HomeMy WebLinkAboutBLD2001-00594 •
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 #: BLD01-00594 Received Date: 10/18/2001
SITE ADDRESS: 381 FARNSWORTH PL Issue Date: 10/29/2001
SEQUIM, 98382 Expiration Date 10/29/2002
APPLICANT: MICHAEL STOPPANI
381 FARNSWORTH PL
SEQUIM WA 98382
SUBDIVISION: Block: Lot: T 13
PARCEL#: 002283012 Section: 28 Township: 30 N Range: 02 W
CONTRACTOR/ OWNER PHONE:
DEALER
PROJECT DESCRIPTION NO MLA REQ'D -ON PRPTY SINCE 1984- MAN HM TITLE ELIMINATION
MAKE: REDMAN
YEAR: 1984
SIZE: 48 X 26 :`°
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 10/29/2002.
REQUIRED INSPECTIONS:
[ Setbacks: B E--- I tA 3 ( I P k
[ ] Footing(Ifcontinous footings are used):
[ locking/Plumbing: -o e /19(3( O 1
[ Final/Skirling/yea /Porches/Steps: &/ if U(3' /ô- < 1 rw•t.p t cc : a K_
HEALTH DEPARTMENT APPROVAL REQUIRED PRIOR TO FINAL INSPECTION �� -/1/ 1---trtv„
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
I
r Review Type:
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD01-00594 Received Date: 10/18/2001
SITE ADDRESS: 381 FARNSWORTH PL
SEQUIM, 98382
APPLICANT: MICHAEL STOPPANI PHONE: 797-8720
381 FARNSWORTH PL
SEQUIM WA 98382
SUBDIVISION: Block: Lot: T 13
PARCEL NUMBER: 002283012 Section: 28 Township: 30 N Range: 02 W
CONTRACTOR/ OWNER PHONE:
DEALER:
REPRESENTATIVE:
PROJECT DESCRIPTION NO MLA REQ'D -ON PRPTY SINCE 1984- MAN HM TITLE
ELIMINATION
TYPE OF WORK T.E MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: REDMAN SETBACK:
VALUATION 52,000.00 YEAR: 1984
LABOR & INDUSTRIES APPROVAL?
SIZE: 48 X 26 BANK HEIGHT:
SEWAGE DISPOSAL:
WATER SYSTEM:
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
STORMWATER: YES NO
Exist: Exist: AREA Plat Conditions
Prop: Prop: Wetland Erosion
Total: Total: Seismic Streams
Flood Way Floodplain
Routing Date: F&W Landslide
%�- � A.C.--- Shoreline Aquifer
Forest: Commercial Rural
Proximity_ , __._ _ —
Type Amount Paid By: Date: Receipt: AF'740Wf/Date LID
Manufactured Homes $141.00 MAM 10/16/01 42161
Potable Water Application $30.00 MAM 10/16/01 42161 oe I 2 9 2001
Total: $171.00
RSO 0 1
DEPT.OF UN D PMENT
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 62;, SHERIDAN ST, PORT TOWNSEND WA .98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
NEW BUILDING ❑ REPLACEMENT
SIZE X GOO ALNn00 NOS83d33P
YEAR / /g9_ e�
MAKE /`�C/)/11/711/ low.6E- /C 7 �'�R r 7 S ` 130
COST axiki/Ow41
BEDROOMS: BATHROOMS: `-+ Aklj+ r
EXISTING EXISTING �C
PROPOSED PROPOSED
TOTAL TOTAL
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER 0 COMMUNITY SYSTEM 'PRIVATE WELL 0 TWO PARY WELL
INDIVIDUAL SYSTEM XConventional "PUBLIC
