
MODILE HOME 0 ADDITION 2ND FLOOR /
O MODULAR HOME 0 ALTERATION BASEMENT , /
-.. 0 DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
r----,„ 0 wOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
-4. -
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
''.7•.,- NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL
SIZE iL/1( ic 7 o 0 @ 135
O INDUSTRIAL
4" (') . SA ..
O HOTEL/mOTEL/DORM ! TORy YEAR 6 , $ I 6
A.1,,C 41 C 0 @ $8
NUMBER OF UNITS MAKE /jy
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST ---
4,... IMPROVEMENT- T. AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP
..„„..,
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF
PRINt' 'PEE TYPE OF HEATING FUEL
FRAmE
O WO D FRAME ELECTRICITY 0 COLLECTIVE SOLAR
...... MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
, 0 STRUCTURAL STEEL 0 GAS 0 COAL
S' 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) '
DIMENSIONS
0 OTHER -
NUMBER OF STORIES TOTAL LAND AREA
(C4C
DEPARTMENTAL REVIEW .
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM
-4:- 0 UBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
(-"-- INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
-_ ,
PUD TYE OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY.. .
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
RIX---:
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 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
i ' OWNER : ,-.
, 1---1 ' L\Tfieiy
1.7' Ytt OA' • _____
> ,
CONT
\-C:(
...‹? - RCM
-___
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
I ATURE OF P. !CANT APP}- 'CATI
__1( al) -E RE EIPT NUMBER CHECKVBE OR CASH
.
. 2__ /4,:p
A\ .v. BY PE: MIT FEES
r_- -
4 BASE FEE INSPECTION
\' P R • . D .
-,/ S d
BLDG SURCHARGE PLAN CHECK
JE ERSON COUNTY ENERGY SURCHARGE $
/A,;/ f--56 TOTAL
PUMPAIG&BtliG ElEPT \BUILDING OFFICIAL 9 1 I NUMBER REFUND DATE 1 Dir ISM
I 0
, .
-__ •.
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account 4/
PP Account46) ."4-7
#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) QAAAA0\ A 0.1Ctik
S<:)
Street or Box 0 4•V 1 I I
City ��
e_.)2).. State/Zip
Home phone LQ.,(1/1/1U2--4.-70 ,(;9 phone 9 `.�J
V
Best time to call
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
I
owner here
*****************
MOBILE HOME DATA:Length (exclude hitch) 7() Width 14- Model Year
Make /2 1(2 Model 0,91).2-,Y1S2/44-(2-0-4*___)
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
nameLtiyhcto, file4) IPark l../
Space # / Date placed in park HP: 6 /
(PLEASE COMPLETE REVERSE SIDE)
# J
MOBILE HOME LOCATION - NOT IN A PARK
Do you own (or are buying) land on which mobile home is ocated Nord 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` oAx
f this land?
Street LT3 }
City
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 locatin:
Moved into Jefferson County from /411/1--
(County State)
Delivered by dealer (name)
Moved from another Jefferson County locatio . YES ,pr NO. If yes, please give
previous address/location. —22()
I
C C(� ' 't "l (4 Q(cTC
Didn't move - pruchased in place. .Yes o NO
Name of previous owner
Address
City State/Zip
If moved, was advance tax paid? YES or NO. If yes, to which Coun ✓'�L
Does the mobile home replace a previous mobile home at this new to do . YES or NO
If this is a replacement, to whom and where did the previous mobile home go?
a
ut
Thank you for your assistance.
u need
Officehelp
at�385n9105r atiQuesbionstaboutstaxesnt
of your mobile home call the Assessors
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, W.A. 98368
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