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HomeMy WebLinkAboutBLD2001-00228 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 #: BLD01-00228 Received Date: 4/18/2001 SITE ADDRESS: 4613 S DISCOVERY RD Issue Date: 4/20/2001 PORT TOWNSEND, 98368 Expiration Date 4/20/2002 APPLICANT: LAWRENCE LAMMERS PO BOX Q BRINNON WA 98320 SUBDIVISION: EARNEST SHORT PLAT Block: Lot: 3 PARCEL#: 001321052 Section: 32 Township: 30 N Range: 01 W CONTRACTOR/ OWNER PHONE: DEALER PROJECT DESCRIPTION NO MLA REQUIRED - MANUFACTURED HOME TO REPLACE BLD00-760 MAKE: MODULINE YEAR: 1991 SIZE: 28 X 56 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 4/20/2002. REQUIRED INSPECTIONS: Setback : Fo9ting(If conti ous footings are �J Plumbin .C / I ) / L- i�t,r'�, . O 125;�i Final/Skirting/Vents/Porches/Steps:Lt., G/ 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 APPLY-SEE REVERSE HOT-LINE AVAILABLE 24 HOURS A DAY SPECIAL CONDITIONS CASE # BLD01-00228 1.) Single wide from cancelled BLD00-760 MUST BE REMOVED from property. OP MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00228 Received Date: 4/18/2001 SITE ADDRESS: 4613 S DISCOVERY RD PORT TOWNSEND, 98368 APPLICANT: LAWRENCE LAMMERS PHONE: (360)796-4192 PO BOX Q BRINNON WA 98320 SUBDIVISION: EARNEST SHORT PLAT Block: Lot: 3 PARCEL NUMBER: 001321052 Section: 32 Township: 30 N Range: 01 W CONTRACTOR/ OWNER PHONE: DEALER: PROJECT DESCRIPTION NO MLA REQUIRED - MANUFACTURED HOME TO REPLACE BLD00-760 TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: MODULINE SETBACK: VALUATION 30,000.00 YEAR: 1991 LABOR & INDUSTRIES APPROVAL? SIZE: 28 X 56 BANK HEIGHT: SEWAGE DISPOSAL: OSS WATER SYSTEM: 2WELL 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 Floodplain Routing Date: F&W Landslide /., C , Shoreline Aquifer _ C - C l Forest: Commercial MR wAlb. ift 1 P Type Amount Paid By: Date: Receipt: APR 202001 Total: JEFFERSON COUNTY DEPT.OF COMl�1�JNITY DEVELOPMENT SIGNATURE: /;w.-_.;.. ( 2.4C i JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUILDING 0 REPLACEMENT SIZE E" X f_ 4 YEAR (f l MAKE Ma d v L %A/E COST J0i a © 0 BEDROOMS: _ �,l-.. ,..., ROOMS: or, it:, Li .I IL,' 1'1a' EXISTING 2 . `' `"' —rXItT1NG x- PROPOSED APR 1 g 2001 PROPOSED TOTAL 2 TOTAL .z_ TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL le TWO PARY WELL 0 INDIVIDUAL SYSTEM 0 Conventional 0 PUBLIC PERMIT # SEP 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. SIGNATURE - ,, . - er-4-11.---,-1....6.t...2.— DATE SL j/i/a/ NAME (PLEASE PRINT) L /4/ it y 1, t L l4 M Ti 4' / FOR OFFICE USE ONLY BASE FEE RECEIPT# ADDITIONAL SECTIONS CASH/CK# SUBTOTAL DATE / / POTABLE WATER —— 11110 An. 1)‘ 91 1/ROAD APPROACH ND ir )IIII5 ) l< TOTAL 0.,„ H:\HOME\PLNCNTR\FORMS\MOBILEAP.10/99 CO 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 NAME: I.. , dQ i V . o L /4 11/ M A 5 The purpose of this questionnaire is to obtain information regarding either the current location of a mobile home or the ADDRESS: (7, 12 ' 0 