HomeMy WebLinkAboutBLD1988-00038 ilILDING PERMIT APPLICATION 411
Jefferson County Building Department•P .O . Box 122040Port Townsend. WA 98368
LOCATION pp,
SPECIFIC LOCATIONI SITE ADDRESS ( U I ' Ra\(P(i RA
POSTAL DISTRICT pi /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK I ' DIVISION TAX NUMBER
PARCEL NUMBER OO2 L2.�-I O(7 1 / 4 SECTION
SECTION IT TOWNSHIP O NORTH RANGE 2.,(J) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL IAA $35 / qLI O
0 INDUSTRIAL SIZE Col
YEAR 0@ $ 1 6 )
❑ HOTEL/MOTEL/DORMITORY
NUMBER OF UNITS MAKE �] $8
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOT L FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $ (C/Li Li
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
- WOOD FRAME Cet r19 ❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL A GAS High eFF ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES , TOTAL LAND AREA nik-
DEPARTMENTAL REVIEW
HE LTH EPAr TMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
Cj / #� 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
/ ( , 1 ND 1 V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM (
APPROVED DATE XI ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM 4
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE PRIVATE ( NAME OF WATER SUPPLY) Weil
PLANNING DEPT . s WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
.--
NAME Ross [� o,, MAILING
f��A I L I N(G^' ADDRESS p ZIP }/� TEL NO
OWNER ; 4 Lnr na Ross t l) 1 I�.CA��10�1`A J I' 183(oi 1 -3 S )
CONT eP `
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIGNAT OF,IAPT2ANT APPLICATION DATELs3B1
0EIPT NUMBER CHECK NUMBER OR CASH
oq/2 188 � a35O
APPR PERMIT FEES
-"1
A R O D D . OO BASE FEE INSPECTION
p ��YB (3 . 50 BLDG SURCHARGE PLAN CHECK
J ENERGY SURCHARGE $ 9 3 . 56 TOTAL
JEFFERSON COUNTY
PLANNING Si BLDG DEPT REFUND DATE I DAT I SSU
971 NUMBER `�
BUILDING OFFICIAL 7t'•
iek 7o 14 (0 -/ .
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Jefferson County Planning and rsui idinn department
Courthouse 3rd Finor J j
PO box- 12.20
Port Townsend, WA P836 5
206-385-9141
PFRMTT # r'3T,dR5-0035 DATE TSSURn. ! 09 i 26 i SR
S i T"F. ADDRESS : 1 R1 RAVRN •
RI1
PORT TO/WNSEND . WA Ors.-sots
c7WNF.R • EVT ROSS PHONE :
MATT,TNC AnnR , i Si RAVEN Rd
:PORT Ti1WNsRI'Vi1 WA :1M.9nr5
CONTRACTOR. . _ NO CONTRACTOR PHONF :
A I111R
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CONTR . T,Ti #h : F.XPTRAT'IOi3 DATF:
PARCF.T, NO. . . , OO2 i 24-i1 i 7
T,EGAT, DESC. . : STR 12-30-02 WWM . TAX #
TOT nT,OCK
ur.:sc;rrsriON OF IMPROVEMENT! single family addition
; Font i nc-r/Sethacks (Shoreline Setback) j Moh i i e Home Flocking:
i Foundation :
; Underground numbing/Underground insulation :
{ i Framing/Plumhing/Chimney:
i Insulation :
( s Sheetrock :
Sewage Disposal System Final :
( i Final/Occupancy Ar;^rnv i
TVA/Ai 7e../ / /, 7:7;4
CALL 385-9 i 4 24 HOURS TN AT ANCF TO SC FT)UT,F. T NSPECTTONS .
Office Hours 9 a .m. to 5 p.m.
inspector ' s Hours - 10 a .m .
24 Hour Recorder for inspections .
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