HomeMy WebLinkAboutBLD1989-00608 f3UILDI 'ERMIT APPLICATION410
Jefferson County Building DepartmentI`r' .0 . 4'Box 1220SPort Townsend. WA 98368
LOCATION //� � y�,
SPECIFIC LOCATION SITE ADDRESS [) )
_ L% `-�`-�POSTAL DISTRICT /SUBDIVISION /LEGAL DESCRIPTION LOT BLOCK .�� D,,ccII�VISION TAX NUMBER ( t*
PARCEL NUM ERt / . /c -.O� 1 / 4 SECTION
PLANNING AREA / SECTION(TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ INGLE FAMILY 0 NEW BUILDING MAIN FLOOR
OP. ILE HOME 0 ADDITION 2ND FLOOR
MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE ,
O WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOME� dLi`/
❑ COMMERCIAL SIZE '-.,( 01 `^-'1 VAX j .• $3 5 _
❑ INDUSTRIAL
YEAR �� $ 16
u 7
❑ HOTEL/MOTEL/DORMITORY
MAKE�5` '1-'i'sciL�.,yyo' d 4 @ $8
NUMBER OF UNITS
❑ OTHER - SPECIFY 0 `j $8
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
• vANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL ' GAS 0 COAL
, ❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS ) /�
0 OTHER NUMBER OF STORIES ( TOTAL LAND ARE/kit
C' DEPARTMENTAL REVIEW
( HEA TH D ARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
c.: "JJ - -' ` 7 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
,‘ / ! ND I VI DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM
' APPROVED DA���(((E ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD T E OF WATER SUPPLY �1 �
Q'''''''., ►!rUBL I C ( NAME OF WATER SUPPLY) l A fll`-7
! APPROVED DATE ■ PRIVATE ( NAME OF WATER SUPPLY J
.: PLAN ING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
0 11. --'
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
��? PUBL C WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
�• A 1R--- NAME OF PUBLIC ROAD
F ' NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
�_ NAME A COAILING DRESS
s %Z IIP TEL NNO�/
OWNER 'W x //j,{` / I ^/ ' �} C%� + ` � ' .i(/��
CONT
STATE LICENSE NO 1
ARCH
Y'HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
G URE OF LANt APP CATiQ ' T I37 /()
REC PT ER k/71
E Nt =R O.CASo w)
APPROV- try PERM II] F ES
A a 5 t BASE FEE INSPECT ION
1
"'it
', 5-0 BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE l)CN -0
TOTAL
7114'Af r,aN�'j• /' ( REFUND DATE D/#T.�
/l u V LrJ 9 1 1 NUMBER
BUILDING OFF;CIAL 1,,'___ _,,I
11
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account
PP Account 4�
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:
Bung
Field visit Excise tax Moving oving
by deputy affidavit permit permit
Delinquent State transfer
Dealer report Application report
by sale
for title taxes
*******************************
MOBILE HOME OWNERSHIP/OCCUPANT DATA
Name(s)
Street or Box
0TState/ZiP ) _
City
Home phone
�'�'� Work phone
T-
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: + (�
Length (exclude hitch)
Width Model Year LZ
Model rc
Make
Serial number
*****************
MOBILE HOME LOCATION - IN PARK
Park name
Date placed in park
Space #
(PLEASE COMPLETE REVERSE SIDE)
0
.11
. ,
• .
...--
.
.-.
-
._
,-----__ — ;-, - •-4... ,,,,.:
. !•••••••1 - •
•.'-'.",.".*:.:.'..;.'.:,'.1:...?..:.1.','. .,. •,r--
-____
i •"''"":-.'"" ' ••'s•'••1.•••••••••.•••••••••••••••-
'2 ••°•''''-'4' '''s.':•.'2:''.:'•.,:.:•.'''••",..'••1'•%1 ' •-• '• ,,', I,a'.1'•2•2.
•,4:;..':". . L,.,:e•J'. i'',..•`'' .•' i =' '=-'-'= "'''''''''''''''.' " '
. • • , • •'•'"' •• • -. '.• •••• ."'''.'s".2•3•••2'2.2-2•2..
