HomeMy WebLinkAboutBLD1987-00001rXI,IILDING PEi-?i�71`F APPLICATION
Jefferson County Buildiriy rtmerat• County Courthouse •Port Townset sh.93368 • 3$5 1310
NE -- —_
I. LOCATION: geographic name S W SIDE OF ROAD_ FEET
NE
• S W FROM IN� T�RSECTIO ROAD AND ROAD
other specific location or/mark: � 1,71 _I 'D �CJ�/ 1 �A J -�
LEGAL DESCRIPTION: " .
(nor e( - Lot Block Subdivision L_
UL 4,i _J ( � Tax Number %Section Section ownship Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
Lew building Single Family ❑New County Resident
❑Addition ✓//'���
❑Multi-Family Is this structure to serve the residential
❑Alteration number of unit::
or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
❑Mobile Home
❑Moving(relocation)
❑Other—Specify ❑YES
❑Foundation only ❑NO
OWNERSHIP E
❑Private (individual,corporation, uli-time Residence
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: R-3 ❑Second Home:Future conversion to
COST — permanent residence
(Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing Z.
N /;� & 35 yg�
c. Heating,air conditioning / /� -�1
d. Other (elevator,etc) , i g O n _h pi/ 2# -9 �(�J(�J
• TOTAL COST OF IMPROVEMENT $_ C7 �C_ �� /
III.SELECTED. CHARACTERISTICS OF BUILDING - ()\rift Ftt_ue
Co tA. Tb.-- co".&c. -ip$ If C— r.- I 13\11
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS C
0 Masonry (wall bearing) ❑Public or Private °Number of Stories
Wood Frame •Total square feet of floor area,
Individu septic tank etc.) all floors,based on exterior
[]Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Public or private company 7,
El Other L Specify i 479-
individ (well, istern) NUMBER OF OFF-STREET
— PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil ;7 RESIDENTIAL BUILDINGS ONLY
electricity t9a�f`1� ` — Number of bedrooms
❑Coal /' TYPE OF MECHANICAL
❑ er—Specify �l��X Number of Full
bathrooms
Partial.. . .., 1
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city an State ZIP code Tel.No.
1. ed4riqr—Pt e_e__ ,c,21__q_.0_ _
Owner
)
2. ./
Contractor State License No _
3.
•
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signatu e appli Address
� � � Application date
c22 a Iyg) ti111) \Ide{ d Poo/s /-6
PLANNING AREA. FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT_
APPROVED BY - —
H/f �� � `�a �7
JvFFE RSO NTY HEA TH E; ARTt,Er'4T
APPNISC2B ��/ FE ', ISSUE DATE -
7 W 1ldd cECE I F'r NUMBER
JAN so 5i)
s 7 /0r, Address 1-- Is `�7 S-F3
BUILDING OFFICIAL t /Jar CO e4^�� R
ounl Bldg. Oept
®t he Printery—Port Townsend jC�,_..,
Air
1011
.3r.F' r' H.1-Ni C.(77 7TTmv FiTTTT.)TTv'C-7,
Jefferson County Planning and Building nepartment
Courthouse, 3rd Floor
PO Box 1220
Port Townsend , WA gR36S
206-3A5-t)i 41
PERM T T # -BT.DR7-OOO 1 T)ATE RFCRTVFT). -Oi /o4 91
STTF ADDRESS : 1 21 3S T4 T M-TWA Y 104
:PORT T.IIff,OW, WA gR3E 5
OWNER -R T CHART) RICE' PRONE : 77q-41R1
MAILING ADDR - 2 1 45O NW VF.TTF.R Rn
-POIJLSRO WA 95370
CONTRACTOR . . :NO CONTRACTOR PRONE :
MATT,T NG AT)T}R :
•
CONTR . LTC #: EXPIRATION DATE :
ARCHTTF.CT t . . _ PRONE!
DF.S T GNER •
MATTING ADDR -
•
PARCF.T, NO. . . : 521334085 HEALTH:
LEGAL DRSC. . :STR :33-28-01 FWM, TAX # 77 RV: DATE !