X 1? b y' previous ownership and location of a mobile home. This will ' help our office determine whether the mobile home is already /N Hon/ 9 P`3.2- ©^ 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: (36 ee) 7 / r additional information. APR 18 �; ; 1) MOBILE HOME DATA: (A) MAKE /VI 6 p v L /i/E (B) MODEL G U ,L 13 R lJ Al 5. A/ (C) YEAR Y/ (D) LENGTH rG (E) WIDTH 2- ,f (F)SERIAL NUMBER (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX) 3 Cf 0 (H) PURCHASE DATE/ 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE MOBILE vY/745'/if /f o Ai C= F.{/ 7' 4/c ADDRESS /4( p 779/1/ (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO (IF NO, WHAT COUNTY? /(/� 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 NO (B) IF LOCATED IN A MOBILE HOME PARK: NAME az ADDRESS OF PARK SPACE NO. (C) IF NOT LOCATED IN A MOBILE HOME PARK: NAME OF LAND OWNER: L A M B y &., L A /i /v/ F/q '- LOCATION (ADDRESS) (p / 3 5 c'"7 /, 0 /S C rr - d'/1/ /i'/), REAL PROPERTY PARCEL NUMBER/DESCRIPTION ,OO/ 3 2 / — U 52 THANK YOU FOR YOUR HELP! ,, SIGNATURT KELLI LARSON, roperty Technician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. ,��soxr o6. Jefferson County Permit Center * Department of Community Development c 621 Sheridan Street.Port Townsend WA 08368(360]370-4450 ----- no , VepSa D 0 \ p,Q \ Till iK tie iollou ucg&444 as eonegetelf as foeoi&le: . Project Description: n//Al a FA- TU ,C' C 17 /-Ia711,4- ,L.,Ay 5 7 r,- /-•k ,4 ,>-/ Al 9 Digit Parcel Identification Number(from your tax statement): Oo ( - .3 1- © S9 Site Address u, ' r# 911#: i G (3 Road Name:'t/Sc d V ER% Zip Code: 9 ? 3 6 g' Legal Description L ri di)C,L) 41.J 4 m m E P 5 ,i Subdivision Name:La mil L i9/CU ES 7 !4 oR-r 7'I-4.-- Block: Lot(s): 3 Section: Township: 3 a Range: L DNS Parcel Size (acres or square footage): /, 3S ,g c k ES Property Owner: 6 ,:-a..) E Aj c 1 NI Phone: Mailing Address: r.J ci_ /— Applicant/Occupant: Phone: (if different from owner) Mailing Address: Authorized Rep: Phone: Mailing Address: General Contractor: / Or Manufactured Home Installer: t1 0' il�ti c° w1 R1�le, Phone: . /,o 71 _ /? Mailing Address: 73 . tn\x Contractor's State License Num er: Expiration Date: Septic Designer: It /4_A p r L © N Phone: 3? O 3 5, .7 Mailing Address: - l li 5T / t ( 1 -� c___ ,f J A 5 g 16 3 l .,vGS ice - OoA� �v•t��N�EN�7 01 Architect:/Engineer: fi, Phone: Mailing Address: ') /?S.-7 1Y6S-r.ibaS 40'c h.). i6tQ -` riSkA)I/ S(t)D,(U,i 92S GS Loan Lender/General Phone: Contractor's Bond Holder: /1 ei A, C Mailing Address: Fire;District: . ...:: Planning:Arei..;i .....;:: . .....;. School.Distric6... Zone . >: ..... .;..................................... 4/98 H:\home\pincntr\forms\universal plot plan Y Y 1<.-- t° � a 5 7.--/--------- r / \ i (--- . 0 ..,,,,,,. 1 --t-- 4 ... ,r 4` ,- i ....LA1Ill Ao- T \ , ......,, rl---, ,,, i z P �� r N p '1 ,c , -o NI fi � � • I N. , O lit" r .L = (X� � ` e .1 et C ? l \A il- ' iwk Ut 1 1 N • \J ( .:k, -6:- i -d 0 -0