HomeMy WebLinkAboutBLD1988-00269 B"i_DING PERMIT APPLICATION
Jefferson County Buil.dilj Department+P .O . Box 122010'ort Townsend. WA 98368
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LOCATION •
SPECIFIC LOCATION SITE ADDRESS -- --- ( I tw,2) �j4(,
POSTAL DISTRICT Y I /SUBDIVISIONHi II qfg_.
LEGAL DESCRIPTION LOT .3 BLOCK DIVISION TAX NUMBER
h PARCEL NUMBER (T �Q ((L j 1 / 4 SECTION
611)71ob I SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE 1T�YtPE OF IMPROVEMENT SQUARE FOOTAGE
XSINGLE FAMILY 1�Q NEW BUILDING MAIN FLOOR
MOBILE HOME //—❑`ADDITION 2ND FLOOR .
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOB I LE HOMES, 0❑ INDUSTRIAL SIZE $35
❑ HOTEL/MOTEL/DORMITORY YEAR $ 16
NUMBER OF UNITS MAKE A $8
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP
r i^-) $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
Wi (WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
N.3 ❑ STRUCTURAL STEEL J\GAS 0 COAL
��sen, �+la 0 REINFORCED CONCRETE ❑\OIL ❑ OTHER - SPECIFY
��/ ❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER
NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
{
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS I
_Q ' 2- j 2 B rag ❑ PUBLIC OR PR I E NUMBER OF EXISTING BEDROOMS
�(. \/ [ ND 1 V I DUAL NUMBER OF PROPOSED BATHROOM r
APPROVED DATE A.
I ND I V I DUAL WEL NUMBER OF EXISTING BATHROOM /
'�""` GPUD ? TYPE OF WATER SUPPLY `^
9 v 5 , /�/ 'X PUBL I C ( NAME OF WATER SUPPLY l(� Fon4.-
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
` L ❑ YES NAME OF ADJACENT WATER BODY
QC () 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 �ry�t 1 MAILING J ADDRESSPi-
/t ZIP x') TEL �NO
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O W N E R mum(
QU r'lM L .-0,
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CONT
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ARCH
T E OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S �-I GNAT URE OF APPL ICNT I�AV/p_DATE I E 1 Pq/� R I CHECs /BE (OR CASH
\\�`& It AP RO •.„A......„.. PERMIT /F'jEES
/ i L( ) BASE FEE I NSPECT I ON
3, ST BLDG SURCHARGE PLAN CHECK
APPROVED ENERGY SURCHARGE $ 7 k„ -;72) TOTAL
p.�� 29i 911 NUMBER REFUND DATE DATE ISS ED
BU LDIN FICIAL d7 2-Y�t '
PI.A�+ 911I1i&51II�,DEPTpxj
�r, ;-�^ JEFFERSON COUNTY
;' �►� PLANNING AND BUILDING DEPARTMENT
` 7.. ` t' P.O. Box 1220
, ► 7 : Port Townsend Washington 98368
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it lard c - F-
s„ i�Ma 111 7$ ;{� a..e. Planning (206) 385-9140
l i ;�� wP _�= M1 i Building (206) 385-9141
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JEFFERSON COUNTY COURTHOUSE David Goldsmith, Director
April 16, 1990
Ms. Mona Carbaugh
501 Beckett Point Road
Port Townsend WA 98368
Re: Mobile Home Installation Permit Cancellation
Dear Ms. Carbaugh:
A mobile home permit was issued to you on December 28, 1988. On December
1, 1989 a cancellation notice was sent to you requesting a final inspection
or your permit would be cancelled. You did contact this office on December
14, 1989 stating that the blocking, plumbing, or skirting would probably not
be done by the end of December. Therefore, in accordance with the
Jefferson County Building Code Ordinance, your permit is hereby cancelled.
If you have any questions, please contact me between 9:00 and 10:00 a.m.,
weekdays at 385-9141.
S c ly,
Michae. Ajax_
Building Official 1
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APPROVED
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JEFFERSON COUNTY
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