LOT , BLOCK SHORF.LTNF.S -
BY! TJATF:
TW.SCRIPTTON OF TMPROVEMF.NT: Single family residence
RUIT.DTNG TYPE -RFS RF.T)ROOMS--- BATHROOMS-- MAIN FL . . . : 1400 sf
TYPE OF TMPROVEMENT:NEW EXIST. - 0 F.XTST. : 0 2NTi FT, • i6OO sf
GARAGE/CARPORT •A PROP. . - 3 PROP. . -• 3 3RD FT. 0 sf
WOODSTOVF -V TOTAL. : 3 TOTAL. : 3 BASEMENT. . : 0 sf
URC OCCUPANCY GROUP-RR SEWAGE DTSP. . :SF.PTTC CARPORT. . . : 0 sf
TYPE. OF CONST WATER SUPPLY. -PRTVATR GARAGE - 784 sf
UNITS . : 1 STOR ES: 2 HEAT TYPES . :WOf/ RR! DECKS O sf
D T MFNSIONS - MORTT,F HOME COMMF.RC:TAT,- 0 sf
FRAME TVPF.:WOOi7 MAKE - VR : TNTltTSTRTAT,- 0 sf
EST COST. $ : RO572 ST7.F : RANK KT. . . : O ft
PRO.T GRP. . . 1 044 SR S F.TBACK: 0 ft
Owner/agent FEES
Signature! type amount y date recpt
PRMT $ 58O . OO O 1 /On/R ! 25q32
fate. '
Issued By:
na to-
580 . 00 TOTAL
�! h
_J t". t�� ty t". t"C�" L JTV
C;Z J l l TNT- -y
t"s i.!1 !.i l 1 �1'i-I t=�M. !'C IVf j 'T'
.Jefferson county Planninn and !'S1I7 1dina Department
Courthouse, Arch innr
_ Pi
nor J RoX 1 220
Port Townsend WA 9R36R
206-3R5-9141
PF.rRMTT" #. . . . - RT,R7
u00,
S T TF. F' DDRFSS . 1 21 .'S.'S h"T1�!•TWi11' 104
IJH"i"F.
PORT WA ISSURi�- : 01 j i .�irs7
A"�i RTCF. -----
MATi,TNG HIJIJK : 7'I4.50 NW VRTTFR RD ---h-[)IVF----------------
779-41R1
t'OULSRO WA 9R370
CONTRACTOR. _ ! NO CONTRACTOR
MH T T�T?VG Aflf7R ' --- --.
Ph4OTVF!
CONTR .------ --- RXP T RAT T ON DATE !
____T,1.F. `-------------------------
1 (,J-11, i)'"•5T'Sf,(!(KTR .S.S-2R-011 F.WM: _TAX # 77 - ._
P ...
PARCRTOT,
DF,4(;KTP' Ttiiv (1F TiviPrY(1VF.MFiJT -
Single family residence----------------------------
( ) nnot i na/SeT hacks (Shoreline Spt naC'K 1 /Mnh i l p Romp R 1 nr • -K7T`n.
1 1 FnlJnr',ai n. .
1 f nClpl^nrniln ' •-„ __...
Underground Pi limo i nn/l/noprnr
nlJn(7 Insulation ! _
i Pramira Plllmhina/Chimney-
T+nsniai-inn -
Snpptr
ndir -
?�Spwac�p Disposal SVS1 pm Final :
—
✓1 ma i i Or nunanc-v
Hnnrn
• ��a i ,
/- d�
24. TTO11K4 TN AOVHNCR
Hours
'clu s q a . m. S(;riF.r3iiT,F• TivSPF.( TT(JNS.
Inspector 1,S to 5 �. m
n7J rS 9 - I (1
_- _ 4. i-irnlr a - m•
Kp.dnrdpr for
i nSnpf.T i cm
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COMMENTS:
1. Recommend use of low water use fixtures.
2. Divert all sources of surface water away from the septic tank and drainfield
(i.e. from roof drains) . -
3. Do not park or drive on the septic tank or initial and reserve drat
4. Install D-box level on level slab and water level.
5. Drainfield lines maximum 1" - ,fall in 5' . drainfield areas.
6. Call health department for final inspection. Give e minimum of three working days
7. Remove trees and level drainfield area as necessary.