HomeMy WebLinkAboutBLD2000-00653 {
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 #: BLD00-00653 Received Date: 10/4/2000
SITE ADDRESS: 3155 CENTER RD Issue Date: 2/5/2001
CHIMACUM, 98325 Expiration Date 2/5/2002
APPLICANT: AUTUMN SCOTT& CHUCK EASTON
3155 CENTER RD
CHIMACUM WA 98325
SUBDIVISION: Block: Lot: T 10
PARCEL#: 901352006 Section: 35 Township: 29 N Range: 01 W
CONTRACTOR/
DEALER
INSTALLER: JAIME KOZELISKY WAINS0626 Expires: 7/22/200
1112 JACOB MILLER RD PORT TOWNSEND WA 98368
PROJECT DESCRIPTION MOBILE HOME INSTALLATION
MAKE: LIBERTY
YEAR: 1986
SIZE: 14 X 66
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 2/5/2002.
REQUIRED INSPECTIONS:
['Setbacks:Q/(
[� Footin+,If confi lausfootings are used):PAPJ QfG 44/3,e9c -
[ ] lock Plum in C _ ` / - /
[ Final/Skirting/Vents/P rches/S s`' ? ��� J ---�--�.
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.
HOT-LINE AVAILABLE 24 HOURS A DAY
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
-- -er- r S NEW BUILDING ❑ REPLACEMENT
SIZE x I �j I/p
j:1chi 1�C �
h br&l, -- YEAR 7 YJ 11
c�oe MAKE 7fl0L1 /2 �� iv\(e_ ► r �N
U I'riSL- COST 0-0 0
BEDROOMS: BATHROOMS:
EXISTING EXISTING
PROPOSED PROPOSED
TOTAL TOTAL
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER ❑ COMMUNITY SYSTEM ✓t PRIVATE WELL ❑ TWO PARY WELL
A INDIVIDUAL SYSTEM Conventional 0 PUBLIC
PERMIT # SEP7/-338 0 Alternative Name of water system:
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 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 business hours.
. — 36
SIGNATURE di,1
((�./ (' DATE
NAME (PLEASE PRINT) ,/I4 \cs C 1
gg' FOR OFFICE USE ONLY
BASE FEE RECEIPT#
ADDITIONAL SECTIONS CASH/CK#
SUBTOTAL { .t I � DATE !—
POTABLE WATER
911/ROAD APPROACH
TOTAL
H:\HOME\PLN CNTR\FORMS\MOBI LEAP.10/99
PLEASE MAIL TO: '
JEFFERSON COUNTY ASSESSOR
JACK WESTERMAN III JEFFERSON COUNTY COURTHOUSE
ASSESSOR PO BOX 1220,PORT TOWNSEND WA 98368
(360) 385-9105
MOBILE HOME INFORMATION FORM
OWNER'S NAME / MAILING ADDRESS: THIS IS NOT A TAX STATEMENT�T NAME: I.(-ul n-L 1,, it The purpose of this questionnaire is to obtain information
S� Ce�h regarding either the current location of a mobile home or the
ADDRESS: 1' previous ownership and location of a mobile home. This will
l `, f a C yl �j S -C---
_ help our office determine whether the mobile home is already
l ' TT 02 on the tax rolls in Jefferson County or if it has been moved to
this county from another area. Please see reverse side for
TELEPHONE NO: 7. ' 2 - ii 9 0a Y additional information.
I
1
1) MOBILE HOME DATA: rr
(A) MAKE j t rly (B) MODEL I r 'V)- it t '-e n ie).E -aIN( c (C) YEAR 1 ci-7G
( r
(D) LENGTH f, b (E) WIDTH )9 (F) SERIAL NUMBER 7 Z 7 ti/CI
(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) 13- 0 00 (H) PURCHASE DATE CV-a 0 D 0
2) PREVIOUS OWNER / LOCATION OF MOBILE HOME:
(A) FROM WHOM DID YOU PURCHASE MOBILE )31A,,c' h� Aiq€,7y
ADDRESS (SJ E. hi,k. '/` C w S JJ'le_, Pk , D i q a? ) Ok-kk '', 1 7�j
�YF(B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? S NO (IF NO,WHAT COUNTY? )
IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? (" -C--/ in A r r o sT h-e-• ES. . ,
3) WHERE MOBILE HOME IS TO BE LOCATED:
(A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO
(B) IF LOCATED IN A MOBILE HOME PARK:
NAME 8L ADDRESS OF PARK SPACE NO.
