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HomeMy WebLinkAboutBLD1988-00046 B 'IIDING PERMIT APPLICATION Jefferson County Buildi : Department.P .O . Box 1220.i t Townsend, WA 98368 LOCATION SPECIFIC LOCATION SITE ADDRESS —TO (l (' W p POSTAL DISTRICT V / /SUBDIVISION \ LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NU B R if PARCEL NUMBER(}f( t77� ()� 7 1 / 4 SECTION E SECTION 7 TOWNSHIP -3 () NORTH RANGE ( (,&) WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE 2KSINGLE FAMILY NEW BUILDING MAIN FLOOR MOBILE HOME ADDITION 4#R0_,_._.__ 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS 0 COMMERCIAL MOBILE HOMES /� ❑ INDUSTRIAL SIZE p� $35 �a/�/ (� ❑ HOTEL/MOTEL/DORMITORY YEAR a({ rh $ 16 '� 7+� NUMBER OF UNITS MAKE ]I� p� $8 v ❑ OTHER SPECIFY ESTIMATED COST OF $8 IMPROVEMENTS ITOT.A17 F RKET VALUE UBC OCCUPANCY GROUP, $ $ �42. SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR ❑ MANUFACTUREDWOODSTOVE 0 PASSIVE SOLAR ❑ STRUCTURAL STEEL 0 GAS ❑ COAL ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) 0 OTHER - DIMENSIONS NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HE LTH .D� jPAR TMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS aL �_ I ❑ PUBLIC OR PR V-A-'F ` � � NUMBER OF EXISTING BEDROOMS /qF1APROV D P INOIVIDUAK1SEPTIC NUMBER OF PR E DATE T E PROPOSED BATHROOM ir INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM J PUD TYPE OF WATER SUPPLY .....5- ❑ PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY) PLANNING DEPT . WITHIN SHORELINE JURISDICTION �0 YES NAME OF ADJACENT WATER BODY I�[ ► APPROVED DATE / ANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO IDENTIFICATION NAME (f l r� MAILING��1 ��pA�D�DRESS ZIP/ TE7L�`cNO OWNER /� c C-`L ' f ©0 W 0 ✓Y Gi� C L�t,� - " ✓ 1 . r -4-1774 Qis� CONT ..:.,34,,J4____ STKTt LICENSt NO ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. IGNATURE OF APPLICANT APPL CAT ON ATE RECEIPT NUMBER CHECK NU BER OR CASH / APPROVED BY PERMIT FEES A P P O ` E r) (( )(5DBASE FEE �Q Q INSPECTION °'I% , F v / 3..3T)BLOG SURCHARGE PLAN CHECK , ' ` 3 (RI) ENERGY SURCHARGE $ 9 ?j PI:';`;:4+,w:'4.0 2f lO �J V ✓ TOTAL NovJNov p 911 NUMBER REFUND DATE J DAT 1 UED BU I�� FUNCYI AL 1 ( /i it inc Derr t- 7 i1 is /, 5 : . .TF.F'FFRSC")TsT C:C7TTN'TV' F4TTT T.T)T TXC; F›FRMT T' Jefferson County Pl ann i ncr and Building Department Courthouse; 3rd Floor PO Box 1220 Port Townsend, WA 91336A 206-385-9141 PERMIT # •RT,T)AR-004Fi STTF. ADDRESS - Fi20 .TOT,TF. WAY HATE. TSSiJF.i)_ - 1 i /1 4 tAA PORT TOWNSF.ND; WA 9A368 OWNER -F.D CA TN MAILING AT)fR ! 1 00A T,AWRF.NCF. PHONE! 3R5-75Ori 3rG PORT TOWNSF.NT) WA 9636R CONTRACTOR. . !NO CONTRACTOR MATT,TNc ADfR ! PHONE: CONTR. LTC #: F.XPTRATTON DATE ! PARCF.T, NO. _ . '001 O71-027 T,E(;AT, T)F.SC. . !STR 07-30-01 WWM; TAX # 19 LOT , BLOCK T)F.SCRTPTTON OF IMPROVEMENT. STN(,T,F. FAMILY RESTDF.NCE ( ) Foot i na/Setharks (Shoreline SPthac-k) /Moh i 1 e ROMP Blocking: ( ) Foundation ( ) Underground Plumhincr/Undercrrnuncl Insulation • ( ) Framing/Plumbing/Chimney- ( TnTation - ( . e rock . /17X4ASLs" 5' 13 a-u- ( ) Sewage Disposal System Final ! 4, Final/Occupancy Approval - rril" ,T / IP , CALT. 385-9141 24 HOURS TN ADVANCE TO SCHET)TJT,F. TNSPF.CTTONS. Office Hours 9 a .m. to 5 p.m. Inspector 's Hours 9 - 10 a -m- 24 Hour Recorder for Tnspections. r f.�r .�r �� t ..l ./.1/ ,/.� O I Ss-a _..7 _ IY5/4 :_____________________ ___________7___,_________ _____o 'K. \ \\ 1 q zer N 11 i 2 N 2 p 3 NIi (-� g ° - tA / i i / / .J1 i 1 / • / / ,' -- / & / ';' / / l0 i CA v) / i 4; 4, 1 i / i I 7 i t l i � � r� . k l �1 T3 3 \ \ s, aki) z � M