HomeMy WebLinkAboutBLD1980-00432 BUILDING PRMIT tPPL� ATI(3N 34Z
Jefferson County Building Department• CYounty rjourthouse • Port TownsenH;Wash.98368 • 385-1310
N E !�
)CATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND `n ROAD
other specific location or landmark: al l Am�`3�fl r"P c°V lc t l Ve. 6r C', ca`
LEGAL DESCRIPTION: 11 0fs)c-c 1 \� d
Y1r�% \A 5`=13 A,f L9 N\
Lot Block Subdivision
cc2,2453037 -Z.-z38 —aa' S"c v —2 3 13 ' 2 w t e4.
Tax Number '4 Section Section Township Range
II. TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
VENew building ❑Single Family
❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Repair,replacement Li]Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking (�Mobile Home
❑Moving (relocation) 0 Other—Specify ❑YES- ❑NO
Foundation only
OWNERSHIP USE
Full-tirne Residence
Private (individual,corporation,
nonprofit institution,etc.) CI Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included — school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing
c. Heating,air conditioning
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $110,C. ,..)
III.SELECTED CHARACTERISTICS OF BUIILLDINNG' -
PRINCIPAL TYPE OF FRAME T`T E OF SEWA E DI O&L DIMENSIONS
'•Number of Stories I7 Masonry (wall beari
❑Public or Private —
•Total square feet of floor area,
Frame
❑ k Individual (septic tank,etc.) all floors,based on exterior ,^� .
❑Structural dimensions .e 0 x b
❑Reinf ced concret TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other--Specify ❑Public or private company
�l NUMBER OF OFF-STREET
X Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY 1 C-L10vy.•••S''k'
1$4..Flectricity Number of bedrooms ,. c��tINV
❑Coal TYPE OF MECHANICAL �f
Number of Full
❑Other--Specify bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel. No.
1. I-Ok t 11 "ryr 1S, 31/ Jt.., 5fi, _5-3,�—
Owner r F.5-5
�1J�-ea �-c� Y'Yt es"�`E'_, i"� o g Ct wF�_C�'_� C6,/ Y/77
2. U i c_ ,,AANA
Contractor State License No.
U j l -'CI .e-- I
3.
Architect
The owner of this building 'd the undersigned agree to conform to all applicable laws.
Signatu e of ap cant Address Application date
oe ,IFC i a � lam``$
a
PLANNING AREA DISTRICT .5
_ SCHOOL DISTRICT ' -3 WATER DISTRICT
3 APPROVED BY
\
JEFFERSON COUNTY HEALTH DEPT\\ ) \ �,5
APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
-.1
('. % j:), g-.4:.- ,e 0 4....51 \5---i ,2.-?-0 41 LC 7
1 D G OFFICIAL
4
.
-p,arv;n y „re-a_
(..,,,,,..
in0b., le,
ooci
.\ 74A"Neri
t,/
\'' \ ._
40.
F \\i IP t) ,�'5• l,Na co
vw
(0 1 - id.
N0 1pa,, <, .N( i
o I .l
S L C eS.1, a Y y
« 4
Manufactured Home:
Year 1981 Make MODULINE/ Width Length
WESTWIND
Vehicle;,Identification Number 6929
Registered Owners:
DENNIS P. SCHOSBOEK and
Names EMMA M. SCHOSBOEK Signatures'
Legal Owners:
Names U.S. SAVINGS BANK OF WASHINGTON Signatures'
'SIGNATURES OF OWNERS INDICATE TERMINATION OF INTEREST IN THE MANUFACTURED HOME THROUGH TITLE PROVIDED BY CHAPTER 46.12 RCW AND
INDICATE INTENT TO PERFECT INTEREST IN THE MANUFACTURED HOME AS REAL PROPERTY WITH THE LAND HE/SHE/THEY OWN AND TO WHICH IT IS/IS
BEING AFFIXED.
2 I 1 U Lt 6,11_C eN Qom+-C ,. g.A
Land to Which Manufactured Home is Being Affixed: I� w n.
Property Tax Parcel Number 002-238-021
Legal Description SKr, ATTACHED
DENNIS P. SCHOSBOEK and
Owners', Names EMMA M. SCHOSBOEK Signatures2
'SIGNATURES OF OWNERS INDICATE CONSENT TO HAVE THE MANUFACTURED HOME ADDED TO THE REAL PROPERTY LISTED ABOVE.
Building Permit Office Certification:
I iry AJ 'Fo'tFetr9)1pEP certify that the manufactured home has been f described above and/or building permit
number has been issued for the ur f affixin the manufactured home to the land and will be
inspected upon completion. 8 199
Zo 3Q r—
NAME - - SIGNATURE L T I DATE PHONE N MBER
County Auditor/Agent Licensing Office Approval: (Not for use by subagents)
I certify that the above application appears to have been completed correctly, and that the applicant has sufficient
documentation to proceed with the recording of this form.
NAME SIGNATURE OFFICE/CAAP OPERATOR NUMBER DATE
Recording Office:
I certify that this form has been recorded in the county records.
NAME SIGNATURE COUNTY DATE RECORDING NUMBER
Note: Every person who falsifies or intentionally omits material information required in an affidavit is guilty of a gross
misdemeanor punishable in accordance with RCW 9A.20.021.
TD-420-730 MFG HOME TITLE ELIM IN/1/90)Page 2 of 2
: ..
. *
,.
,
- - Jr-,=-,- , ,,,.„,,,6...7,,,e..,,, ,-- azi a 74-P..., — ' . p e o.ei:.,p.,,,,-i„, ,,-, , et„„.. ..4,.'VIAseileVic,...4..S / ,
.t.
,
e`:el, we..6..",.../..m.,, .. T',„41' ,,,,$ Pe 4.;11,1,,,, ,,, , ' 4,,,, --4.,/o. p I -
IC. 0.7. ,f7; ,,.
.;-/ 'A ..., "- ' •
"2-e-/--- p-S-5--eq/^,.. &---;,„7—4).,
,-----
S :
CKI' -Ckevie{ -3.- r J-r---ev...r
/49\r--)i:' (1--;- .• =a-
e1. ii24
/ti 9/
(--
6 c-- (I-
44-1"-e-4171 --rmicri-574.1
„ode
------i-c) ,,.
„----------1
//,,4--,
d.-
'1/5/4i fli% 7; Jov;
ilifai)
IL e.k--
.. :'