HomeMy WebLinkAboutBLD1990-00002 eILDING Y 'ERMIT APPLICATION
Jefferson County Building DepartmentoP .O . Box 122 Port Townsend. WA 98368
OCAT 0 '
SPECIFIC LOCATION SITE ADDRESS „7 -7c1-_(_./r � -, 4 -
POSTAL DISTRICT �}-�- /SUBDIVISIOII
LEGAL DESCRIPTION LOT •OLOCk
II.
DIVISION TAX NUMBER .
/ PARCEL NUMBER a.� 1 / 4 SECTION qq^�
PLANNING AREA ( / SECTION)TOWNSHIP_NORTH RANGE l4'l� WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT QUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING M' IN FLOOR
❑ MORILE HOME ❑ ADDITION 2ND LOOR
❑ MODULAR HOME ❑ ALT-ERATION BASEM T
❑ DETACHED/ATTACHED PAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION I COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
1 LE HOMES @ ddd/
❑ COMMERCIAL ' SITE ,� p40
❑ INDUSTRIAL YEAR '�}'//$20
❑ HOTEL/MOTEL/DORMITORY MAKE /0� $ 10 \\
NUMBER OF UNITS \ i
• OTHER - SPECIFY ESTIMA DCOST a $10
::�=�:.7/L.//L AV __
EMENTS
TO AL FAIR MARKET VALUE
UBC OCCUPANCY . 0U ° _ ;
SELECTED CHARACTERISTICS///,OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
' ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
.��iHEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
-_ti ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED'--DATE ❑ INDIVIDUAL WELL _ NUMBER OF EXISTING BATHROOM
PUD _ TYPE OF WATER SUPPLY
D-. .PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
— PLANNING DEPT . WITHIN SHOREL,I_NE` JURISDICTION
❑ YES NAME--"OF JU) IACENT WATER BODY
❑ "
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS • PT ROAD RIGHT-OF-WAY WIDTH -
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
ROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
---
IDENTIFICATION _
NAME ■ ING ADDRESS ZIP TEL N•
OWNER �O 1 _Miff
m .
CONT I.� IL•0 -)CJ R L c) 0_____Im
..monowilio I.. limmassioas -ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
' ST71ATURE/OF 44 P7I ANT APP i T 1 O ATE I PT CH
NUMBER F,C,K, B
Y\'''''' N ER OR CASH
1 �l
APPROVED rY P RMIT FEES
'. _ ' BASE FEE INSPECTION
,'�/�. ` �� BLDG SURCHARGE ` PLAN CHECK
.1,1k;„,2 64477)�•. �` ENERGY SURCHARGE �(� TOTAL
r' ' 'FU E Ifr _ 911 NUMBER REFUND DATE DA E ISSUED
BUILDING OFFICIAL CIS / 96
i •
_T 1~:F•F'F..RSC7N C:C)TTTS'TV WC TT T.T)T NCB AF11=IT• 1- C: ATT ()TT
Jefferson County Plannincr and Building Department
Crnrrtnoiise, 3rd Floor
P0 Box 1220
Port Townsend , WA 98368
2n6-3A -9141
PF.RMTT # •RLfl90-0002 flATF CF.TVF.fl. - 01 /02 i 90
STTF. AflflRF.SS - :3520 RHOT)OT)FND T)R
-HArr,OCK. WA 98339
OWNRR •RTCT•TART) OT.SON PHONE '
MATLTNG AflflR - 3544 RHOTOflF.NflRON DRTR
-HAflLOCK WA 95339
CONTRACTOR. . -RON PUPAS PHONE -
MATLTNG AflflR- PO BOX 603
-CHTMACT)M WA 98325
CONTR. T.TC #7RONALFP150KN RXPTRATTON DATE. - 05/15 /90
ARCHTTFCT/ . . - PTONE•-
flRSTGNF.R
MATT,TNC AflflR -
PARCFL NO . . . - 942903705
LEGAL T)F.SC . _ - STR 03-29-1 F.WM, TAX # 123
T,OT , BLOCK
flF.SCRTPTTON OW TMPROVFMFNT - chimney repair
RT1TLDTNG TVPF. •NON RFT)ROOMS--- BATHROOMS-- MATN FL. . . . 0 sf
TVPF. OF TMPROVF.MFNT ! RF.P FXTST . - 0 RXTST_ - 0 2NT) FL. . . _ - 0 sf
CARAGF/CARPORT PROP. . - 0 PROP. . - 0 3RT) FT. 0 sf
WOOT)STOVF. TOTAL . ! 0 TOTAL . ! C) BASFMFNT. . . 0 sf
TTRC OCCUPANCY GROT1P7 SFWAGF. OTSP. . 7 CARPORT . . . ! 0 sf
TYPE OF CONST WATER STTPPT.V. - GARAGE. 0 sf
TTNTTS. - 0 STORIES - HEAT TYPES . - 1FCKS 0 sf
flTMF.NSTONS ! MORTT.F TTOMF COMMF.RCTAT. : 0 sf
FRAMF. TVPF:WOOT) MAKE.! YR r TNflTTSTRTAT,c 0 sf
F.ST COST . $ - 100n STZFr
PROJ GRP. _ - 166
Owner/agent FRRS
Signature! type amount by date racnt
PRMT $ 25 .00 MKG 01 /02/90 43475
flatec R.C . $ 4 . 50 MKG 01 /02 /90 43475
Issued Ry-
Date - yziet
29 . 50 TOTAL
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