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HomeMy WebLinkAboutBLD2000-00723{ i MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD00-00723 Received Date: 11/8/2000 SITE ADDRESS: 124 E TOANDOS RD QUILCENE, 98376 APPLICANT: CHERYL NELSON PHONE: (206)842-1391 MICHAEL NELSON 11122 MANITOU BEACH BAINBRIDGE ISLAND WA 98110 SUBDIVISION: OLYMPIC VISTA LARGE LOT Block: Lot: 7 PARCEL NUMBER: 701105007 Section: 10 Township: 27 N Range: 01 W CONTRACTOR/ DEALER: INSTALLER: JUSTIN CANTERBURY WAINS00785 7/20/2001 HUNT HOMES BREMERTON WA 98312 PROJECT DESCRIPTION MOBLIE HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: GUERDON SETBACK: VALUATION 17,995.00 YEAR: 1976 LABOR & INDUSTRIES APPROVAL? SIZE: 27 X 48 BANK HEIGHT: SEWAGE DISPOSAL: ALT WATER SYSTEM: PUBLIC BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO STORMWATER: YES NO Exist: Exist: AREA Plat Conditions Prop: 2 Prop: 2 Wetland Erosion Total: 2 Total: 2 Seismic Streams Flood Way Food Plane Routing Date: it ki F&W aslide IN Shorelin fer Forest. Comme . I ral A roveo'Latedtk31�iVit J Type Amount Paid By: Date: Recei . pp Manufactured Homes $141.00 MAM 11/08/00 35418 =' `c �'' / I Potable Water Application $30.00 MAM 11/08/00 35418 L V Total: $171.0064-- C d' 4Cai Area Rv9w tll i:1F_BLD_App_Mob.rpt 10/29/99 • • Jefferson County Department of Community Development November 13, 2000 621 Sheridan Street, Port Townsend, WA 98368 (360) 379-4450 CRITICAL AREA STANDARD WAIVER Applicant: CHERYL NELSON MICHAEL NELSON 11122 MANITOU BEACH BAINBRIDGE ISLAND WA 98110 Critical Area Review Case Number: CAR00-00386 Project Description: 140-pressurized trench Parcel Number: 701105007 S-T-R: 10-27N-01 W Site Address: 124 E TOANDOS RD QUILCENE WA, 98376 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 s all as proposed and portrayed on the Universal Plot Plan. Deviation, additions or rel ti of p oposed development activities will require further review pursuant to the Jefferson C un C itic Areas Ordinance. 1 D partment of Community Development Staff c: File I:\F_CAR_Waiver_Standrd.rpt 12/13/99 JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUILDING ❑ REPLACEMENT SIZE YEAR / '/ 2 MAKE a COST BEDROOMS: BATHROOMS: EXISTING 2 EXISTING _ PROPOSED PROPOSED TOTAL TOTAL 2 TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: ❑ SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL 7 INDIVIDUAL SYSTEM 0 Conventional E5 PUBLIC PERMIT # SEPOo-2 7 Alternative Name of water system:eyint iC IjISTA IF WATERFRONT PROPERTY, A/c,N e.. 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. SIGNATURE L�-v,, _. /� � DATE //- tolf— 4/6) NAME (PLEASE PRINT) W�Lf'1 � /rC / j�-- FOR OFFICE USE ONLY BASE FEE / f- c G RECEIPT# 33_ q/ ADDITIONAL SECTIONS CASH/CK# 240,S SUBTOTAL ! /'/ 1. DATE ��/ Li l 00 POTABLE WATER -© 91 1 L OAD APPROACH' TOTAL ��\ ✓ l -CJ U H:\HOME\PLNCNTR\FORMS\MOBILEAP,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 NOTA TAX STATEMENT NAME: /l4 Ai. ,4Z 4: �_'1 r- The purpose of this questionnaire is to obtain information /J regarding either the current location of a mobile home or the ADDRESS: ! 0 /,,> �1' . previous ownership and location of a mobile home. This will / / help our office determine whether the mobile home is already s. ' ni A :1 Z _ 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: c �" `� .� /2 additional information. 1) MOBILE HOME DATA: (A) MAKE C7 OCR DOK) (B) MODEL TATL 2 (C) YEAR I 1 (D) LENGTH (E) WIDTH (F) SERIAL NUMBER 5_%'64C I U (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) 0,99r J (H) PURCHASE DATE ///1MC 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: J (A) FROM WHOM DID YOU PURCHASE MOBILE + T // IC esNOM 4.) ADDRESS 3(60 f1W e. / G,N+fS7` Ckr:g:ThY1i 1.14 (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO,WHAT COUNTY? l C it IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES (B) IF LOCATED IN A MOBILE HOME PARK: NAME 8L ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: /1 NAME OF LAND OWNER: I"f t� - A • f Ms G k—)1� r- A LOCATION (ADDRESS) 1// : M AAJiTGd g C / i 1v A.) F bAt gilli c,t f,�. t'Jw REAL PROPERTY PARCEL NUMBER/DESCRIPTION 3 0 1 1 0 S.-- 0 Q' THANK YOU FOR YOUR HELP! � '� SIGNATURE KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. .... . .4.. -^ •'' ' '- ' - " ' .'-, . .---, .. -., .. .-4- , - ...,.,. -„.....,„,..,,,,,..,. ,,,„„,, , -.......„ (----\ -...., ........_ - . .... ..., ./' 'NNNN.`'v .c.s **.' .3'i CN 44,,„1, -' Nre ' ›C ; I I 1 •::. c., ,)% r? I e I .5- ,i „,..... --, - ...,........ -,....„ I ... ..... '''''.1 7 ' ...\\ . , N N ( ' I Ik''' $ •k) i • -.. 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