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HomeMy WebLinkAboutBLD1987-00018 S W SIDE OF .._ROAD FEET I. LOCATION: P opr,phic name r- I ((�� S W FROM INTERSECTION OF ROAD AND 1 7 1 bbQj La_I_e_... ROAD other specific location or landmark: _���' "`''-A ,^VJl� s�r_^t 1G� �� LEGAL DESCRIPTION: Subdivision '►f/ Lot Block �3 � I Lk) ao� }�o l� ` i lax Number Y.Sect ion Section Township Range II.TYPE AND COST OF BUILDING- TYPE OF IMPROVEMENT BUILDING TYPE >Z4ingle PUBLIC WORKS APPROVAL )New building Family O Addition ❑Multi-Family Road Access Permit No. number of units ❑Alteration 0 Hotel,Motel, Dormitory Utility Permit No. Repair,replacement number o/units O Wrecking 0 Mobile Home Emergency Services No. ❑Moving(relocation) ❑Other—Specify Street Width A Foundation only • B: . Additional Permits Required: OWNERSHIP Private(individual,corporation, nonprofit institution,etc.) 0 Public(Federal,State or local gov't.) UBC OCCUPANCY G8OUP: — COST (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. If use of existing building is being changed,enter proposed use. a. ElectricalG� _ i, b. Plumbing q 1 I.J p main `4, �� - "1 0 j 3, (:J r; Heating,air conditioning I H`LI1 li3 el�'-k I ) 1502-d. Other(elevator,etc.) 31 o O b p7 N c a l lD . n J /n W f 1 L • TOTAL COST OF IMPROVEMENTS "7 7 III.SELECTED CHARACTERISTICS OF BUILDING - DIMENSIONS �', PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •yur�IO of Stories = O Masonry(wall bearing) ,,,.0 Public or Private ex.( '". •Total square feet of floor wee, ► 2(..k,00d Frame Alndividua (septic t:an ,etc.) all floors,based on exterior S ""�" dimensions Structural steel TYPE OF WATER SUPPLY `' •Total land Brea,sq.ft. Reinforced concrete 0 Public or pri to company ❑Other—Specify L NUMBER OF OFF-STREET • `�J individua (well, stern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors ❑Gas :; ID Oil RESIDENTIAL BUILDINGS ONLY Number of bedrooms TYPE OF MECHANICAL 0 Coal Number of Full Other—Specifybathrooms Partial tt IV. IDENTIFICATION - is Name Mailing Address—Number,street,city and State ZIP code Tel.No. • 1. _ .,r_brir(a dt Rcenca, 1 f)>7 r�'Itnbs L(x e Rorxrl , C cf' .? N/3a- °"""' .fie.aiet'f 14 Q'7,2.. is 2. ('''' I state License No. 1 Contractor {{ f _ it Architect The owner of this building and the undersigned agree to conform to all applicable laws. f Address Appiiartion date Signature of apVlK•nt aka-00-- ©v./..3d 8 ._ U + PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT j APPF;O ED BY `� APPROVED 3Y APPROVED BY OraJEFF n� p T, PLANNING DEPT. �. JEFFERSaN y` HEAL of -NO---LINE EP APPROVED SY i �� PERMIT FEE ISSU(...,E DATE RECEIPT NUMBER O ...._ .,44,, I 5, OC) .7...._ ,... . , BUILDING OFFIC 1_____12_,51g__ -AS7 8 i 2 / : , . -.{ I g, OO _ uoT PPoo T/,t Pi.n(rry - film TO..nsrnd i o H!J (c/30 1 .T F'.W 'F R F; C)T\T C77 C3 z 7 T\T'T'V B U T T.T3 T T\T C=4 "P-F'.TRD01-11- rn Jefferson County Planning and Rui ldincg Department Courthouse, .Srd Floor PO Box 1220 Port Townsend . WA gS368 2O6-385-y14 1 PF.RMTT # •RT DR7-OO1 5 DATF TSSiiFD. : O7/OS/R7 STTF ADDRESS : 1 R7 G T RRS LAKF. RD :CHTMACiiM. WA g8325 OWNER R T CHARD RR( AN PHONE. • 7:32-4072 MA T T,TN(' AnnR - i R7 CTRRS T,AKF ROAD !CNTMAt TiM WA gR325 CONTRACTOR. . :NO CONTRACTOR PHONE. : MATT,T NC ADDR CONTR. T,TC; #• F.XPTRATTON DATF - PART;r.T, NO. . . : qOi 342O i s T F.OAT, DF.SC. . : STR 33-29-01 WWM. TAX # TOT 1 BLOCK T,OWFT L DAY SP DFSCRTPTTON OF TMPROVF.MFNT : single family residence i n-ootina/Sethacks (Shoreline Sethack) /Mnhiie Home Rincking i Foundation : i Underground P l nmh i ng%underground Tns»i a t i nn : ( i FraminglPiumhina Chimney. ( 1 Tnsulatinn : 1 Sheetrock: i Sewage Disposal System Final ! ( 1 Final /Occupancy Approval : -t-9 CALL 5-y 1 41 24 HOURS TN ADVANC r. TO SCHFD11LF. T NSPFCT T ONS . 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