HomeMy WebLinkAboutBLD1999-00291 Jefferson County Permit Center * Department of Community Development
a; 621 Sheridan Street, Port Townsend WA 88368(3601319-4450
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Project Description:
9 Digit Parcel Identification Number(from your tax statement):
f
Site Address
911#: Road Nam °} ) c Zlp Code: r '
Legal Description
Subdivision Name: E-DC tjty3 PO i Block: Lot(s): �.,.-
Section: g Township: 8. N' Range:
Parcel Size (acres or square footage): 1 .-
Property Owner: , / Phone:
Mailing Address:
g7,2 %- a1 !i D r,i®! r-P1 c' L. (.4
Applicant/Occupant: Phone:
(if different from owner)
Mailing Address:
Authorized Rep: .�- . Phone: 7,- 017:3
Mailing Address: BB
fro Lam, r- cD t ; A, S-
General Contractor:
Or Manufactured Home Installer: 0 � 41s ,-8 t 'aU iLDC, ige,:hone: 7 7./
Mailing Addre .2 nrt la raD 1 E. L.0)L , rt 9.87,?es,
Contractor's State License Number: Expiration Date:
Septic Designer: Phone:
Mailing Address:
Architect:/Engineer: Phone:
Mailing Address:
I o " A,+ 6/ e rrre Zoe / 6- a
Loan Lender/General 4/4 rep Atli,v6 Phone:
Contractor's Bond Holder: /94.CD ni1q
Mailing Address:
FOR 01-'141 CE'USE:ONLY
Fire District: Planning Area: School:District: Zone:
4/98 Jl:\home\pincntr\forms\universal plot plan
' 4 ON eb Jefferson Couunty�Permit�enter 'r Department of Community Development
r�, 21 Sheridan Street,Port Townsend WA 88368[3601 378-4450
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Project Description:
Building Type: Project Type:
Ll Single Family Frame Type:
V New CY Wood
d Garage( ttache /Detached ❑ Addition
❑ Modular ❑ Steel
❑ Alteration/Remodel ❑ Concrete
❑ Commercial ❑ Repair
❑ Multi-family/# of Units ❑ Masonry
❑ Demolition ❑ Other:
❑ Industrial
❑ Other:
Bedrooms: Bathrooms: Type of Sewage :Dis osal . "
P Type of Heat:
Clpose one:
Existing: Existing:
Proposed: Eroposgd: a Sewer ❑Community System ❑ Electricity ❑ Oil
Total: Total: ❑ Indtvtdual System ❑ Woodstove ropane
If not sewer,fill out the following: ❑ Heat Pump
❑ Conventional ❑ Alternative ❑ Other
Permit# SEP
Water Supply:
❑ Private well ❑ Two Party Well CIPublic:Name of water system: I
Square Footage:
For Office Use Only 1
Main Floor -2 c c,i I 0 7 75 UBC OCCUPANCY GROUP 1C-
2ND Floor Base fee
3rd Floor 4s �
Plan Check fee if 4 7 . co 1
Htd Basement `'' f 67 12 J i
� CP� Li.State Surcharge fee _
Unhtd Basement Subtotal
Carport/Gr�2AG� C-���,' ., ! .
s Pot Water Review fee Z'7 '6
Decks O I- ,f Hit
q 911/Rd Approach fee qGi ub
Commercial TOTAL I q a g.4(0
Industrial
Receipt # i C.l 23
Other Cash/Check #
Total Valuation:..
Initials
Or I 'Q
1 � 5D , Date S .Z G I , 9
Estimated Cost: J
If within 200' oft e S oreline,
Distance to Bank or Ordinary High Water Mark
ft. Bank Height ft.
Signature:
Date: