HomeMy WebLinkAboutBLD2000-00173 . f
MANUFACTURED/MOBILE HOME INSTALLATION PERMIT
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
(360) 379-4450 FAX (360) 379-4451 (800) 831-2678
PERMIT #: BLD00-00173 Received Date: 3/16/2000
SITE ADDRESS: 131 ARABIAN DR Issue Date: 4/11/2000
BRINNON, 98320 Expiration Date 4/11/2001
APPLICANT: ARVELLA M WALKER
PO BOX 246
BRINNON WA 983200246
SUBDIVISION: LAZY C RANCH DIV 3 Block: Lot: 179
PARCEL#: 966900138 Section: 34 Township: 26 N Range: 02 W
CONTRACTOR/ BLYN CITY BUILDERS PHONE: 683-9522
DEALER PAT RICHARDSON
251 OLD BLYN HWY
Contractor's License BLYNCB066CZ Expires 02/14/2001
PROJECT DESCRIPTION MANUFACTURED HOME REPLACEMENT
MAKE: SKYLINE
YEAR: 2000
SIZE: 38X28
THIS PERMIT IS VALID FOR ONE YEAR AND IS NOT RENEWABLE.
THE FINAL INSPECTION MUST BE SCHEDULED AND PASSED WITHIN THAT YEAR.
THE EXPIRATION DATE IS 4/11/2001.
REQUIRED INSPECTIONS:
[� Footing/Setback_d continous footings are used): mA' `'// 9/0 D L> _
[ ) Lycking/Setbacks/Plumbir29:e?K j it, /O�
[inal/Skirting/Vents/Porches/Ste Y.AN 6 . -2. -
/A//9 0 IC /WC i;-(19(
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9:00 a.m. -4:30 p.m.
Inspector's Phone Hours 8:00 a.m. - 9:00 a.m.
SPECIAL CONDITIONS MAY APPLY - SEE REVERSE
HOT-LINE AVAILABLE 24 HOURS A DAY
SPECIAL CONDITIONS CASE # BLD00-00173
1.) THE MOBILE HOME WILL BE REMOVED PRIOR TO FINAL INSPECTION.
I:\F_BLD_Permit_Mobile.rpt 10/29/99
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MANUFACTURED/ MOBILE HONE INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00173 Received Date: 3/16/2000
SITE ADDRESS: 131 ARABIAN DR
BRINNON, 98320
APPLICANT: WALKER ARVELLA MAY PHONE: (360)796-2000
PO BOX 246
BRINNON WA 983200246
SUBDIVISION: LAZY C RANCH DIV 3 Block: Lot: 179
PARCEL NUMBER: 966900138 Section: 34 Township: 26 N Range: 02 W
CONTRACTOR/ BLYN CITY BUILDERS PHONE:,9G 683-9522
DEALER: PAT RICHARDSON
PO BOX 777 CR,CsLQx=L-- 3(,c, e-)—1 wz
CARLSBORG WA 98324
Contractor's License BLYNCB066CZ Expires 02/14/2000
PROJECT DESCRIPTION MANUFACTURED HOME REPLACEMENT
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: SKYLINE SETBACK:
VALUATION 40,000.00 YEAR: 2000
LABOR & INDUSTRIES APPROVAL?
SIZE: 38X28 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUBLIC
BEDROOMS: BATHROOMS: STORMWATER: YES NO AREA
Wetland Erosion
Exist: Exist: 0 Seismic Streams
Prop: 2 Prop: 2 Flooding Landslide
Total: 2 Total: 2 F&W Plat Conditions
Shoreline Aquifer
Routing Date: Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: /t 4roved/Date
Potable Water Application $30.00 MAM 03/16/00 25471
AP y 1 � ,
Permit $141.00 MAM 03/16/00 25471
Jeffers nee f�d`
Total: $171.00 & B Odin o my Panning
9 Department
1:\F_BLD_App_Mob.rpt 10/29/99
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
❑ NEW BUILDING REPLACEMENT
SIZE 3E2)x 2.
YEAR 2.000
MAKE 54kyl11:v
COST UO6000
BEDROOMS: BATHROOMS:
EXISTING 2 EXISTING 2
PROPOSED �., PROPOSED 2,
TOTAL 2. TOTAL _
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
0 SEWER ❑ COMMUNITY SYSTEM ❑ PRIVATE WELL 0 TWO PARY WELL
XINDIVIDUAL
SYSTEM--0 Conventional IZ� PUBLIC
`�PERMIT # SEI 'j- />U Alternative Name of water system:
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE nI ft BANK HEIGHT ri)1r1 ft
By signing the application form, the applicant/owner attests that the information provided herein is true and correct to the best of their
knowledge. Any material falsehood or any omission of a material fact made by the applicant/owner with respect to this application packet
may result in this permit being null and void.
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable attorney's fees
and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit.
I further agree to provide access and right of entry to Jefferson County and it's employees, representatives or agents for the purpose of
application review and any required later inspections. Access and right of entry to the applicant's property or structure shall be requested and
shall occur during regular busi ess hours.
.(.");
SIGNATURE 1 *1 DATE
NAME (PLEASE PRINT) O'i ,< i1 CA I
FOR OFFICE USE ONLY
BASE FEE / /- 0 RECEIPT#
ADDITIONAL SECTIONS CASH/CK# 't +
SUBTOTAL / 7- ca DATE
POTABLE WATER r % 0 0
911/ROAD APPROACH �'C>
TOTAL (1 0
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Jefferson County Department of Community Development
���,�so1v coG 621 Sheridan Street,Port Townsend WA 98368 (360) 379-4450
o Universal Plot Plan
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Fill in the following blanks as completely as possible:
Project Description:
9 Digit Parcel Identification Number (from your tax statement):
g6,(0??00I'S1 %4%(4:1OO13' ci4,4ctQo 140
Site Address
911#: 131 Road Name: Arc, b;G o Zip Code:
Legal Description 119 Igo
Subdivision Name: "D;j, 3 Lazy C. -Ran c Block: Lot(s): !s
Section: 1 Township: Range:
Parcel Size (acres or square footage):
Property Owner: 1 t� Phone:
�r v e �� d 314 - 7 CB 2000
Mailing Address:
131 iqrdbia,r
Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: '..._.' � ( Phone:
Mailing Address:
5I 01d Lyrw Hu, 5e9u RS
General Contractor:
Or Manufactured Home Installer: ,Lyvi C,'-�� �u �cte t S Phone: (0 (09 ,..qc,2 2.
Mailing Address: �yy/ r {.Qj r e /+' y� ®® /d ry
Contractor's State License Number:& ( E . Expiration Date:
� nC-e06(.0CZ u. $i 09
Septic Designer: Phone:
rJhot
Mailing Address:
Architect:/Engineer: Phone:
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder: iiJJ
Mailing Address:
FOR OFFICE USE ONLY
Fire District: Planning Area: School District: Zone:
1/00 H:\home\pincntr\forms\universal plot plan
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