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HomeMy WebLinkAboutBLD1995-00661 1 MOBILE HOME INSTALLATION APPLICATION Jefferson County Permit Center Castle Hill Mall 621 Sheridan St. Port Townsend, WA 98368 360-379-4450 PERMIT # •BLD95-0661 DATE RECEIVED. : 11/07/95 SITE ADDRESS: 308622 HWY 101 :BRINNON, WA 98320 APPLICANT. . . :MERIL DRAPER PHONE: 360-796-3103 MAILING ADDR:P 0 BOX 252 :BRINNON WA 98320 INSTALLER. . . :CM BLOOM PHONE: MAILING ADDR: CONTR. LIC #:WAINSO238 EXPIRATION DATE: 07/01/98 CONTRACTOR. . :GORST LAND DEVELOPMENT PHONE: MAILING ADDR: 259335 HWY 101 : SEQUIM WA 98382 CONTR. LIC #:GORSTLD098L1 EXPIRATION DATE: 06/07/96 PARCEL NO. . . : 502104054 ALT: CON : LEGAL DESC. . :STR 10-25-02 WWM, TAX # BY : DATE: LOT , BLOCK , WATER: DATE: CAR DATE: DESCRIPTION OF IMPROVEMENT: MOBILE HOME INSTALLATION BUILDING TYPE *MOB BEDROOMS--- BATHROOMS-- CRPT/GAR. . : 0 sf TYPE OF IMPROVEMENT:NEW EXIST. : 0 EXIST. : 0 DECKS • 0 sf GARAGE/CARPORT • PROP. . : 3 PROP. . : 2 COMMERCIAL: 0 sf UBC OCCUPANCY GROUP: TOTAL. : 3 TOTAL. : 2 INDUSTRIAL: 0 sf EST COST. $: 0 SEWAGE DISP. . : SEPTIC BANK HT. . . : 0 ft PROJ GRP. . : 7260 WATER SUPPLY. :PWELL SH SETBACK: 0 ft MOBILE HOME MAKE:FLEETWOOD YR: 96 SIZE: 26/56 Owner/agent FEES Signature: type amount by date recpt PRMT $ 125. 00 EMH 11/07/95 113519 Date: B.C. $ 4 . 50 EMH 11/07/95 113519 Issued By: Date: SO . vi - S1,1)es ? 'te firs/ T- I/,2 ' S� $ 129 . 50 TOTAL c�.s JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MOBILE HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUILDING l REPLACEMENT SIZE ,r6. //O l T 5P �2 / YEAR / �, MAKE fike P' )OO d O4K/e ' COST 55J, FO4422 BEDROOMS: BATHROOMS: EXISTING EXISTING PROPOSED PROPOSED TOTAL 3 TOTAL Z TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: ❑ SEWER ❑ COMMUNITY SYSTEM PRIVATE WELL X INDIVIDUAL SYSTEM ❑ Conventional ❑ PUBLIC PERMIT # SEP ❑ Alternative Name of water system: IF WATERFRONT PROPERTY, DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT ft SIGNATURE t72sy G/ L DATE //-2— 7• NAME (PLEASE PRINT) j O 1 /7 1' lei 1 c `o — I�U✓/� ��d�LS v��L l vi h-, e `O0 -Ga?.,S'— e2cf1/ • FOR OFFICE USE ONLY .»>: : • .................................................... STATE SURCHA;RGI± 4 50 CASH C!C �.�::� .:.`` �: H: CME P1 NCNTR FORMS 06 E F\ 1 IL AP, RM • JEFFERSON COUNTY BUILDING PERMIT Jefferson County Permit Center Castle Hill Mall 621 Sheridan St. Port Townsend, WA 98368 360-379-4450 PERMIT # •BLD95-0661 DATE ISSUED. : 11/28/95 SITE ADDRESS: 308622 HWY 101 :BRINNON, WA 98320 APPLICANT. . . :MERIL DRAPER PHONE: 360-796-3103 MAILING ADDR:P 0 BOX 252 :BRINNON WA 98320 CONTRACTOR. . :GORST LAND DEVELOPMENT PHONE: 800-683-2811 MAILING ADDR:259335 HWY 101 :SEQUIM WA 98382 CONTR. LIC #:GORSTLD098L1 EXPIRATION DATE: 06/07/96 LOAN LENDER. : MAILING ADDR: PARCEL NO. . . : 502104054 LEGAL DESC. . : STR 10-25-02 WWM, TAX # LOT , BLOCK , DESCRIPTION OF IMPROVEMENT: MOBILE HOME INSTALLATION ( fr) Footing/Setbacks (Shoreline Setback) : - l lam._ P;-5-1s 4 tL', /-FludIcLat4on ( • 3/a c .•.� ( l� l� i-/ ► c�L- £_A- L C(J -- ( ) Underground Plumbing/Underground Insulation: ( ) Framing/Plumbing/Chimney: ( ) Insulation: ( ) She ock: ( Final/Occupancy Approval: ,����, 14,2( /;/ L 26 THIS PERMIT IS VALID FOR ONE YEAR. 24 Hour Recorder for Inspections CALL 379-4455 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS Office Hours 9 a.m. to 4 : 30 p.m. Inspector's Phone Hours 8 - 9 a.m. • ZZ? co r Oa C w o�ck �x:4• CI [ . N w cm oa r— cn t l' u c i * al ,,k.TA 4 -4*.-4'0 L 41 �� Z 6' W "----i i L L 3d4lIQ.do J Z V II SN UU 2 i g ,t ZW _ ZU r p< F Pi' i --.-0 i vl V ± ' : ul gg��, • Nmn ;t 1 `.era O (A • ....--= .:. El 7P' X A ii, 0 , _.oc�� H.-_ -��° 2 �m D or n -- t"TiZ---- { i kCO O m a N �� a . Jefferson County Permit Center Date 621 Sheridan Street Fee Port Townsend WA 98368 Rec # CRITICAL AREAS QUESTIONNAIRE Ck # ' Case # Applicant Name Building Application _ Land Use Application _ Shoreline Application On-site Sewage Application Subdivision Application _ Other: 1 . Is there any standing or running water on the surface of the YES NO property or on any nearby property at any time during the year? If YES, please describe: 2. Has any portion of the property or any nearby property ever been YES NO identified as a wetland or swamp? If YES, please describe: • 3. Are any willows, skunk cabbage, alders, or cottonwoods present YES NO on your property or adjacent properties? If YES, please describe: . = • • 4. Are there any indications on any portion of the property or on any YES NO nearby property of rockslides, earthflows, mudflows, or landslides? If YES, please describe: • 5. Please indicate which line best represents the steepest slope found _ on your property. (Check appropriate box) i . • 4. Q 4 �Q •4•• �4P / / / / / / / • ��-,; - - r / -/ i / / / �/ �'� - / / / / i / / . iiii i i i/ i �� .- I / / /-/ / I �/ �i �/' . •i i/i i i , /,./ ,/ ��'� I//iii i '," ' C) uniiiy/ • `� 5-. -r- -- 7 0 (Questionnaire Continues on Back) • � • • L • • 6. Does the site have steep slopes with little to no vegetation? YES NO • If YES, please describe: 7. Does the site contain high percentages of silt and/or very fine YES NO sand? If YES, please describe: 8. Does the site contain ground water seepage or springs near the YES NO surface of the ground? If YES, please describe: The applicant hereby certifies that all of the above statements and the information contained in any other transmittals made herewith are true, and the applicant acknowledges that any action taken by Jefferson County based in whole or in part on this application may be reversed if it develops that any such statement or other information contained herein is false. 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