HomeMy WebLinkAboutBLD1987-00360 BUILDING PERMIT APPLICATION '
Jefferson County BuildingWartment• County Courthouse • Port Towns Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
N E 4(/ G
S W FROM INTERSECTION OF ROAD AND / /2-6(. ROAD
other specific location or landmark: /A /
LEGAIDESCRIPTION: l C 0 ea�CJ /r` d </
PGA. _ _V 4-1- Lot Block � I Subdivision� `('.�/,
//O"O� aO� Tax Number 'As Section an ownship Range
II.TYPE AND COST OF BUILDING -
TYPE OFIMPROVEMENT BUILDING TYPE MOBILITY
` J New building Single Family ❑New County Resident
❑\\\Addition El Multi-Family Is this structure to serve the residential
number of units El Alteration or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
0 Wrecking I ';?, obile Horne/
❑Moving (relocation) r, : . -Specify ❑YES ONO
❑Foundation only d "'6 •.,.-ti_ eve_
USE
OWNERSHIP ❑Full-time Residence
❑Private (individual,corporation,
�77 ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
--'` ❑Second Home:Future conversion to
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: permanent residence
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.
X a. Electrical If use of existing building� is being changed,enter proposed use.
b. Plumbing CR X (o
el
c. Heating,air conditioning G�
d. Other (elevator,etc.)
•
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
i DIMENSIONS
1 PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories
❑Masonry (wall bearing) ❑Public or Private •Total square feet of floor area,
❑Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
dimensions
❑Structural steel
TYPE OF WATER SUPPLY❑Reinforced concrete •Total land area,sq.ft.
p� ❑Public or private company
mei cifyy / NUMBER OF OFF-STREET
V,l2Ct r•��if! ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
El Gas Outdoors
i
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
El Coal TYPE OF MECHANICAL
Pro Number of Full Lr''
then-Specify bathrooms
• Partial
I IV. IDENTIFICATION-
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
9 ,
Q 77
t. Ej�I _ keei Q j 96�A 7 - J'
Owner '
2.
Contractor State License No.
3. ,
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
ign ure of applicant Address Application date
-(A.Ae—A4-e-/Zo_-.41 q_Ci el?Itit Pi- 6)14144-44. „2-i0 -Le 7
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY SDQ C`rAPQ'AV OTC.-1 % V".""1/4.va0Z►wL Ply ' $ 4-l``"'d
bi et,
JEFFERSON DEPARTMENT O�--"t
APPROVED Y: PERMIT FEE ISSUE DATE RECEIPT NUMBER
�S'\tV CORM
-- (3J (:), II
BUILDING OFFICIAki ild'L. UeoL
The Printery -Port Townsend
A�1 d r e s s /S 3 Z 0 6 �_I�F /4-U� �—`�=- -- -
Tplicant ' s Name_ 6PiO , 3rg�4-'�`v'— Stets �w�9 gssl6L
Phone (home)
Zq � - 5 y � 3 (worL)
T_2 �� Ra4/
Building Location (legal description) Si �
9 i v 2. 3
22 ? -- 0±5 1-' 3
•
"Parcel ?:umber y�
Adjacent Water Body �Li c j4eA bl�a �"`
Based on the information, the most waterward side of the proposed structure must be set
back at least feet from the high water mar
- feet from the edge of the bluff or bank �'f
Anot able to be determined without additional information
A,ow,. rCwW N22p(
-{�,� 1/S �Nck• /p ft. fi, 3),vi3,z� ,v4Nv
Additional comments: IFco.„.k lNti <,-,,i3'^
.-C-1 ood c,01( i • c '.v '
r
T ow Pcofx Signature efferson County Shorelines
aiAdministrator
! 6¢ Jefferson County planning �, Building Dept.
w!� r��ood County Courthouse
Q IZ �n o� `��2`-' Port Townsend, 1 A 98368
frettk Pool .are 1 385-14 27
Bluff stability
��Bluff or Bank height
Adjacent residential Structures within 300 feet? yes no
If yes, existing setback of adjacent homes:
Home #2:
Home �1:
foot setback from bank
foot setback from banky ---- -— t property
L �" foot distance from applicant, s�_ foot distance from applicants propezj-
applicant. Should any information be -
Much of the above information uirementpmaydbeychanged "
inaccurate, this setbackq _ � !I'�,_ � /,y��,���Q,�
� V'eA °1( 1 'd oil l''/q �6 - /'/e1'41-6
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