HomeMy WebLinkAboutBLD2002-00210 • i MLA02-00198
Review Type:1
MANUFACTURED/ MOBILE HOME INSTALLATION APPLICATION
Jefferson County Department of Community Development
621 Sheridan Street Port Townsend, WA 98368
PERMIT #: BLD02-00210 Received Date: 4/12/2002
SITE ADDRESS: 100 MUNCIE AVE
QUILCENE, 98376
APPLICANT: CATHY E CARLILE PHONE: (360)765-3241
PO BOX 352
QUILCENE WA 98376-0352
SUBDIVISION: QUILCENE Block: 8 Lot: 1-3+
PARCEL NUMBER: 991200801 Section: 24 Township: 27 N Range: 02 W
CONTRACTOR/
DEALER:
REPRESENTATIVE: WENDY WARD
1267 CEDAR ST
PORT TOWNSEND WA 98368
PROJECT DESCRIPTION: MANUFACTURED HOME INSTALLATION
TYPE OF WORK MOB MANUFACTURED HOME: SHORELINE:
TYPE OF IMP NEW MAKE: BELMONT SETBACK:
VALUATION YEAR: 1980
LABOR & INDUSTRIES APPROVAL?
SIZE: 14 X 66 BANK HEIGHT:
SEWAGE DISPOSAL: CON
WATER SYSTEM: PWELL
BEDROOMS: BATHROOMS: PARCEL TAGS: YES NO
Exist: Exist: STORMWATER: YES NO
Prop: 2 Prop: 2 AREA Plat Conditions
Total: 2 Total: 2 Wetland Erosion
Seismic Streams
Flood Way Floodplain
Routing Date: _ \ _c �,, F&W Landslide
Shoreline Aquifer
• i n..
r
Type Amount Paid By: Date: Receipt:
Approved/Date
Manufactured Homes $141.00 MAM 04/12/02 46335
Potable Water Application $30.00 MAM 04/12/02 46335
Total: $171.00
•
JEFFERSON COUNTY COMMUNITY DEVELOPMENT 621 SHERIDAN ST, PORT TOWNSEND rWA' 98368
MANUFACTURED HOME INSTALLATION PERMIT APPLICATION
❑ NEW BUILDING �] REPLACEMENT
SIZE �L�_
YEAR ---�c` -- n,
MAKE -- e
COST — — --- — — MlL
BEDROOMS: BATHROHRO OMS:
EXISTING 3_- EXISTING r 5 ,,Y
cV
PROPOSED PROPOSED ELOPMENT
_, ' � OEPT. OF�CO'�ti�� '� -
TOTAL _; _— TOTAL _� .J
TYPE OF SEWAGE DISPOSAL: WATER SUPPLY:
❑ SEWER 0 COMMUNITY SYSTEM X PRIVATE WELL 0 TWO PARY WELL
ja INDIVIDUAL SYSTEM Conventional 0 PUBLIC
PERMIT#SEP 0 Alternative Name of water system: ____ _ _ - _
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGH WATER LINE ' ft BANK HEIGHT__11/4%')/�—_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_— „0k v bLA-U
NAME(PLEASE PRINT)—_—C.,O. \1\V� _ 0_(vl� I v
J
OR OFFIC USE ONLY
BASE FEE 1;‘ ' ( ) RECEIPT# 5
ADDITIONAL SECTIONS L, CASH/CK#
SUBTOTAL I !�1 : DATE J1L'7c_ v
POTABLE WATER 3O_r_Q 6
911/ROAD APPROACHK
— pi,` .. d
TOTAL
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