HomeMy WebLinkAboutBLD1989-00465 L3UILSNG ERMIT Af PLICATIUN I
Jefferson County Building Department.P ,Q . Box 1220'Port Townsend. WA 98368
LOCATION P . Lk 1) 4-0o ;
P ,No✓`',,'^A/ _1 Co U
SPECIFIC LOCATION SITE ADDRESS S % e -
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT 5 BLOCK
DIVISIONTgX NUMBER
PARCEL NUMBER 74 c()A 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP
NORTH RANGE r I- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT
SQUARE FOOTAGE
❑ SINGLE FAMILY
Lt NEW BUILDING MAIN FLOOR .3O03 ' (A ✓
VI 0 MOBILE HOME ❑ ADDITION
❑ MODULAR HOME 2ND FLOOR r�q �!, ��
❑ ALTERATION BASEMENT �-� v
❑ DETACHED/ATTACHED ❑ REPAIR
GARAGE CARPORT
❑ REPLACEMENT GARAGE /`Fa., ,6
.-
❑ WOODSTOVE
❑ WRECKING/DEMOLITION COMMERCIAL
A MULTI - FAMILY ,J ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS L/,L
❑ COMMERCIAL ( , / MOBILE HOMES
0 INDUSTRIAL SIZE ,______0 @. $35/05 /°177' ;f❑ HOTEL/MOTEL/DORMITORY MAKE 1u @ $ 1 6 ��,�/,
i NUMBER OF UNITS C0 @ $8
i 0 OTHER SPECIFY ESTIMATED COST OF (I @ $8 //// 37k/1c'
] IMPROVEMENTS
UBC OCCUPANCY GROUP $ $O7/�A�1L�% 1�AeS p�-/ VALUE
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
ail WOOD FRAME ELECTRICITY
❑ MANUFACTURED � 0 COLLECTIVE SOLAR
0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS
❑ REINFORCED CONCRETE ❑ OIL ❑ COALZero ChM/❑ MASONRY OTHER - SPEC 1 FY �7aQ / •
( WALL BEARING )
❑ OTHER DIMENSIONS
NUMBER OF STORIES___ TOTAL LAND AREA
DEPARTMENTAL 'REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS A. WI I' 0 PUBLIC OR PRIVATE
? 1 r NUMBER OF EXIST 1 NG BEDROCNb1S r
�C APPROVED DATE ❑ I ND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
PUD 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM _SW
TYPE OF WATER SUPPLY
4 PUBL I C ( NAME OF WATER SUPPLY) Lu DLoci.) L )c I-e_APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
_raa..w.ew.,...w
PLANNIN DEFT , VIFTHIN SHORELINE JURISDICTION
4 - `' /A YES NAME- F ADJACENT WATER BODY
el .NO t
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
OWNER
MAILING ADDRESS ZIP TEL NO
•O ► ' •oar * omV PO ietg-h(Sp. >i Lj37�1a
�1 .�, ff _p i . L(A N.�c,� (A g �5 (ems
CONT v t F��i ilQU.K., b
` �ti( rS� ATTz:>rra s E
RCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF Arp F A A/PP IC�TIION DATE RF,CEIPT NUMBER'� CHECK NUMBER O- CASH
0 8
5/1
D BY - PERMITFEES,i ,ilef, ���---
Ub3. S"® BASE FEE
�. ,.;in „�.._�� INSPECTION
{ 19 354 BLDG SURCHARGE S61 , PLAN CHECK
JEFFER cry
PtANNN�Q 4 OG 7V E C�-` ENERGY SURCHARGE /X58
$ L t TOTAL
1 ,Uo 81I NUMBER REFUND DATE 7714SUED
BUILDING OFFICIAL1I ;
• •
. •FROM: PLANNING AND BUILDING DEPARTMENT
ADDRESS REQUEST
1 • ' Z__ NEW ADDRESS ADDR
ESS CHANGE
2 • NAME: POPE RESOURCES
60M Paradise Bay Rd. Suite #4 Pt. Ludlow, WA 98365
3 • MAILING ADDRESS:
4 • TELEPHONE• 437-2101
5. LOCATION: Please attach map.
LEGAL DESCRIPTION:
SECTION 17 TOWNSHIP 28N lE
RANGE
LOTS_ BLOCK PLAT
6. ROAD NAME: _�l-P v
BETWEEN ST. &
ST.
MILES/FEET FROM
ST.
7. NEIGHBORS:
NAME:
ADDRESS• N S E W
NAME:
ADD RESS: N S E W
NAME:
ADDRESS: N S E W - a
8 . FEE PAID CASH
CHECK N0.
NEW ADDRESS
STREET:
._.____________________________
CITY: 1
REAL MILE POST
date entered
-- a lat.e sent
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