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HomeMy WebLinkAboutBLD2001-00490 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#: BLD01-00490 Received Date: 8/28/2001 SITE ADDRESS: 255 S MAPLE RD Issue Date: 8/29/2001 PORT HADLOCK, 98339 Expiration Date 8/29/2002 APPLICANT: HELEN YACKULIC PO BOX 86 PORT HADLOCK WA 98339-0086 SUBDIVISION: SOUTH PORT TOWNSEND Block: 12 Lot: 14-16 PARCEL#: 996401205 Section: 2 Township: 29 N Range: 01 W CONTRACTOR/ OWNER PHONE: DEALER PROJECT DESCRIPTION NO MLA REQ'D -MANUFACTURED HOME INSTALLATION To Replace Burned Out Mobile MAKE: OLY YEAR: 1981 SIZE: 14 X 70 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 8/29/2002. REQUIRED INSPECTIONS: [ ] `;ethacks: [ ] Footing(If continous footings are used): [ ng/Plumbir4 ©fc1/ : /0-/ -o-E. [ I Final/Skirting/Vents/Porches/Steps:`` ✓'/oNO . /D- j oZ 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 Review Type: MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT #: BLD01-00490 Received Date: 8/28/2001 SITE ADDRESS: 255 S MAPLE RD PORT HADLOCK, 98339 APPLICANT: HELEN YACKULIC PHONE: (360)385-6893 PO BOX 86 PORT HADLOCK WA 98339-0086 SUBDIVISION: SOUTH PORT TOWNSEND Block: 12 Lot: 14-16 PARCEL NUMBER: 996401205 Section: 2 Township: 29 N Range: 01 W CONTRACTOR/ DEALER: REPRESENTATIVE: PROJECT DESCRIPTION MANUFACTURED HOME INSTA_LATION TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE: TYPE OF IMP VALUATION MAKE: OLY SETBACK: YEA : 1981 (.--) \CD� I ER 14 X 0 BANK HEIGHT: LABOR & INDUSTRIE A OVAL? SEWAGE DISPOSAL: OSS WATER SYSTEM: PUBLIC BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO Exist: Exist: STORMWATER: YES NO Prop: 2 Prop: 1 AREA Plat Conditions Total: 2 Total: 1 Wetland Erosion Seismic Streams Flood Way Floodplain — Routing Date: F&W Landslide Shoreline Aquifer Forest: Commercial Rural Proximity , — Type Amount Paid By: Date: Receipt: A • ved/DateL ' Manufactured Homes $141.00 MAM 08/28/01 30325 Potable Water Application $30.00 MAM 08/28/01 30325 AUG 2 9 2001 Total: $171.00 DEPT.OF C N D :® MENT cif kiATI • a i JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST,_PORT TOWNSEND WA 98368 MANUFACTURED HOME INSTALLATION PERMIT APPLICATION ❑ NEW BUILDING T REPLACEMENT SIZE ‘A YEAR MAKE Xi GpJ���pQ a O COST • ��� �� BEDROOMS: BATHROOMS: pF EXISTING , EXISTING i PROPOSED PROPOSED TOTAL TOTAL TYPE OF SEWAGE DISPOSAL: WATER SUPPLY: 0 SEWER 0 COMMUNITY SYSTEM 0 PRIVATE WELL 0 TWO PARY WELL ;~INDIVIDUAL SYSTEM 0 ConventionalFUBLIC 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 1,feoid.—�� DATE -2?-O/ NAME (PLEASE PRINT) Ii/ydy J � - FOR OFFICE USE ONLY BASE FEE r RECEIPT# ) ADDITIONAL SECTIONS CASH/CK# SUBTOTAL DATE / ~ POTABLE WATER 911/ROAD APPROACH TOTAL H:\FiQ ME\PLNCNTR\FORMS\MOBILEAP.10/99 I C:-.3 co cD CO _..,I r r D' Q) t� ; 1 ' 1 '-'- cm ,.w a Cu NI- CCI v o I tk"a CO — 2 Lu > 03 Ca cam-, CD Nil g:EA w 3C = ID a W CO F— cCC o� C3 a _ c. ER = _ _ _ _ t Nit a. Li.,