1 ' .•. . " . •.• ill •. .•. .---.‘..• ••174::::•:;".1•e;''•:."'•;"':'-;;;•••''''':::'l's:;:1:10 72..;•.•••1.2,...; ''••••!•••• . . . . . . . .,. . e •••-.2,,'••••0,•'''.,••‘',.....':;',',Zs.;,:.;,;::.,•,...-;,..:,,:,, I
• • • • • • • • • • • • • - • • - -•-•,....Z.'''•;' '..•'.':••.•. .1=',....•••',........•1.....v,:i
' .•. • • • • • • • • • • • • • • • • • • • • -.-'•',14. ''.:.....;.,:.,-.•'.-;,;..;,•:,..-,:,,=., I 7.-1--„
.-•.-.717-••,--
i ' • • • ' • • • • • • • • • • • • ' • • • • • • • " . 4-.= L.1,',.:1.:.•,..,,,,,,..„,.,, I ;.'.=•...,'..,%•'3'71-rr..,,-,_1•'.....'"...7.'''•':•-:'... 7.-7-..,,,,
, 1.•..... .'.•... ... ... . .•...•.•.•••-•.•• • .•• . • • r.........7••••/"............./............. .','.Aae'''''. ! e::.::::::::::::*:;%::.::,::•::•;;;,•;,,
• . r,,,..,....,...,,,,,;+,1,....=,...,...,,,,_•,..,..•
. . . . , ''''''''';'::.'''':-;.',P:::•••'....:1::.•:::::.;
.,....1:-•••,•. -•', . , , ..... --. ,
- . . • •.• .•I• • . .•. ..-... .. •.••. •••• • :•'.......,.......,•••'..,....-i,.....:•••••:•......;';-•..--..................: i . --......‘..2...,,.,,.,...x.,,..• '
• .. • - • • - • i : -••`-,............. ,
.„.. .
•'-=.-7: '"7,77.,'',.:-...; • • • • ' ' • " "i. ,:.,.2-7,_. ..::::,:,::-::::::::::::.::.-....:.; '.. !
• . . . . . . . .
. .. I 5_12,RSAN PRI2PAE.
•
: ::::::-.'L.19.:.,,:..-..•:.:.:. , i- •.• . . . . . . . . . . . ..,
t7..:......:-..:.1.:.;-....:::.i.7-7:z. -=.-r•1- •.- • • . . • • • :-•,--77_.,---'1;:..:::::.-:::'.. ::•.•••.:• ••:::-; --
::::.......:s.-1:::::::-::::::7.---7_, =:• •.• ' I. 4.-..............::„........................................................, , t ,
: ---- -4-----,. •— z-- :.•_•-•. -.-.•.-.-.-. f.:::-:;-•::::::::::::::-:::-:::• :::•/..:-.::::L•*:-',.-;",:•;:;'::-:::.:.:.:.1 i : ;
• i
..... .......
- :;••-•:-....--•-••••::::::-....-'s:-......•'-;-::• ". • • • " • • " • • -1-•-•-•••••••-•-:•:•:•:-:-:.:•:-::://:-•?:-•:,.--:--:•;•:-•:•:-::-::-•;:::-•:--;-•:.-•.:-•.:-..:.::•:-...::. . .
•• '•••••••-•••••••/-zsz--•-•-•-••••••• I
............,.
i if,•:-::•::•:-.-::-::-f--::-2.:-•;-::::. I
I ..
:•
. f t . .l::••••••••••••:•:•••:••••-" • :-.''•-• •.'''• • •••-•• ",:-:--4::•:
1 .
! i .
, ..,... .. '_::..,..c-r::-:-::-:-:-:-:-:-:-:•:•:•:•i 1 1
;-:-:1-:-:-:-:•:•:-:-:-:-:-:-:-:-:-:-:1 ---) k:;:-•,:-::-::-::--,::::-:::::-•,:-;:l I 1
t :-:•*•••••.-:-:•••••:-:-:-:-:•:-:-:-:-I • fi..--.--/S.,././i/f.--.-1; I ,--.0. I
I - —
.....::TA.':.::.:•:•::••:•::-:•:::•::: ! I i ;:-...-:.-:-'....-•••••••.; - ' ,- •......... '': '-'':....•:::-..-:•::-..-:-:-:-; ',..--:•-',:••:•-••••••'.-•:-•:••••••••" I i '
i -.••-.•-.•• • - i
i -..../.........-:-:-:-•;:•:-:-:.-:-:-:-:-:-i i I •
; j:::::::;:::::.:::;::;:: _ : ,__ ; i'-'.-: ''-'-'-:•-•:•-:-...-:-:•••:•:-:•:t •-' l';':.--:::::-::-::-::-f..-://:/..1! i
i I ;I
.::•t::-..-:--....---:-:-:-:-:•:-:•:-
--.......•.-.•-.-.•.'.; - ; --•-• ;......... ....••-•"4:-:-:-:•:-:-:::-:•:-:-:-.-...." a : •...,.....,-,.......:......,
--•-.--•••--• . i i •,.. I .
