HomeMy WebLinkAboutBLD1989-00450 - i
13UOING)i 'ERMIT 'APPLICATION
411
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Jefferson County Building DepamenteP .O . Box 1220'Port Townsend. WA 98368
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LOCATION
SPECIFIC LOCATIONSITE ADDRESS /3/ -rime (:))(11Y-: ',,,7 1-) .:17,
iPOSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVI ,ION TAX NUMBER
.( PARCEL NUMBER (00/ - 3-33-0/1 1 / 4 SECTION
PLANNING AREA ,ISECTION .3 . ,. TOWNSHIP 32. NORTH RANGE
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BUILDING INFORMATION
BUILDING TYPE TYyZ" OF IMPROVEMENT SQUARE FOOTAGE
0 SINGLE FAMILY 2(NEW BUILDING MAIN FLOOR
'.' 0 MOBILE HOME 0 ADDITION 2ND FLOOR
...
O MODULAR HOME 0 ALTERATION BASEMENT
0 DETACHED/ATTACHED 0 REPAIR CARPORT
q/It)
GARAGE 0 REPLACEMENT G A R A G plappor 9.05 s ilerg 4/4 e (:;,,,)%444"r
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING j INDUSTRIAL
NUMBER OF UNITS -
MOBILE HOMES
0 COMMERCIAL
SIZE 14_1 W. 4'3J
' 0 INDUSTRIAL
0 @
O HOTEL/MOTEL/DORMITORY YEAR
MAKE 0 @ $8 )(
UMBER OF UNITS ESTIMA COST OF"
E4THER /- SPECIFY a-E $ 16
A @ s. JITn,Z
D
..2/. ./1 Cop
impn EMENTS TOTAL Fi%, RKET VALUE
UBC OCCUPANCY GROUP $ $ /C) 7,
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SELECTED CHARACTERISTICS OF BUILDING
,,-PR,OCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL,
' WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE
O MANUFACTURED 0 WOODSTOVE 0 PASSI. OLAR
O STRUCTURAL STEEL 0 GAS ,O.-etrAIC
O REINFORCED CONCRrTE 0 01 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS 9•8X4490 .
4 •
) 0 OTHER - . NUMBER OF STORIES t , TOTAL LAND AEA
DEPARTMENTAL REVIEW •
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HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BF ROOMS
[ ,'Jill. I C OR PRIVATE NUMBER OF EXI ,., BEDROOMS
L
1 NO).V I DUAL ( SEPT I C ) NUMBER OPOS ED BATHROOM
APPROVED DATE c
...--1-14D I V I DUAL WELL f ER OF EX I STING BATHROOM
PUD 4, TYPE OF WATER SUPPLY
44 0 PUBLIC ( NAME OF WATER SUPPLY)
f-:
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
1 0 arne....A....,70.4m.MAni.4*V.I.WWW,461,MONXT
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES) NAME OF ADJACENT WATER BODY
V ,
[VI(K)
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....,,,,.., APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
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 ,
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OWNER L yy) 0 i-Q\e. ; .
-1 ;:;IL. 4,1j1,):-i 38
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( l'Iti 0 I r } tie,tr' I-4):,),''. '' ,:if J-/ : 33
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CONT "1" ,,yyt4 --e)i4-1-row ske aL 4-4A)t,t
it re. 9() ,,,th '--, _
Li i:.;'-1-.', q,./4-, ' )' 7)i:...., '.,) /
..._
11
ARCH
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THE OWNER OF THIS BUILDI G AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
..,.„..,*_
SII/TMCCIITICA T( APPLATi 4-f
i0N- OATE REcEIPT NTB4;11 CHECK1 7UM VR CASH
14 . A i 16t1, ,7
APPROVED BY r R'hi i T s
APPROVE
BASE FEE INSPECTION
AD
..1---
AUG i 6 198S \ _,. i........ .,. BLDG SURCHARGE PLAN CHECK
ERERoy SURCHARGE $
JEFFERSON COUNTY TOTAL
PLANNING it SLOG DEPT
9 I 1 NUMBER REFUND DATE y, ISS ED
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BUILDING OFFICIAL \ -) sk
11111W-
y low CoUntry._ Suite B e 16521 Hi 99 • Lynnwood. WA 98037-3161
1 STEEL BUILD4NGS' Everett Line: (206) 2",1�f171
aummummummini Toll Free 1-800-824-9552
—� • mt Administrative Headquarters. (206) 743.1555
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"loomew DIVISION OF _.. r.. ,t. i
Quality: Our Future Depends On It'"
A
Site Plan
PLEASE CHECK:
L 'Property dimensions NSeptic and drainfield EAccess to proposed building
63Existing buildings LJSewer lines 2'Lot size
t Proposed building ;}'Setbacks of proposed and Ievation of property
E,1Easements existing buildings Bodies of water
L1'Main road with name Floorpian
Job name: 1'6 e,(t,+;.-_ M c}, Job Site Address: I ! 9' (- Y Vi !t ` i' 0
Legal Description Ice,/ `�11 1 - C` 0 \t-t- 7 ,. - , — —
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Owner has verified and approved the location of accessories, orientation of the building to the north, and verifies that all items specified in paragraph
B of the contract are shown on this drawing and vice versa. Customer signature:
8t'1984 PermsBNI lntlustrbs
nN,n!w^•tee n•M.+inn anarvl iwr.mn.InlnYf �P>