HomeMy WebLinkAboutBLD1989-00599 OILDING 'ERMIT APPLICATION .
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Jefferson County Building DepartmentsT .O . Box 1220mPort Townsend. WA 98368 .
LOCATION
SPECIFIC LOCATION LOCATION SITE ADDRESS (()
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIV17N TAX NUMBER ,S
PARCEL 7977(57773=2L) 1 / 4 SECTION
PLANNING AREA SECTION -) 5 TOWNSHIP ,___ ... _NORTH RANGE ,--,R (4 1 WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
MptDILE HOME CO 0 ADDITION 2ND FLOOR
-1: PULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT -r_G-NR•PcerE OeCK. ,2 7,2 .
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
7BILE H07.
0 COMMERCIAL
SIZE 0 a $35
-• 0 INDUSTRIAL •
YEAR a 16
O HOTEL/MOTEL/DORMITORY $ '
MAKE .;7' @ $6 c.7,2 /7co
NUMBER OF UNITS____
O OTHER - SPECIFY -----0 @ $8
ESTIMATED COST OF
IMPROVEMENTS
UBC OCCUPANCY GROU p,;----
$
_ liTO I R MARKET VALUE
7
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
c2> MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY .
0 MASONRY ( WALL BEARING )
DIMENSIONS -7---
O OTHER - , NUMBER OF STORIES TOTAL LAND AREA A
- -
DEPARTMENTAL REVIEW
— . ..
) HEA TH EPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF ;71337P7JEFTEIi------"DROOMS
c,.. ,
9' 5- Cf PUB,- I C OR PR I VATE NUMBER OF EXISTING BEDROOMS
7i DI VI DUAL ( SEPT( SEPT I C ) NUMBER OF PROPOSED BATHROOM I
APPROVED DATE
CS-- [1 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
..4) PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE RIVATE ( NAME OF WATER SUPPLY a/t.
CZ PLANNING DEPT .
WITHIN SHORELINE JURISDICTION
ik-jli 0 YES NAME OF ADJACENT WATER BODY
0 NO ..%
APPROVED DATE BANK HEIGHT SETBACK
. —
PUBL.)IpirRKS DEPT ROAD RIGHT-OF -WAY WIDTH
V-)
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD --
APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES 0 NO
TIFICATION
NAME MAILING ADDRESS ZIP TEL NO
.
R Or 0 W 7?7it g ' .
......z;
Mar 01' --.616-11,-) 7 g609
QI ------ yi I -- ,
CONT
. gTWTL Licrnsz,. nu—,
ARCH
THE
--- ,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
•
711 OF APPLICANT
4 APP I AT! ATEATIPTNUMBER CHECK NUMBER CASH
"g9 ci
APPRO ED BY PERMIT FEES 6-----( c:90T, cleal
A P P V 7-1-2D-- BASE FEE I NSPECT ION
_ (2.)(-'- 6/( S'- BLDG SURCHARGE PLAN CHECK
P 1 5 1 9 .
JEFFERSON COUNTY ENERGY SURCHARGE $ 3, s-u
TOTAL
PI ANNING&BLDG DEPT 9 NUMBER REFUND DATE I D_AT7p; 1,"(,
BUILDING OFFICIAL C7,77?
4kyr...........--
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OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account 0!
PP Account 11
DATE Cr(! 3( /
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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.
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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
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MOBILE HOME OWNERSHIP/OCCUPANT DATA /
Name(s) (A ) ` I�1.J U/YY� LjL J -
ey
Street or Box q(r) v l d a �� , oe,/
City a �)(/i/1.i- State/Zip 7 S CQ
4 --
Home phone ?? --7 /6. 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 ►�J
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MOBILE HOME DATA:
Length (exclude hith) Width / Model Year /64n�(?�
Make v V Model
Serial number
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MOBILE HOME LOCATION - IN PARK
Park name
Space # Date placed in park
(PLEASE COMPLETE REVERSE SIDE)
! •
MOBILE HOME LOON - NOT IN A PARK
land on which mob#let,1�nm .` s located or do you
Do you own (or are buying) OWN CBUYING -.: ' RENT
rent the land? (CIRCLE) _ __...--
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 land?
Street
• City ‘"14"'
fyou rent the land what is the name and mailing address of the land owner?
I y
Name
/9-- _____
Street or Box
State/Zip ._---=
City
Telephone number
***********
MOBILE HOME HISTORY ` 0("7/
Date you purchas
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 6, NO. If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes NO... '
Name of previous owner
Address
State/Zip
City
aid YES o, NO. If yes, to which County
If moved, was advance tax p � _..---`� or NO
previous mobile home at this new location
Does -the mobile home replace a
f this is a replacement, to whom and where dad the previous mobile come go?
I 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 valuation ''notice will be mailed to
youu when it's valued and added to the assessment
.)
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
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