HomeMy WebLinkAboutBLD2001-00160 N
itifiv.° JE�'�'ERSON COUNTY '017
„ „
DEPARTMENT OF COMMUNITY DEVELOPMENT n
4,,4111/1:* '� 621 Sheridan Street•Port Townsend • Washington 98368 MAR 2 2001
S'� 6� 360/379-4450 . 800/831-2678 • 360/379-4451 Fax
COUNTY
EFFERSON
•
DEPT. OFJCOMMUNITY DEVELOPMENT
BUILDING PERMIT SUPPLEMENTAL CONTACT
INFORMATION
Property Owner: Phone:
(if different from applicant)
Olympic Real Estate Development ( 360) 437-2101
Mailing Address:
70 Breaker Lane Port Ludlow, WA 98365
General Contractor:
Or Manufactured Home Installer: Phone:
Olympic Real Estate Development ( 360) 437-2101
Mailing Address:
70 Breaker Lane Port Ludlow, WA 98365
Contractor's State License Number: Expiration Date:
OLYMPRE010M8 6/1/01
Septic Designer: Phone:
N/A
Mailing Address:
Architect:/Engineer: Phone:
P Near
Mailing Address:
Loan Lender/General Phone:
Contractor's Bond Holder:
Parker Smith & Feek 1-800-457-0220
Mailing Address:
FOR OFFICE USE ONLY
Fire District: Planning Area: School District: Zone:
11
BLD SUPP CNTCT FORM.doc 1/31/01
�� Jefferson County Permit Cantor * Department of C1 uu y Bove�pn t
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Project Description: k), ! r,(!A- N. R 4t\y__ -i-o , , EF
Building Type: Project Type: rame Type: 1
Single Family 7 New 0 Wood
Garage Attached/Detached Addition Steel
Modular Alteration/Remodel Concrete
• Commercial ❑ Repair Masonry
• Multi-family/# of Units 0 Demolition E Other.
Industrial
0 Other
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: Existing: G Sewer :Community System Electricity 0 Oil
Proposed: Proposed: ` Individual System 0 Woodstove ❑ Propane
Total Total If not sewer,fill out the following: 17, Heat Pump
Conventional ❑ Altemative 2 Other
Permit # SEP
Water Supply:
Private well 2 Two Party Well 0 Public:Name of water system: , .. ...:a,
Square Footage: For Office Use Only
Main Floor 0.2/7sp19 N. - (2- UBC OCCUPANCY GROUP _
2ND Floor ‘,/7707Y{S —MM. g,SS Base fee qe3 . "j
3rd Floor Plan Check fee c 3 S. / 3
Htd Basement State Surcharge fee Li. S 10
Unhtd Basement Subtotal /0 3 , 3O
Garage/Carport Pot Water Review fee
Decks 911/Rd Approach fee - 9- "
Commercial TOTAL /(7 S-c, • 3r
Industrial ___ Receipt # _._ O _3 9
Other - Cash/Check #
Total Valuati _________ Initials
Or Date --S
Estimated Cost:
If within 200' of the Shoreline,
IDistance to Bank or Ordin, High Water Mark ft. Bank Height ft.
Signature: / Date• J�.. /