HomeMy WebLinkAboutBLD1999-00067 0 •
Jefferson County Permit Center * Department of Community Development
^�150N C
', i;; G,. 621 Sheridan Street,Port Townsend WA 98368(360)379-4450
.P.14-7:%V DErMi? A_, ,Thr
0
„sri,i,,,,,. u ,p, 0 C d i go
Project Description:
Building Type: Project Type: Frame Type:
X. Single Family ❑ New X Wood
❑ Garage Attached/Detached : Addition ❑ Steel
❑ Modular -a( Alteration/Remodel ❑ Concrete
❑ Commercial ❑ Repair ❑ Masonry
❑ Multi-family/# of Units ❑ Demolition X Other._k!L)i7 c ref e
❑ Industrial
El Other: 'Fotin..det iio//
Bedrooms: Bathrooms: Type of Sewage Disposal: Type of Heat:
Choose one:
Existing: o2. Existing: ❑ Sewer :Community System ❑ Electricity 7.Oi1
Proposed: Proposed: ❑ Individual System 1*Woodstove ❑ Propane
Total: s? Total: If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional ❑ Alternative ❑ Other
Permit # SEP
Water Supply:
❑ Private well ❑ Two Party Well X Public:Name of water system: Per f I c c&i"i s eA d
Square Footage: For Office Use Only
_
Main Floor UBC OCCUPANCY GROUP Z��
2ND Floor Base fee ( I 1 '
3rd Floor Plan Check fee o \,
Htd Basement _^ _ State Surcharge fee Li , ---'0
Unhtd Basement Subtotal k 3 0 -Cl
Garage/Carport - e- - Pot Water Review fee c ,,)-
Decks 911/Rd Approach fee
Commercial s TOTAL ‘ ' O\- a 3
JIndustrial \ Receipt # \U k0-1 t j
Other Cash/Check # 3 1 ,.G ,
' ��Total Valuation: .� Initials
Or Date - -q°k
Estimated Cost: �° ��
If within 200' of the oreline,
Distance to Bank or Ordinary ' fer Mark ‘ 3 ft. Bank Height / 713 ft.
t-'
1I n
Signature: ,2( L f /j4 7.7-, / I
s ca l Date: 99
III
JEFFERSON COUNTY BUILDING APPLICATION
Jefferson County Permit Center
Castle Hill Mall
621 Sheridan S. .
Port a_l. 1uwn'"Jeia. i, WA 98368
360-379-4450
PERMIT #
_vt'10�6 DATE RECEIVED. : 02/08/99
SITE ADDr SS : 1431 I O iAL-
RD
: PORT lAL'LVt...n., WA 98339
APPLICANT. . _ :LOHN VAN ACKEREN PHONE : (360) 385-0446
MAIL INUG Asti; < :PO BOX 113c
:PORT HA LOC==K WA 9 M$3
..,;�j rvrr,l.,-, �
C__ TRAi T OR. , : 0 v.3 h C - ZU.` I-IC- PHONE :
MAILING ADDR:
CONTR. LIC # : EXPIRATION DATE:
ARCHITECT;„: PHONE :
DESIGNER MA I L I NG ADDR:
PARCEL ?'O : 901021009 Landslide Plat ("end Wetland Flooding
LEGAL DESC:STR 02-29-01 W WM eismic Streams Erosion F & W
LOT ; BLOCK , TAX #26 Shoreline Aquifer
Area Com. Forest : Adj . 300 '
DESCRIPTION OP IMPROVEMENT: � tV�_�t_ __i �- er� ,1., il o ♦�Sv� �e (basement)
di:.. �LLL�Jii� iLt:.Jw...t ... residence ....a��.�.L6i�..i1' )
BUILDING TYPE •RES BEDROOMS--- BATHROOMS MAIN FL . . . : 0 sf
TYPE OF I iPROVEMENT:_A_L EXIST. : 2 EXIST. : 2 ADD 7 L FL, . _ i0 sf
GARAGE:/CARPORT `ROP 0 PROP. . : 0 uTED BSM- . : 0 sf
WOO STOV E TOTAL. _ 2 T O SAL. : 2 UNHT BSMT. : 0 sf
BC OCCUPANCY GROUP: SEWAGE D SP. . OTHER, _ „ : 0
rq+ _ �TPry �v T� S�
vD. OF CO ST WATER S1/ PLi . :CIT- R T j. AR. . : 0 sf
UNITS . : 0 STORIES : 0 HEAT i P S . :WOD%OIL/ DECKS 0 sf
DIMENSIONS : COMMERCIAL: 0 sf
FRAME TYPE:CONC INDUSTRIAL: 0 sf
SST Lu-1 f4 _ _...nn f feu irl 170 fL
PROJ GRP. . : 6735 SH SETBACK: 60 ft
(Wi r!acn®t FiRRc
Signature : 2r
I Y irD c amount by date r J _c.
P MT $ 97 . 25
RAC 02/08/99 0671
PLCK y, L.9 . .LL"i RAC 11GjUu%� 9 iv�7ii
L V • 4 .50 RAC 02 j 08/'JJa 10671
Issued By: I 01 9 i999
Date : %N unnn County Planning
(bld_appi .txt 41 W uilding Department
i1 130 . 93 TOTAL