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HomeMy WebLinkAboutBLD2001-00718 MLA01-00637 Review Type: I MANUFACTURED/ MOBILE HOME INSTALLATION APPLICA-iN • Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00718 Received Date: 12/31/2001 SITE ADDRESS: 2450 CENTER RD CHIMACUM, 98325 APPLICANT: STACEY E THOMPSON PHONE: (360)732-4421 2600 CENTER RD CHIMACUM WA 983258749 SUBDIVISION: Block: Lot: T 9 PARCEL NUMBER: 901263011 Section: 26 Township: 29 N Range: 01 W CONTRACTOR/ OWNER PHONE: DEALER: REPRESENTATIVE: PROJECT DESCRIPTION MOBILE HOME INSTALLATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP NEW MAKE: MARLETTE SETBACK: VALUATION 2,000.00 YEAR: 1964 LABOR & INDUSTRIES APPROVAL? SIZE: 52 X 10 BANK HEIGHT: SEWAGE DISPOSAL: CON WATER SYSTEM: PWELL BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO Exist: Exist: STORMWATER: YES NO Prop: 2 Prop: 1 AREA Plat Conditions Wetland Erosion Total: 2 Total: 1 Seismic Streams Flood Way Floodplain Routing Date: F&W Landslide -2r 15 I © l (Pq Shoreline Aquifer llf Forest: Commercial Rural Proximity_J Type Amount Paid By: Date: Receipt: Approved/Date Permit $141.00 MAM 12/31/01 42500 Potable Water Application $30.00 MAM 12/31/01 42500 Total: $171.00 JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION NEW BUILDING ❑ REPLACEMENT SIZE .52 >C/o RL—DEC 3 1 2001 YEAR 19G T/ kt 1 .ve l I MAKE 11�r I e- DEPT. OF COMMUNITY DEVELOPMEN1 COST 4. 2, env BEDROOMS: BATHROOMS: EXISTING v40 EXISTING PROPOSED 7.--" PROPOSED TOTAL TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM 18''15RIVATE WELL 0 TWO PARY WELL INDIVIDUAL SYSTEM EI Conventional 0 PUBLIC PERMIT # SEPdI 2210 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 aa� /,� DATE <3--/}'r/**'*-1 NAME (PLEASE PRINT) CD1 ( FO OFFICE USE ONLY BASE FEE /9/. 6 O RECEIPT# I4' 00 ADDITIONAL SECTIONS - CASH K # 3 1.5 Cr, SUBTOTAL /'/7' C O DATE 1—i3(/ 0( POTABLE WATER 30 0 0 911 OAD APPROACH)2QVs: -�C✓ (� TOTAL • 0 V H:\HOME\PLNCNTR\FORMS\MOBILEAP.10/99 • E t!4 7 E PLEASE MAIL TO: RSON COUNTY ASSESSOR JACK WESTERMAN III J ERSON COUNTY COURTHOUSE ASSESSOR DEC 31 2L: . 1220, PORT TOWNSEND WA 98368 (360) 385-9105 MOBILE 1-19MMRtygni,MRtt OWNER'S NAME / MAILING ADDRESS: THIS/S NOT A TAX STATEMENT NAME: L f e,r e-K --C o le The purpose of this questionnaire is to obtain information /? regarding either the current location of a mobile home or the ADDRESS: Z6 O o l ��/ �`/!' fcct(( previous ownership and location of a mobile home. This will � ��,� 2� help our office determine whether the mobile home is already hit C V lrtZ C-t/ 9 e�/3 on the tax rolls in Jefferson Countyor if it has been moved to this county from another area. Please see reverse side for TELEPHONE NO:( 60 73 —77 / additional information. ,< zS2-ft XTe// z y 1) MOBILE HOME DATA: (A) MAKE Marl/ e -C_ (B) MODEL (C) YEAR /`/ L' d, (D) LENGTH 3 2i (E) WIDTH / - (F)SERIAL NUMBER'` (G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX)02 C (H) PURCHASE DATE /014/7...- / 2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: (A) FROM WHOM DID YOU PURCHASE M v`O� €-s BILE 14a I lJ-- -sold �� �j • ADDRESS P 11 ' Sx 3 7 -, I D r`� `I C� s LA4 9f (B) WAS MOBILE HOME ASSESSED IN JEFFERSON COUNTY LAST YEAR? YES NO IF NO, WHAT COUNTY? ('/c77 i i j IF YES, WHAT WAS PREVIOUS ADDRESS OF MOBILE? /tf 3 re ,L4 t DuJ L . 1?A 3) WHERE MOBILE HOME IS TO BE LOCATED: (A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES CC (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: �Th2 LOCATION (ADDRESS) ` J O l P/IZ� , el.- jj jdc_ ', aA G REAL PROPERTY PARCEL NUMBER/ DESCRIPTION / 0/2 (� ,, !/ THANK YOU FOR YOUR HELP! "eel' SIGNATURE KELLI LARSON, r�echnician THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION. Lc g 51)\1( (avo o le LL Z 2 XVI ' odor . o OO9Z 106 .� �o M� £ xdl ..../ v tro0£9Z106 z a _ ,A 9z �--� 01 /25 l t Fr���5/1CJ ,9£xhz i 40‘‘ I ` rid 4 0rn; � p vl �•c�i - 16 • �. ; C- . Cni co :lil kel z �h 0� 1 N 2 / rn /UzlV? 1 / .g ri IS • , 1 6 J e 3 ......,,,,...„,„,,,..„,,,.............., 1 4 *D C6 't 1: ...-- ,_ .. .".\, 6 XVI__, _-_,. IA M f_ L I.0c9Z I06 � � 3 \ \ w \ \ OD a o . \ \ —� 1 s8 ,. \ \ )\/4\ 3 I L. , —'—."—"°°---- A.... ,......., ._ 1 • Yy, \ \ 1 "—' • 1 x r I ,0 4 • 1 W • ° — E. v'i'"3 o i a-z • OD• a V 0 SQ' l SL3 f