'. ""."•••••• . 0 i
. !••-••-•••::::: ::: ,--;-:- ; !-- i
-±'• ....,:-:-4:-:-:•:-:-:.:-:-:•:-:-:-:-:-:-:, A rn ///1.--,7:7.-/.--,-; I I La i-r
....:;.' ...-...---..---.-.....--..1 't -.' V.----:".<"l.•'-':"/-1 i In '
- LI' i t
" ,_-.- i'..-":•:•:•:•:•:•:•:•:•:-:•:-::..; a ;....--„,0_...,--..--1 . I I
: t- i.-.--:.-..-:•:-.-:-:-..-:•:-:-:-:-:...:i ..... i•-•.--•.--;-•,•.--,,:-......-„•::-::•::-::-..ti t t
•3_-:-:._: • ."' :::—=---Z;•/--:/-->>>:-;.•-: „:•,i...ti)
• -..-- I r.J1L HEAT OF---. i
2: . :_:. ::-:::-..•-•-.::-..-..--.-:.-•--:::.:-:-:...! a: ,:::::::•:::::::::::.;.::-...-:.::-.1 ! :
= . 7••••••••-•-:•••:•••••:-%:•:-•-•, .--•- = 1-•:..1.--.-•:,•:;•:':•••••••••'•-•/' ; •
i ;•••••:.:•:-:-:-:-:.:-:i ..„--, ,..-•_, ......--: ':-..-
- t i
I ,
•-••••••••••' ; ..-..-.-......-...
- - -'• .•'•'•• - ---- = ,-Lc.1 :......... .....:::-1-:•:-:-:-•-:-:-:-:-:-.-:•-::::::- i
;-•......:::.::::-.•;:-;:.::.::.: ;
-_- • ..... .....--- -,;:"--.•::-••:-:-•:-:•'.:••••••••:, .. :.. . . • _ _ . .
.. .•- -• ••." ••-••• ••• - '::, ..;s.:•::••••••:..:..:.-.-.:-..;,;..".,, ; .
• :
•
, ••--•--••••• - - i •
-••••••••••*•••• i i............_ ,
••- i- ........... — .
- . . .. .. ..-7.-1:-:-...:::::::•:-:::::'. i I• .•..•-.-... ..• --•
1 -1--,'•-, i
• '..:::.: •.::.:::.: -1 TT - 1:::::::::::::.•::: : '...:•:...-1
••••••'•••••'• ' '. :47; •......... ....::-: --1'.•::-:•:-:•:-:-:-:-'•:-:-:•:•:-; I
......•.... . —
" " .........• '';'......;::- ..::::::::- ....:.--:7; i I
• .-• -r-*••'--'•••••"."'-1 ...........::-..,!.::';':::.::::•:...........:::.:.•:: ' , I .
,:::.....:::i
1 .
... i.:.:::.•.:.:::.:.::::•.:.•••;-;:'.•••••••:.*:.;:.':.'..;:. ::::..-:-::•::-::•'.•::•::-:.•':-2.1 I i
7-: ..';' .....1•:- '..-:'•:.•::•-•.. 1 .
I 1
.••.•...• .
, 1 ;
i::::::•••:::::::::.:."::-::.:::::.:•.:::".•::-.:::*•:•:-:'-"•":-::' 4'.••."-.-:: :•:::-:•:•:-:-:•:.•:.•:.••-•.:- •..,•-: --•-,•-••••••••/-4 ; I 1
•
= - 4' ..:::::::•:-::::: _1
A i •1:1 (; A •
- L___:--r P...•_,,,,...).1-056--r k j a...i.i.)C Lo --=3
•
-,----:=..1-...,---,i-;:::, •:-.-.-:"._,-1 7;7'-.7-•-• .:-,--7---, ..,:--,,,-..-.••,,.,.!...,-=-". --..= -——- -— ::::0;:.1;:', 1, ',:::-.7 .--::—.:
1 ,"/ -,
.-1--t•..-.7-,..I a =el"'= -= ,--r•
IIII , Ilt ! : 1, 1 1 tif. 1 ; : 11
'If,7".TH •-•,,,..
•
APPROVED
APR 2 8 1989 c i>1/-16/C--
JEFFERSON COUNTY
PLANNING &BLDG DEPT
5---3 - %-7-
-1-1-- cl, s-•e.+-&,..-&:__ ct)„c_._ bt (76,-4.1-4. 3u6.1e----d-
I,0--2.--Q,..-7 -- .•-si.„,„\<:\x,3; ) 0 1‘_>in,,k --c.. 5 t‹,CAA:
4----
,
,
, 3/E//170
,
j/t)Zil
----
01
!:(
k
i