HomeMy WebLinkAboutBLD2000-00365 MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00365 Received Date: 6/6/2000
SITE ADDRESS: SHI NE
PORT LUDLOW, 98365
APPLICANT: IDA MAE TESTER PHONE: (360)437-9250
1721 SHINE RD
PORT LUDLOW WA 98365
SUBDIVISION: TESTER SHORT PLAT Block: Lot: 1
PARCEL NUMBER: 821344054 Section: 34 Township: 28 N Range: 01 E
CONTRACTOR/
DEALER:
INSTALLER: ,F,1.II 9MPCON - (3 +H4J91-3-
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PROJECT DESCRIPTION MANUFACTURED HOME REPLACEMENT
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: ARDMORE SETBACK:
VALUATION 94,000.00 YEAR: 2000
LABOR & INDUSTRIES APPROVAL?
SIZE: 42X62 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
STORMWATER: YES NO
Exist: 4 Exist: 2 AREA Plat Conditions
Prop: Prop:
Wetland Erosion
Total: 4 Total: 2 Seismic Streams
Flood Way Food Plane
Routing Date: F&W Landslide
Shoreline Aquifer
Forest: Commercial Rural
ro
Type Amount Paid By: Date: Receipt: A R��
Manufactured Homes $141.00 MAM 06/06/00 31613 APPROVED
Add. Manufactured Home $29.00 MAM 06/06/00 31613 ,�,� '� e2it
Pef 4A@ Water Application $30.00 MAM 06/06/00 31613 J U N 2 1 2000
Total: $200.00
Jefferson County Planning
Building Department
I:\F_BLD_App_Mob.rpt 10/29/99
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 #: BLD00-00365 Received Date: 6/6/2000
SITE ADDRESS: 1725 SHINE RD Issue Date: 6/21/2000
PORT LUDLOW, 98365 Expiration Date 6/21/2001
APPLICANT: IDA MAE TESTER
1721 SHINE RD
PORT LUDLOW WA 98365
SUBDIVISION: TESTER SHORT PLAT Block: Lot: 1
PARCEL#: 821344054 Section: 34 Township: 28 N Range: 01 E
CONTRACTOR/
DEALER
INSTALLER: KIRK SILVES WAINS0282 Expires: 6/30/200
PROJECT DESCRIPTION MANUFACTURED HOME REPLACEMENT
MAKE: ARDMORE
YEAR: 2000
SIZE: 42X62
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 6/21/2001.
REQUIRED INSPECTIONS:
[ Footing/Setback (If continous footings are used): - r�'"/ y` d Q ,C.i ., ftij
jt4 to �Jbacks/Plumbing: Ol< q/1S�OD,Y�o`�
[ ] Fina1Skirting/V orches/Steps:
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
7_ HOT-LINE AVAILABLE 24 HOURS A DAY
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k�gso r c� Jefferson Can Community County Permit Center * Department of Conity Development
621 Sheridan Street.Port Townsend WA 08368(360]373-4450
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Project Description:
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9 Digit Parcel Identification Number(from your tax statement):
Site Address
911#: Road Name: S.l-4 % f U E Zip Code: Cj
Legal Description _
Subdivision Name: I ESE S G Kr L/4( Block:
et Lot(s): I
Section: •3
I Township: R I Range: 0 / £
Parcel Size (acres or square footage): .• 3Q
Property Owner: - 1 R: I Phone: 25_
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Mailing Address:
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Applicant/Occupant:
Phone:
(if different from owner)
Mailing Address:
Authorized Rep: one:
De n v, ► e 11 I Ph 7‘0 -eie3� -.226 Mailing Address: o
General Contractor:
Or Manufactured Home Installer: E d I J 2 tyift c 1 Phone: LJ '' ,
Mailing Address: 11:7ti;lle f' t � tl /9
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Contractor's State License Number: ( Expiration Date:
Septic Designer: IPhone:
Mailing Address:,3
20 0/I l) s,7: p ► 4,0 04,6,3 gip- 9s 'b.5'
Architect:/Engineer: p:(0_,ter /rie Phone:
Mailing Address: // i / c
Loan Lender/General Phone:
Contractor's Bond Holder: /V QA--Hi 5O udic ,L ' A I
Mailing Address: '
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JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST. PORT TOWNSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
/ NEW BUILDING 7 REPLACEMENT
SIZE
YEAR c
MAKE
COST --"I a OCO C.)
BEDROOMS: BATHROOMS:
EXISTING 3 EXISTING
PROPOSED PROPOSED 2
TOTAL TOTAL
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
El SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL
I1NDIVIDUAL SYSTEM lti' conventional IBLIC (�
PERMIT # SEP ci? 6OYZ/D Alternative Name of water system: ft) 1J # I
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE ft BANK HEIGHT 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 atto.rney'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 business hours.
SIGNATURE ���� 17(at � �e ��cch� DATE
NAME (PLEASE PRINT) J /Vi ae_ I EST E .
FOR OFFICE USE ONLY
CIO
BASE FEE Il,r RECEIPT# W I
ADDITIONAL SECTIONS 1- � CASH/CK# Q
SUBTOTAL I / � DATE 1(Q/ C
O )
POTABLE WATER
911/ROAD APPROACH
TOTAL
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