HomeMy WebLinkAboutBLD1991-00065 tt •
LOCATION
SPECIFIC LOCATION' SITE ADDRESS r L9 ' (JLr/^P15 , VDl-/L�' /CJQL6jL)
POSTAL DISTRICT 21 /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
)g, SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR / 2,0. SU
❑ MOBILE HOME 0 ADDITION 2ND FLOOR 45/D, SD 44 •
❑ MODULAR HOME )4 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES (f�
❑ INDUSTRIAL SIZE a Silo
❑ HOTEL/MOTEL/DORMITORY YEAR a $20
NUMBER OF UNITS MAKE @ $10
❑ OTHER - SPECIFY ESTIMATED COST OF (� @ $10
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP
SELECTED CHARACTERISTICS OF BUILDING
PR CIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME [L��'/ CTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTALAND JAAE29
0.
e /
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED. BEDROOMS 3
❑ P1�8L 1 C OR PR(I VATE NUMBER OF EXISTING BEDROOMS
N D I VI I D UA L ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 I ND I V!DUAL WELL NUMBER OF EXISTING BATHROOM/
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
'
APPROVED DATE
PRIVATE ( NAME OF WATER SUPPLY �..,,,., 'y
PLANNING DEPT, WES SA F NAE DJJUAREITCTION
WATER BODY
Gii ( %❑ NO / is l
APPROVED DATE BANK HEIGHT /I) 13( � )- SETBACK Z( t(-"PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH - A��'JlL'dlc `
NAME OF PUBLIC ROAD /
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
En
/fC
) 4 n/17 3 4 �) /,J4. 4 9'37 a
N t 9/i4•AI �4./u' ,'2-,x4li TATE L/gr.'
�1`kNt- r c.i,,.) Pnv1- � �
S .)19. .18371) 771-1s3°
IP4A 0,E4. •' HFE * J J t t eilniv-A-1s6/ ,
IEfi OF THIS BUILDING 0 THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
OF APPLICANT APPLIC TIO DATE RECEIPT NUMBER CHECK NUMBER OR CASH
PROVED B PERMIT FEES
BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE
TOTAL
,
DATE ISSUED
REFUND DATE T
911 NUMBER
DING OFFICIAL.
4
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_TF:F wF R z c NT CnC)tT1\T9''Y R1:7T T.T)T 1\TC; 1 F.RTv=T 'V
JPffPrson County Planning and Building apartment
Courthouse, 3rd Floor
PO Box 1220
Port TnwnsPnci . WA 9R.R R
206-3A5-9141
PERMIT # •RT,T)91 -OOHS T)ATF TSSTJFT). -03/OFi/91
STTF AT)T)RFSS ! 20Fi OT,YMPUS RT,VT)
•PORT T,TJT)T,OW, WA 953F5
OWNER •RAYMONT) RRTJMMFT, PHONE.' 437-96R4
MATTSTN(; AT)T)R , 20Fi OLYMPUS RT,VT).
-PORT T,tIfT,OW WA 95365
CONTRACTOR . . !NTFMAN CONSTRTJCTTON PHONE! 779-7530
MATT,TN(; A DR! 2 10 N F. F.RTCKSON LANE
POTJT,SRO WA 98370
CONTR. IC #!NTFMAC*1 50KP FXPTRATTON DATE ! 03/30/91
PARCFT, No., . . ! 975900029
LEGAL T)FSC. . -STR 04-2 R-01 RWM. TAX #
LOT BLOCK OT,YMPTJS BEACH
T)FSCRTPTTON OF TMPROVFMFNT- remnde l of existing single rPs i c9ent e
) Fontincg/Setbacks (Shoreline Sethack) /MohilP Home Blocking!
( ) Foundation
( ) Underground Plumbing/Underground Tnsuiation !
( ) Framing/Plu hina/Chimney-
's Insulation : 3/} q/
) ShPPtrnck ' A/d/ b a cI 3/ - J91 0/1—
( ) Sewage Disposal System Final :
( ) Final /Occupancy Approval :
/� z ;
�NroL f or
CALL 385-91 41 24 W)TJRS TN ADVANCE TO SCHEDULE TN. PFCTTONS.
Office Hours 9 a .m. to 5 p.m.
Inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Tnsnect i ons.