HomeMy WebLinkAboutBLD1989-00036 r
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F F 'F.RSC)TV' CTCiTIi'1TV RYTT T•T)T F'F.RTVIT 'T'
.T ffersnn County Planning and Ruilding Department
CnurthnusP, 3rd Flnor
PO Rnx 1220
Port Townsend : WA 9836R
206-385-9141
HATE. TSSUF.n. : 05j05fR9
PFRMTT # •BT�nR9-003f
STTF. ADDRESS: 21 DFFR RTDGF
:PORT TOWNSF.Nn, WA 9S35R
PHONE.: 3H5-4057 OWNER • T, R . RTNGRRTNG
MATT,TNC; ADDR :PO BOX 192
:NORfT,AND WA 9R35R
PHONE:
CONTRACTOR _ . :NO CONTRACTOR
Tv1ATT,TN(; AnnR :
CONTR . LTC #: FXPTRATTON DATE.:
PARCEL NO . . . . 001292004
T,F.GAT, DRSC _ . : STR 29-30-01 WWT+1; TAX #
T.OT RT,OCK
DF.SCRTPTTON OF TMPROVFMFNT : singiR family rpsinence
( ) Fnnting/Setbacks (Shoreline SPthark) /Mnhile Home Rlncking
( ) Foundation :
( ) Underground Plumbing/Underground Tnsulatinn :
( i Framing/Plumbing/Chimney:
( ) Tnsulation :
( ) ShePtrnrk :
( )
Swag Disposal System Final :_
( Final /Occupancy Apprnvalc 104 /
C,AT,T, 3R5-914.1 24 HOURS TN ADVANCE TO SCHEft1T,F. TNSPECTTONS .
Office Hours 9 a .m . to 5 p.m.
Inspector ' s Hours 9 - 10 a .m .
24 Hour Recorder for Tnspec.tions .
BUI",G 'FRMIT APPLICP,TION
Jefferson County Building Department*P . O . Box 1220 @PoriTownsend , WA 98368'
LOGAT I ON _ a o '�.
SPECIFIC LOCATION SITE ADDRESS. - -- •
POSTAL DISTRICT, Pl- /SUBDIVISION
LEGAL DESCRIPTION LOT B - BLOCK DIVISION TAX NUMBER
PARCEL NUMBERn einivizA0-a m1 i SECTION -I9
p
PLANNING AREA SECTIOI& 29 TOWNSHIFV3OM NORTH RANG ( rt . / W. .NM
BUILDING INFORMATION
UILDING TYPE T E OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY EW BUILDING MAIN FLOOR IH'JC)C�
MOP ILL HOME ADDITION 2ND FLOOR ( � .
❑ MODULAR HOME ❑ ALTERATION BASEMENT IQ(QO
El CARPORT DETACHED/ATTACHED ❑ REPAIR GARAGE p)(-)GARAGE ❑ REPLACEMENT
❑ WOODSTOVE ❑ WRECKING/ DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES Jj�J /�
❑ COMMERCIAL SIZE 11 ''ff)� ,{ $ 35 ( h(')C)
❑ I NDUSTR I AL YEAR I I'[ W p1 $ 1 6 (,, j /�v '
❑ HOTEL/MOTEL/DORMITORY MAKE ���i IA a $8 1'ZR&
NUMBER OF UNITS �Q� � $8 (�) 1� b
❑ OTHER - SPECIFY ESTIMATED COST OF �I
n IMPROVEMENTS _4 TOTA1,.%,7 FAIR M RKET VALUE
UBC OCCUPANCY GROU $ $ f "
SELECTED CHARACTERISTICS OF BUILDING
) WOOD PRR CIPLE TYPE OF FRAME
FRAME PRINCIPLE TYPE OF HEATING FUEL
lil ELECTRICITY ❑ COLLECTIVE SOLAR
LST MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
/0 OIL ❑ OTHER - SPECIFY
❑ REINFORCED CONCRETE --
❑ MASONRY ( WALL BEARING ) DIMENSIONS S
❑ OTHER - NUMBER OF STORIES 2 TOTAL LAND AREA . wly-
DEPARTMENTAL 'REVIEW v
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
4010 [] PUBLIC OR PRIVATE NUMBER OF EXIST IPIG BEDROOMS
1 ND 1 V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM,.2��
APPROVED DATE ;1 I ND I V I DUAL WELL NUMBER OF EXISTING BATIK
PUD TYPE OF WATER SUPPLY
(:3 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 'APR I VATE ( NAME OF WATER SUPPLY zi A"n �
PLANNING DEPT . WITHIN SHORELINE JURISDICTION .��7�
❑ YES NAME OF ADJACENT WATER BODY
X NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD /
NAME OF PRIVATE ROAD SA"-^- S f-em c1
. - --way
APPROVED DATE
ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
1.. MAILING ADDRESS ZIP TEL NO
NAME } �p �yq
OWNE L. Z. �1L 1�.1': r.I f?3, a,X 1 / ..Z ��yt Y����L i� � (h�.SY / Q�'� 3 � [�
xt3
cowl-: _cr. „-,-¢, 1 �. s v.
A f
RCH
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
(GNAT RE OF APPLI, NT APPLICATION. DATE RECEIPT NUMBER CHECK NUMBER OR CASH
rf 1' _. .`,1, .i / PERMIT FEES
l ry6, ."50 BASE FEE I NSPECT I ON
1 3 1, 50 BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY
PLANNING&BLDG DEPT $/ �l(J C ENERGY SURCHARGE S(Oci n( TOTAL
I 0 ) ' 9I1 NUMBER REFUND DATE DAT ISSUED
BUILDING OFFICIAL Cl l l-.� _ .
.(o / /D . 57
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