HomeMy WebLinkAboutBLD2000-00640 BUILDING 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#: BLD00-00640
SITE ADDRESS: 522 FREDERICK ST Received Date
10/3/2000
Issue Date 10/11/2000
PORT TOWNSEND, 98368
APPLICANT: WILLIAM PETERSON Expiration Date 10/11/2001
PO BOX 221 PHONE
TOKELAND WA 98590-0221
SUBDIVISION: COVE ADDITION
PARCEL NUMBER: 945901903 Block: 19
Section: 16 Township: 30 N Range: Lot: 3,4 +
CONTRACTOR: 01 W
STAPF CONSTRUCTION
PO BOX 212 PHONE: (360)385-3199
PORT HADLOCK WA 98339
Contractor's License: STAPFC*249J8 Expires: 04/08/2001
LOAN LENDER/ STATE FARM
BOND HOLDER:
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
REQUIRED INSPECTIONS:
[ ] Footings/Setbacks (Shoreline Setbacks): A"�i o,9
[ ] Foundation: �3�w"�
[ ] Underground Plumbing/Underground Insulation:
[ ] Shear Wall:
I' ] Framing/Plumbing:
[ ] Propane Tank/Lines:
[ ] Insulation:
[ ] Sheetrock:
I ]' Final/Occupancy Approval: r-'/(
HEALTH DEPARTMENT APPROVAL RE UIRED PRIOR TO FINAL INSPECTION.
THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED
BUILDING INSPECTION HOT-LINE 379-4455. CALL 24 HOURS IN ADVANCE TO SCHEDUL
Office Hours 9:00 a.m. -4:30 p.m. E INSPECTIONS.
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
f ..
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00640
SITE ADDRESS: FREDERICK ST Received Date: 10/3/2000
PORT TOWNSEND, 98368
APPLICANT: WILLIAM PETERSON
PO BOX 221 PHONE:
TOKELAND WA 98590-0221
SUBDIVISION: COVE ADDITION
PARCEL NUMBER: Block: 19 Lot: 3,4 +
945901903 Section: 16 Township: 30 N Range: 01 W
CONTRACTOR/ STAPF CONSTRUCTION
PHONE: (360)385-3199
DEALER: PO BOX 212
PORT HADLOCK WA 98339
Contractor's License STAPFC*249J8 Expires 04/08/2001
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME
TYPE OF IMP NEWSHORELINE:
VALUATION MAKE: FLEETWOOD
YEAR: SETBACK:
LABOR & INDUSTRIES APPROVAL? SIZE: 2000
40 X 42 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
BEDROOMS: BATHROOMS: NO
STORMWATER: YES PARCEL TAGS: YES
Exist: Exist: NO
Prop: 3 AREA
Total: 3 Prop: 2 Plat Conditions
Total: 2 Wetland— Erosion
Seismic Streams
Routing Date: Flood Way Food Plane
0 \ F&W Landslide
Shoreline
Forest: Commercial Aquifer
Rural
Type Amount Paid B
Manufactured Homes r Date: Receipt: A proved/D to
$141.00 MAM 10/03/00 34390 '" H '
Potable Water Application `. 1—,1$30.00 MAM 10/03/00 34390
Total: $171.00 '/� i
OCT 1
e SW County Phming
8.3uilring Department
i:1F_BLD_App Mob.rpt
10/29/99
JEFFER ON CO NTY OMM NITY DEV L PMENT,621 H RIDAN T P RT T OWNSFNn WA
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
NEW BUILDING
❑ REPLACEMENT
SIZE
YEAR 06c,
MAKE �-� , �
COST 4/ 0 D d ��.✓
BEDROOMS:
BATHROOMS:
EXISTING
PROPOSED EXISTING
PROPOSED
TOTAL
TYPE OF SEWAGE DISPOSAL: TOTAL
WATER SUPPLY:
❑ SEWER
0 COMMUNITY SYSTEM
❑ INDIVIDUAL SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL
Conventional
PERMIT # SEP 01 PUBLIC
❑ Alternative
IF WATERFRONT PROPERTY, Name of water system:
DISTANCE TO BANK OR HIGH WATER LINE -
By signing the application form, the a ft BANK HEIGHT � ft
knowledge. An pplicant/owner attests that the information provided herein is true and correct to the best of their
y maitalnt b f nullel g and void.uhood or any omission of a material fact made b
may result in this yer a
by the applicant/owner with respect to this application packet
I further agree to save, indemnify and hold harmless Jefferson County against all liabilities, judgments, court costs, reasonable
and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the grantingof this attorneys fees
I further agree to provide access and right entry permit.