(C) IF NOT LOCATED IN A MOBILE HOME� PARK:
NAME OF LAND OWNER: /)(4. 1(i4-i\ \ NC.o
LOCATION (ADDRESS) 3' )Ss- C k 1Q r- ) C/,1 I� C Q .4JJ J k)A ?S ? ��
REAL PROPERTY PARCEL NUMBER/DESCRIPTION/ 9 C / 352, t D 6 S e.c. r J J' /0 W h di;p 2.47)
g a el e., I CU,2_s 7/ TAX J C
THANK YOU FOR YOUR HELP! Ottic4.4 / C4
SIGNATURE
KELLI LARSON, roperty Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.
Q
MANUFACTURED/ MOBILE HOME INSTALLATION (-44 i_4- 7
/`J f
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT#: BLD00-00653
SITE ADDRESS: 3155 CENTER RD Received Date: 10/4/2000
CHIMACUM, 98325
APPLICANT: AUTUMN SCOTT& CHUCK EASTON
3155 CENTER RD PHONE
CHIMACUM WA 98325 732-4984
SUBDIVISION:
PARCEL NUMBER: 35 T Block:
901352006 Section: Lot: T 10
Township: 29 N Range: 01 W
CONTRACTOR/
DEALER:
PROJECT DESCRIPTION MOBILE HOME INSTALLATION
TYPE OF WORK MOB
MANUFACTURED HOME:
TYPE OF IMP NEW
MAKE: LIBERTY SETBACK:
VALUATION SHOE.
5,000.00
LABOR & INDUSTRIES APPROVAL? YEAR:
SIZE: 1976
14 X 66 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: 1 �� _
BATHROOMS: PARCEL TAGS: YES
Exist: Exist:
Prop: 2 Prop: 2 AROEA MWATER: YES ��
Total: 2 Total: 2 Plat C. �.ns
Wetland
Seismic Erosion
Routing Date: Flood Way Streams
F&W Food Plane
l Shorelin Landslide' ri ;.,C �z=
Forest: ommercial . c Aquifer
Type Rural
Amount Paid By: Date: Receipt; Approved/Date
Manufactured Homes
Potable Water Application $0.00 MAM 10/06/00 � =�
$0.00 MAM 10/06/00 :73,4'c
C//
Total:
r 1414*4.141 4 ,A - --'''' —
ij.
--,,Pifiew ,
.,:: -,„
i:1F_BLD_App_Mob.rpt �.. --
v , ( /� �� '
10/29/99
Jefferson County Department of Community Development October 6, 2000
621 Sheridan Street, Port Townsend, WA 98368
(360) 379-4450
CRITICAL AREA STANDARD WAIVER
Applicant: AUTUMN SCOTT& CHUCK EASTON
3155 CENTER RD
CHIMACUM WA 98325
Critical Area Review Case Number: CAR00-00443
Project Description: mobile home installation
Parcel Number: 901352006 S-T-R: 35-29N-01 W
Site Address: 3155 CENTER RD
CHIMACUM WA, 98325
FINDING: The development, as proposed and portrayed on the Universal Plot Plan, does not encroach on
an identified critical area nor any associated buffers.
CONCLUSION: The proposed development meets the waiver requirements established in Jefferson County
Ordinance 05-0509-94.
CONDITION: The development shall be as proposed and portrayed on the Universal Plot Plan. Deviation,
additions or relocation of proposed development activities will require further review pursuant to
the Jefferson County Critical Areas Ordinance.
,f.
r
Department of Community Development Staff
c: File
I:\F_CAR_Waiver_Standrd.rpt 12/13/99
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