PERMIT # SEPgfJ 3 ❑ Alternative Name of water system: ='1.SiWit 24-Tl.YA/
IF WATERFRONT PROPERTY, c5 �i /e C"CJ/�'I f�/SIN,
DISTANCE TO BANK OR HIGH WATER LINE N/i/ 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 _ .et- -, awn! DATE /0 6 `-`a160l
NAME (PLEASE PRINT) /17/C///9 �, jj C .. 5r9f P/9A1/14=74 c-6-
't) sTp/,l9/V'/
FOR OFFICE USE ONLY
BASE FEE C b' RECEIPT# Il(
ADDITIONAL SECTIONS -•/ • CASH/CK# Lf
SUBTOTAL / t° C� DATE
POTABLE WATER
911/ROAD APPROACH
TOTAL "7/" U
H:IHOMEIPLNCNTRI FORMS IMOBILEAP.t O/99
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* ' .n.. PLEASE MAIL TO:
r
, JEFFERSON COUNTY ASSESSOR
JACK WESTERMAN III JEFFERSON COUNTY COURTHOUSE
ASSESSOR y to 1 ' PO BOX 1220,PORT TOWNSEND WA 98368
������� DCVi (360) 385-9105
MOBILE I-1O FORMATION FORM
J�
OWNER'S NAME / MAILING ADDRESS: THIS IS NOTA TAX STATEMENT
NAME:/n,re- 5 TOPPf3/v//E/LE Ei .S%Z)PP/9ml The purpose of this questionnaire is to obtain information
regarding either the current location of a mobile home or the
ADDRESS: 6 c71 /Pt A /'LA C previous ownership and location of a mobile home. This will
help our office determine whether the mobile home is already
5 &c LJ/!°n ./ 9 S38a2 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: (360 5402 — g 7gc,- additional information.
S O'r- /'gr7-/3 C h`r 2 AW9 L ,RC2/ rY T 1'4, 44i
1) MOBILE HOME DATA: / P� Y. t�
(A) MAKE g� 1P/Y)/ A (B) MODEL / G E/�C / (C) YEAR / !3 Cf
(D) LENGTH 4 e (E) WIDTH 41: (F) SERIAL NUMBER //cg//333
(G) YOUR PURCHASE PRICE(DO NOT INCLUDE SALES TAX)4so), 000 (H) PURCHASE DATE o) —/5—/99
(LA N72 1` /-/t)/Y1 E)
2) PREVIOUS OWNER / LOCATION OF MOBILE HOME: /�
(A) FROM WHOM DID YOU PURCHASE MOBILEj?Av) �'/C1y SUE C,i9VBE/r&ER
ADDRESS 38/ FilkA SLt)ZWTH ,4 E/ SE i o/nj /t.,� ye g6
(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/ I ril AA=s'w-' T1! PLAC( S E'CO/in
w/9 �9S38Q
3) WHERE MOBILE HOME IS-a$-B6 LOCATED: Ica /;_
(A) WILL THE MOBILE HOME BE IN A MOBILE HOME PARK? YES NO
(B) IF LOCATED IN A MOBILE HOME PARK:
NAME 8i ADDRESS OF PARK AIM SPACE NO.
(C) IF NOT LOCATED IN A MOBILE HOME PARK: / /�
NAME OF LAND OWNER: /DAU/� t- j//(Jt7 SDE 6-Pflu EA6- R
LOCATION (ADDRESS)r 3/ FA/2NScc..;3Dg7t/ PCPC&" .S6-et Cl//Y3 L.t>/A 7$3t
REAL PROPERTY PARCEL NUMBER/DESCRIPTION CO* ,a2 2'3 0 Ica —'THE/vOQ77t ..)toFie i of i NE
.tfISl 3asFEET oFi/f6 WEST,2/83 FE6-7er THE/VOP7,7///ACrOF IHE sic) avARTEk'
t7/=SEc770A) g/ *TocoAiS/1/P3o NceJ?/1 ,C/3Nt�,Edit E$7 w,in /N ✓7P EASMN
C to/V y, /9Sti,/t/�%On/ 4
THANK YOU FOR YOUR HELP! - `��,1j `6 iJc
/ / SIG ATURE
'iRSON, roperty Technician
THIS FORM CONFORMS TO THE STANDARDS OF THE STATE DEPARTMENT OF REVENUE AND IS SUBJECT TO AUDIT VERIFICATION.