HomeMy WebLinkAboutBLD1982-00008 THIS BIS NOT
FINAL ED .
PERMIT WAS
CANCELLED
PRIOR TO RECEIVING ALL
INSPECTIONS AND HAS NOT
BEEN
ISSUED A CERTIFICATE
OF
OCCUPANCY
Ordinance No. 12-1203-12.
"Pursuant to this Ordinance, effective January 1, 2013, if your permit is less than five years old, additional renewals may
ive years from the
r
be approved at the current annual renewal rate. If your permit s older
n writingfto the building off�c al and must provideate of issuance, in ea
to be considered for an extension, you must submit a request
justifiable cause for an extension. Payment of all accrued renewal fees is required prior to approval of an extension."
R105.5 Expiration. is
Every permit issued shall become invalid unless thesuch
authorizeis suspended bpended ory such abandon d for commenced
of 180
days after its issuance, or if the work authorized by permit
days after the time the work is commenced.an 180 days building official
extension shalled to gbe requested in writing and
more
extensions of time. for periods not m
justifiable cause demonstrated.
R105.6 Suspension or revocation. of
The building official is authorized to suspend he basor is ofke ancorrert cts nacdcuraterohir�incomplete information,provisionsdar in
wherever the permit is issued in error
violation of any ordinance or regulation or any of the provisions of this code.
iiii°TV RtITT.1-3TT4C7;
Jefferson County Piannina and Building nenartmPnt
Courthouse, 3rd Floor
Pi, Box 1220
port Townsend ; WA 983E
206-385-q141
DATE TSST7r,n. -il7j7c,irs
2
PF.RTJTT #. . . . !BLUE-32-000R DATE
S T T F. AnnR ss , 1 7 1 OBB T NS R I) ----------------------
:NORnT.ANn; WAgR3Sr� ------------------ �n��,
(�wNFR--------STFVF,N ORACF.
MAT T,TNG AnnR 7 1 i i ROBB i NS Rn -----------------------
.NORF,T,ANn WA 9/1358 -----------------
CONTRACTOiR --NO CONTRACTOR
MATT,TNG AnTiR :
F.XpiRAiT7iv nATF.! -----------------------------------
CONTR . LTC St:
--
PARCFT, NO - . • 9i (T84i1i4i31 F:wi�i . TAX
T,F.0 AT, DF.SC . . ! STR 08_2q-
LOT • BLOCK
nRSCRTPT T ON OF T MPROVRMRN T ! single family --------------------------------
-Footing/Setbacks ;
i q(2:21
BUILDING PERMIT APPLICATION
Jefferson County Building Department• County Courthouse • Port Townsend, Wash.98368 • 385-1310
N �)
I. LOCATION: geographic name S W SIDE OF ►\d� rr%S �t ROAD awe/I' �' ('eFEET
ON E ^� p
W FROM INTERSECTION OF �I4i� 0r ROAD AND 4 -i-.'lo(tgh 2$14t ROAD
other specific location or landmark: /)/ 461/i�/r/9 4)'')( -1/2
LEGAL DESCRIPTION: Vi
Lot Block Subdivision
, )/(1721d bfu /01)0/-7/ , Aq N l5 cum
(in) 1)
j 7 / f Tax umber
'4 Se ion , Section Township Range
II.TYPE AND COST OF BUILDING 3 " 6J L to af�' //)/
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
X New building I'Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
❑Alteration
number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
❑Wrecking l_J Mobile Home
❑Moving (relocation)
❑Other-Specify ❑YES- X NO
❑Foundation only
OWNERSHIP USE
%Full-time Residence
NI Private (individual,corporation,
nonprofit institution,etc.) — ❑Second Home: Recreation Cabin,etc.
CI Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: >' ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
Nonresidential- Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing r
yl,a t h ] LOC-, X 3o 7:- 3 3 I So
c. Heating,air conditioning . i'J 1'9 i X ( ,- j _ I , ', 1 ' ,
d. Other (elevator,etc.) S 'i'�a 7( _e y S Li 7 ,9-
• TOTAL COST OF IMPROVEMENT $ S 21 Lt 4 f. ---- —�
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) *Number of Stories
❑Public or Private
Wood Frame •Total square feet of floor area,
gIndividual (septic tank,etc.) all floors,based on exterior
ED Structural steel dimensions '72 C?0ic
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
1 4 1'16
❑Public or private company
❑Other-Specify NUMBER OF OFF-STREET J
Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil Mei 5 jy 11 RESIDENTIAL BUILDINGS ONLY /)
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL
il Other- Specify kIGOOC c - Number of Full. . . . . . ..
S Qi�r bathrooms
Partial1.
IV. IDENTIFICATION-
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
1. Sreuek. S, ❑Orem #"" ---F9 44 t(', Narek(4 ., 4.s4, I b5'S elij35-(!s 3i3Sj646
Owner toil
f�,.4/7bI. . �,
�E'i�+se PI (jYfit� IOs-'t l"C.(,f /,J�r� e� � ..
2. 6C'Ct C TiciCl .. H(4.9141, • 64,444� t f)C, [ s /635--15 3 8 5--' G
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Address Application date
,,,ZWir..- a-, ..,4A,,z.4._e_Se.--_ * a. ri,411er 0). Air-Aiq,„( tkok. 1,635-x 1---6,--
a
PLANNING AREA ( FIREDISTRICTl SCH•• DISTRI£ C%'-� WATER DISTRICT
o APPROVED B�Yth ikevx 0Ai I 6Y�ME � , rj_G- �. ,.✓c7 °el
1.
., t (fit` _ -.
JEFFER ON COUNTY HEALTH DEPT ,� ', 'w
a.
I APPROVED BY: PERMIT FEE ISSUE DATE PERMIT NUMBER
a
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