HomeMy WebLinkAboutBLD1987-00421r iiii
111. BUILDING PERMIT APPLICATION111111
Jefferson County Building Department • County Courthouse • Port Townsend, Wash 98368 • 385 1310
N E
I. LOCATION: propraphrc name
$W SIDE OF ROAD FEET
N E ROAD
S W FROM INTERSECTION OF ROAD AND
other specific location or landmark 1 _
LEGAL DESCRIPTION: Subdivision
Lot Baock .� 1
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
-' 'New building ❑Single Family ❑New County Resident
El-Addition ❑Multi-Family 'Is this structure to serve the residential
-.,i' 0Alteration number of units or commercial needs of those employed
` 0 Hotel,Motel, Dormitory at either the US.Navy's Trident or
.� 0 Repair,replacement number of units Indian Island Facilities?
Wrecking ❑Mobile Home
• Moving(reloca,ion) ❑Other —Specify ❑YES ❑NO
0 Foundation only
USE
OWNERSHIP ❑Full-time Residence
0 Private (individual,corporation, , ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
i ❑Second Home: Future conversion to
ID 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.
a. Electrical If use of existing building is being changed,enter proposed use.
ot
b. Plumbing / :. ( r- — ( (-(. /' (�
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1
c. Heating,air conditioning
d. Other (elevator,etc.) •
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
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 ❑I etc.) all floors,based on exterior
�`'! l i It F?.A- dimensions r
Ej Structural steel
TYPE OF WATER SUPPLY •Total land area,sq.ft
❑Reinforced concrete • 1 "
(t.Q Public or private company
l ❑Other—Specify NUMBER OF OFF-STREET
Individual cistern) PARKING SPACES
x;� Enclosed
Ctie-,D • PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors
Gas `( l 2r, )(`, (- RESIDENTIAL BUILDINGS ONLY
/
_ ❑Oil Number of bedrooms fj
❑Electricity TYPE OF MECHANICAL
❑Coal ' Full
Number of
0 Other—Specify bathrooms Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
-// / )L/ 2 ( il't ' / t
�4
46
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2. State License No.
µ-,,, Contractor
'w,;, 3
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
'Address Application date
Signature of applicant J '
a� 'CIF": \ / ,...--.)-
e PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
'' , -k. - . ••- \'a. ....ik:., 1•'""'"Immoiiiii -r-:\\\
.' JEFFERSON Cam, H I- KEPT ' All -.A► "' "Pk:.—_'''
I APPROV B PERMIT FEE ISSUE DATE RMIT NUMBER
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I. I-- BUILDING OF ) ' 0t-. j( rytk..-
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NOTICE TO TITLE tl i.-----
Filed for the record at the request of:
Jefferson County
County Courthouse
Port Townsend, Washington 98368
When recorded, return to:
Shirley Riffe
100 Mountain Trail Court
Brinnon, Washington 98320
NOTICE IS HEREBY GIVEN TO Shirley Riffe, her heirs and assigns, and the
general public.
DESCRIPTION OF REAL PROPERTY AFFECTED: Lot 9 Olympic Canal Tracts
Division 5, Block 14, (Assessors Parcel 98130459).
STRUCTURE TYPE INVOLVED: Single Family Residence.
ADDRESS OF STRUCTURE: 100 Mountain Trail Road, Brinnon, Washington 98320.
NOTICE IS HEREBY GIVEN THAT the above referenced structure does not
comply with the provisions of the Jefferson County Ordinance 2-84 nor the
life safety requirements of the Uniform Building Code RCW 19-27.
This notice will be removed from public record by Jefferson County upon
issuance of a valid certificate of occupancy for said structure and
property. ---��-��
Dated this / 3 day of L./v 1989.
,00 .==,fg•-t- ;4
dsmith, Di ctor
Jefferson County Planning and Building Department
Acknowledgement /7
Subscribed and? s r to ore me this
day , 1989.
6 16,/,,,,-)
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1 V { K M7 ,+
_ . _ nd for ?L .' f ashington,
residing in , Washington.
J
-----27/17 401410441. • E- el.% .0 /201/31/9'D
VOL 283 twa 142
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