I further
review and dy accreqess
later ghtins oftionsy to Access Jefferson Countysdri ofan
and it's employees, representatives or agents for the
shall occur during regular business hours. applicant's property or structure shall be requested and
entry to the purpose of
SIGNATURE
NAME (PLEASE PRINT) DATE ' ®«
FOR OFFICE USE ONLY
BASE FEE
ADDITIONAL SECTIONS RECEIPT#
CASH/CK#
SUBTOTAL i 1 IA ,
POTABLE WATER lJ DATE
91 1/ROAD APPROACH o
TOTAL
H:IHOMEIPLNCNTR4FO RMS\MOBILEAP.10/99
f
-
MANUFACTURED/ MOBILE HOMEe INSTALLATIONAPPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD00-00640
SITE ADDRESS: FREDERICK ST Received Date: 10/3/2000
PORT TOWNSEND, 98368
APPLICANT: WILLIAM PETERSON
PO BOX 221 PHONE:
TOKELAND WA 98590-0221
SUBDIVISION: COVE ADDITION
Block: 19 Lot: 3,4 +
PARCEL NUMBER: 945901903
Section: 16 Township: 30 N Range: 01 W
CONTRACTOR/ STAPF CONSTRUCTION
DEALER: PO BOX 212 PHONE: (360)385-3199
PORT HADLOCK WA 98339
Contractor's License STAPFC*249J8 Expires 04/08/2001
3
,50° ri
PROJECT DESCRIPTION MANUFACTURED HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME
TYPE OF IMPSHORELINE
VALUATION NEW MAKE: FLEETWOOD
YEAR: SETBACK:
LABOR & INDUSTRIES APPROVAL? 2000
SIZE: 40 X 42 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PUD
PARCEL TAGS: YES
NO
BEDROOMS: BATHROOMS:
Exist: STORMWATER: YES NO
AREA Plat Conditions
Prop: 3 Prop: 2
Wetland Erosion
Total: 3 Total: 2
Seismic Streams
Routing Date: Flood Way Food Plane
1 Shoreline W Landslide
L' Aquifer
Forest: Commercial Rural
Type Amount Paid B A roved/D to Manufactured Homes y� Date: Receipt: ��
$141.00 MAM 10/03/00 34390 ;._ 'R 1
Potable Water Application $30.00 MAM 10/03/00 34390 SU
Total: $171.00 �/
frilotltire
a son Cu, ty ,.,,3ning
Building Department
I:\F_BLD_App Mob.rpt
10/29/99
RETURN ADDRESS /97-7tk',P77ew Pa;R,*;T Tv' El
WASHINGTON MUTUAL BANK
y7��2
1336 CORNWALL AVE
was 0 93 9.1.10
BELLINGHAM, WA 98225
'�>4 ) de3 y25—
LJA> o” 91.4
L��DeST I,JFtWASHINGTON MANUFACTURED HOME PLEASE CHECK ONE
purtmrnt of
IicEii1flG APPLICATION TITLE ELIMINATION
['TRANSFER IN LOCATION
Anyone who knowingly makes a false statement of a material fact is guilty of a felony, and upon conviction may be punished by a fine,imprisonment,or both(I�CW 6Al2 21oOM REAL PROPERT
1 MANUFACTURED HOME
TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VINJ . ._,y
1999 WESTON 48 X44 !AFLW31A,B-,C1623•2 WE13
2 LAND
LEGAL DESCRIPTION'ON PAGE
MANUFACTURED HOME WILL BE Pn AFFIXED 0 REMOVED REy�4�PE�Tx Z`vc PEAR L NUMBER
LOT BLOCK y lUJ 1
PLAT NAME
3 and 4 19 Cove Addition SECTION/TOWNSHIP/RANGE
3 GRANTOR(S)REGISTERED/LEGAL OWNER(
COUNTY NUMBER ADDITIONAL NAMES ON PAGE
1600 NUMBER OF REGISTERED OWNERS
1 NUMBER OF LEGAL OWNERS
NAME OF REGISTERED OWNER 1
WILLIAM E. PETERSON
NAME OF ADDITIONAL REGISTERED OWNER
ADDRESS
522 FREDER I CK STREET CITY STATE ZIP CODE
PORT TOWNSEND WA 98368
NAME OF LEGAL OWNER
WASHINGTON MUTUAL BANK
NAME OF ADDITIONAL LEGAL OWNER
ADDRESS
CITY STATE ZIP CODE
1336 CORNWALL AVE
BELLINGHAM WA 98225
I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AWARE THE REGISTERED OWNER(S)OF THIS
VEHICLE AND THIS INFORMATION IS ACCURATE:
Signature of Registered Owner and Title,IF APPLICABLE
Signature of Additional Registered Owner and Title,IF APPLICABLE°,
2 A—NOTAF j ymp,S AMP NOTARIZATION/CERTIFICATION NEM
_� ` -
\� rr ICATION FOR REG TERED OWNERS)SIGNATURE
�� �MPLEeY / State of Washington
��; 1.„ County of -T>o1{ff l Signed or attested
?• R Y.��:'4 y before me on �'� Q Z
. •r 2 21,,Lp0� : 0 = by WILLIAM E, PETERSON
\:.::. �� •F i PRINT NAME OF REGISTERED OWNERSignature ,C� • -
v NOTARY OR AGENT
IPI�T�• 1 p.�`T`\�� by PRINT NkjitAME OF/REGISTEREDOWNER PRINTED NAME OF NOTA
A Y
rr//��NfJi1t1111«�>>\ Title it.; /CL; County/Office No.OR
DEALERSHIP P0'1 ION/AGENT/NOTARY AND: Dealer No.OR
Notary Expiration Date I �
4 TITLE COMPANY CERTIFICATION i '.
a
I certify that the legal description of the land and ownership is true and correct per the real property records.
NAME(TYPED OR PRINTED)
TITLE COMPANY/PHONE NUMBER
CNItf--' TO 13385F772 F.,71:'. ,CO !
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