HomeMy WebLinkAboutBLD2001-00468 .4, ? a
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 #: BLD01-00468 Received Date: 8/14/2001
SITE ADDRESS: 6062 SR20#23 Issue Date: 8/21/2001
PORT TOWNSEND, 98368 Expiration Date 8/21/2002
APPLICANT: R BRUCE BROWN
LINDA BROWN
6062 STATE ROUTE 20 OFC
PORT TOWNSEND WA 98368-9301
SUBDIVISION: Block: Lot:
PARCEL#: 001333004 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR/ OWNER PHONE:
DEALER
PROJECT DESCRIPTION NO MLA REQ'D - MOBILE HOME INSTALLATION
MAKE: REDMAN
YEAR: 1979
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 8/21/2002.
REQUIRED INSPECTIONS:
[ J Setbacks:
[ J Footing(If continous footings are used):
BI ckin Plumbing6��tvv� Co �� 4-4 c7t j .. `I - ?L) U,
[if' Final/Skirting/Vents/Porches/Steps: j _ . q- (-J-7
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
1
•
Review Type:
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00468 Received Date: 8/14/2001
SITE ADDRESS: 6062 SR20#23
PORT TOWNSEND, 98368
APPLICANT: R BRUCE BROWN PHONE: (360)385-2991
LINDA BROWN
6062 STATE ROUTE 20 OFC
PORT TOWNSEND WA 98368-9301
SUBDIVISION: Block: Lot:
PARCEL NUMBER: 001333004 Section: 33 Township: 30 N Range: 01 W
CONTRACTOR/ OWNER PHONE:
DEALER:
REPRESENTATIVE: JIMMY SCISM
6062 SR20
#23
PROJECT DESCRIPTION NO MLA REQ'D - MOBILE HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: REDMAN SETBACK:
VALUATION 6,000.00 YEAR: 1979
LABOR & INDUSTRIES APPROVAL?
SIZE: 14 X 66 BANK HEIGHT:
SEWAGE DISPOSAL: OSS
WATER SYSTEM: PUBLIC
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
STORMWATER: YES NO
Exist: Exist: AREA Plat Conditions
Prop: ;a'?, Prop: 2 Wetland Erosion
Total: 3'2 Total: 2 Seismic Streams
Flood Way Floodplain
Routing Date:
S)✓// k
F&W Landslide
g/4z_ Shoreline Aquifer
Forest: Commercial Rural
Proximity
Type Amount Paid By: Date: Receipt: Apo;
rodivED
Manufactured Homes $141.00 MAM 08/14/01 30117
Potable Water Application $30.00 MAM 08/14/01 30117
Total: $171.00 AUG 2 1 2001
F ERS COU
DEPT.OF -.:.; n 4 a,‘d;, T
SIGNAT <<r • _
r
a a.
■
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST. PORT TOWNSEND WA 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
0 NEW BUILDING 0 REPLACEMENT
SIZE 1 if x 66,
YEAR 4Ci 9 CI
MAKE rx'/ A'(m_L 1 11 cr,V\
COST l, cO
BEDROOMS: ✓ BATHROOMS:
n r
`'
EXISTING EXISTING
PROPOSED 3 PROPOSED
TOTAL TOTAL a.
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
0 SEWER ❑ COMMUNITY SYSTEM ❑ PRIVATE WELL 0 TWO PARY WELL
NI/INDIVIDUAL SYSTEM 0 Conventional if 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 DATE y/t/o
NAME (PL E PRINT)
�,. FOR OFFICE USE ONLY
': BASE FEE * * ppa�yy I
yam, � �� � RECE[PT# i,� IV
,ADDITIONAL SECTIONS; , CASH/CK#1
SUBTOTAL ' x r 0 'i O /
POTABLE WATER 5 ¢ - " 1,,e .
... $ -,'IX, ',,'', .:.* lo ate` a ... r
911/ROAD APPROACH - ,,, 4. �TOTAL v
H3HOME\PLNCNTRIFORMSIMOBlLEAP,1 0/99
A
R
.,....- \ I
, ,
-rt.
V\ \
.......... J
sieno,5 4+.0J ♦tj
is] SNMD ) a;.l.
Jaf,to
�i� �S E S I V +1,(3
V
1
ii
0
I_ ,, ,
0
, 1
cit. ,
i
i
i
1 -- --.--.7r.-"-.)
i
t
l•
0 '�
N.
1I 4
Pin v