HomeMy WebLinkAboutBLD1989-00611 Bei_DING . ERMIT APPLICATION
Jefferson County Building Department ,PA . Box 12201rt Townsend, WA 98368
r* . . •
LOCATION
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT 1- /SUBDIVISION WOC-[-1 , 7151,
LEGAL DESCRIPTION LOT ATIPc_fiit)13LOCK DVelON TAX NUMBER
PARCEL NUMBERI .114C • 1 / 4 SECTION
PLANNING AREA SECTION /('-, TOWNSHIP ,.s .7 NORTH RANGE -.N.L: WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY XNEW BUILDING MAIN FLOOR
MOBILE HOME 0 ADDITION 2ND FLOOR
1,CN
0 MODULAR HOME 0 ALTERATION BASEMENT
c ,„ 0 DETACHED/ATTACHED
0 REPAIR CARPORT
GARAGE
0 REPLACEMENT ,
GARAGE
VC.Th 0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE 119mv ,
\3(7) 0 COMMERCIAL SIZE 11°1-'%.k o 1- 0 a $35
O INDUSTRIAL
„v.\ [975, A @ $ 16
e' -- . 0 HOTEL/MOTEL/DORM I TORY YEAR
MAKE_11100,.0 t 1-hf'. 0 @ $8
NUMBER OF UNITS i
----
--- 0 OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $
----------- —
SELECTED CHARACTERISTICS OF FJUILDING
. — .
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
O WOOD FRAME ' ELECTRICITY 0 COLLECTIVE SOLAR
XMANUFACTuRED 0 WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING )
DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
L'>"- • .-1
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS .z-
c--)`, 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
, I ND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM I
APPROVED DATE
I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
Q ' PUD TYPE OF WATER SUPPLY
'',...1
. '
APPROVED DATE 0 PUBLIC ( NAME OF WATER SUPPLY)
O PRIVATE ( NAME OF WATER SUPPLY) ,,,,
c"\--- ..._—_____ _r . ,&a,...:ZMo ..,,,• ,..g.,.....%, 10111EIMOR
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
NO
....on,,t APPROVED DATE BANK HEIGHT SETBACK
",...) PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME or PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
_ —
IDENTIFICATION
— ---
NAME MAILING ADDRESS ZIP TEL NO
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OWNER
*' 1 .
0 1- ---• ir0 1 0 0 M 6° e-Vi..1 V> ' CO 17(0" Wr)53
32 ,
4 t --i- :'' '
506
7:1 CONT
--514444sT------Arcri9
'ff
ARCH
THENOWNER OF THIS1BUILDING AND THEpUNDERSIGNED:GREEETOICONFORMETO ALLCApPLICABLERLAW%771 (2-/-ehei-kefe' iaLice, ..,1_044 , _ 31 71 I 4 V
APPROVED BY PERMIT F .ES
i
4 I7E 49 n r— IC:—
.- ' -'.7 5.0 C.) BASE FEE _ I NSPECT I ON
• --- 4,so BLDG SURCHARGE
PLAN CHECK
ENERGY SURCHARGE $ ,Cl/ , )('-')
all TOTAL
-11-27----
911 NUMBER RErUND DATE DATE ISSUED
.......---...-
BUILDING OFFICIAL
te il D- /6',.2.L---
_ ,
, -
OFFICE OF THE ASSESSOR, JEFFERSON COUNTY
MOBILE HOME QUESTIONNAIRE
RP Account 41
PP Account II
DATE
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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.
*******************************
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) j &41; )
Street or Box d c/ /1/41,.,(.,t,o-ri�..{� ( t
City ro if, �.C�1fvu_. / Liu 4 - State/Zip
Home phone 76 s-- 9 SU / hone
Best time to call ,9� � 7 702- 9 ? 7/72 2
(specify home or work)
NOTE: If you rent the mobile home give name, address, and telephone number of
owner here 7Z45F-/1 t,
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MOBILE HOME DATA:
,ll Width // Model Year /175—
Length (exclude hitch) /� /
X� 7 I7
Make Model Y r ) 6-6-
Serial number
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MOBILE HOME LOCATION - IN PARK
Park name
Space # 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 RENOWN or do you
rent the land? (CIRCLE) YING--
Assessor's Real Property account (parcel) number (The 9 digit number on the tax
statement or valuation notice) .
-Ikekr0
What is the street address of this land?
Street v2 0 2 `2 3 s,1— {`� 7 6 /
City
If you rent the land what is the name and mailing address of the land owner?
Name --- -,_..__ _
Street or Box
State/Zip
City
Telephone numbei-
***********
MOBILE HOME HISTORY
Date you purchased / 2 ✓k - y f
Purchase price 0-'v'() , 0
How did this mobile home get to its present location:
Moved into Jefferson County from (County or State)
Delivered by dealer (name) L-'VL+-. f . eT
Moved from another Jefferson County location? YES o
A19� If yes, please give
previous address/location.
Didn't move - pruchased in place. .Yes or NO
Name of previous owner
Address
State/Zip
City
If moved, was advance tax paid? 0 ' or NO. If yes, to which County
revious mobile home at this new location? YES ore
Does the mobile home replace a p
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.
If mobile home is new to this
assessment valuation notice will be mailed to
you when it's valued and added to
.)
Please send completed form to: JEFFERSON COUNTY ASSESSOR OFFICE
PO Box 1220
PORT TOWNSEND, WA 98368
FROM: PLANNING AND BUILDING DEPARTMENT
ADDRESS REQUEST
FLAGGED:
1 . ' c/ NEW(/L)( JL1LØ
ADDRESS ____ADDRESS CHANGE
2 . NAME: ) J
3 . MAILING ADDRESS: 00 t.. C._, Co 14
4 . TELEPHONE: lc)ce). 1 ` 9 o
5 . LOCATION: Please attach map.
LEGAL DESCRIPTION:
SECTION J TOWNSHIP / tANGE ,9 Lk-)
LOT BLOCK PLAT
S. ROAD NAME: 6:),(J(./Lie__i2,Atr(,ar-4---- •• - - •
BETWEEN•
MILES/FEET FROM • S .
4 ,'
i
7 . NEIGHBORS :
NAME : NSEW
ADDRESS:
•
NAME: NSEW
ADDRESS:
NAME:
ADDRESS.
8 . I'EE PAID CASH CHECK NO.
NEW ADDRESS
STREET:
CITY:
REAL MILE POST
•
date entered Plarte sent ,
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