HomeMy WebLinkAboutBLD1989-004807--- ---- --- ----- ______ _ _ ____ _....
11OLDING , 'ERMIT APPLICATION 410
Jefferson County Building Department.P .O . Box 1220'Port Townsend. WA 98368
r-
LOCATION .
SPECIFIC LOCATION SITE ADDRESS 7 , tki
POSTAL DISTRICT
\) JSUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
in . _ 1 / 4 SECTION
PLANNING AREA , ) PARCEL
TOWNSHIP
n.NN7BER Mc, iii NORTH RANGE . Wm
ITI
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
0 SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT /
. 0 DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE ,
WOODSTOVET0 WRECKING/DEMOLITION COMMERCIAL
O'MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS _
MOBILE HOMES
O COMMERCIAL
SIZE
O INDUSTRIAL
YEAR 0/ @ $ 1 6
O HOTEL/MOTEL/DORMITORY
MAKE ./(71 a $8
NUMBER OF UNITS 7 ,
.._
O OTHER - SPECIFY i 6 @ $5
ESTI
MATED COST OF -.
-f213 IM OVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU
_
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOvE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
%..., '
0 MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
-...
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
1\„,) 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
.............r......-OXIMIPIne
PUD TYPE OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OFI=LI=2.2m __
...,....
,not....anno-ame*•0,X,Ies,a,0117•Awn.4,?
PLANNING DEPT . W.lthiN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
ONO
APPROVED DATE BANK HEIGHT SETBACK
Q) ...._
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
NAM V MAILING ADDRESS ZIP TEL NO
5(:)OWNER
CONT
-
,
CrLk.NSE NU 1
kNi ARCH
r THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNURE OF APPLI NT
.,1-..
l
APPLICATI to,TE
APPROVED BY REFTN,LER CHECK NUMBER OR CASH
/(P/i/
. ,
PERMIT FEES f. 1-fi 0---:--)•!--)'2"--- - -1(A ) BASE FEE . . INSPECTION
-
41;a-) BLDG SURCHARGE PLAN CHECK '
ENERGY SURCHARGE $
c29. 5()
TOTAL
-.--.
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
. .
.CORDED I
338273 O
NOTICE TO TITLE 444Q �
Filed for the record at the request of: JE ER OU COUNTY M1DTDR
Jefferson County at4L2rr 145mdu TT
County Courthouse
Port Townsend, Washington 98368
When recorded, return to:
Paul Tenbrink
17781 Highway 101
Quilcene, Washington 98376
NOTICE IS HEREBY GIVEN TO Paul Tenbrink, their heirs and assigns, and the
general public.
DESCRIPTION OF REAL PROPERTY AFFECTED: Within Section 11, Township 27 North,
Range 02 West, WM. (Assessors Parcel 702111003).
STRUCTURE TYPE INVOLVED: Single Family Residence.
ADDRESS OF STRUCTURE: 17781 Highway 101 Quilcene, WA 98376
NOTICE IS HEREBY GIVEN THAT a woodstove and fireplace insert inspection was
not approved for the above referenced structure. Therefore, the building
department will not and cannot attest that the woodstove and fireplace insert was
installed consistent with the requirements of the 1988 Uniform Building Code and
RCW 19-27.
Dated this t ___t4-!rday of r-e.Nj , 1991.
, Director
Jefferson County Planning and Building Department
Se"tar
Acknowledgement
Subscribed and yori to before me this
day • , 1991.
*4_014_
/-
N'Dtc_=y p .) is an• t1.4.` 1 +a.te o Washington,
residing in `%/ .' . ,;_ ti , K,: / , Washington.
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