HomeMy WebLinkAboutBLD1988-00303 BUILDING PERMIT APPLICATI
Jefferson County Builc,,,,g Department• County Courthouse • Port Tote nd, Wash.98368 • 385-9141
• ,� N E„t
(Ilan I. LOCATION: 'geographic name 2V, SIDE OF ROAD FEET
N E
S W FROM INTERSECTION OF ROAD AND seam)at—Le ROAD
other specific location or landmark:
GAL QESCtRIPTION:
0---Q--�-+— Lot Block Subdivisio
l ` , 11 ice -
Tax Number Ys Section Section Township Range
II. TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY /7
lew building ❑Single Family ❑New County Resident
❑Addition ❑Multi-Family
Is this structure to serve the resid tial
❑Alteration number of units or commercial needs of those a ployed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Tri nt or
number of units Indian Island Facilities? I
❑Wrecking ubiie Home
❑Moving (relocation)
0 ther—Specify ❑YES ❑NO
_. ❑Foundation only
USE
OWNERSHIP
ull-time Residence
ElPrivate (individual,corporation,
nonprofit institution,etc.) Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local ov't.)
9 UBC OCCUPANCY GROUP: Cl Second Home: Future conversion to
COST permanent residence
(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
INO To be installed but not included school,secondary school,college,parochial school,parking garage for
i 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.
b. Plumbing l/fX7 0+ c. Heating,air conditioning r4 // V
(k)`4 d. Other (elevator,etc.) MCA — , G l 8� 1 oo s
,
• TOTAL COST OF IMPROVEMENT $ I V ((
III.SELECTED CHARACTERISTICS OF BUILDING -
1
PRINCIPAL TYPE OF FRAME I TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) ❑Public or Private
•Number of Stories
e ❑Wood Frame •Total square feet of floor area,
]Individual (septic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •
•Total land area,sq.ft.
•VjOther—Specify [ Public or`private company
/ i ' —jy I Individual (well PARKING
NUMBER OF OFF-STREET
C�!��fUr t/v \ PARKI SPACES
Enclosed
---.--' PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
> ❑Gas Outdoors
�( El oil RESIDENTIAL BUILDINGS ONLY
Electricity Number of bedrooms a
Coal { s.
TYPE OF CHANICAL
❑Other—Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION -
Name �y ,�/ �j Mailingail Address/—Number,street,city and State C ZIP code / C Tel.No.
1.Owner t3 (,( `t-r ! [ OI) /`7(1/l� /�J ) ! � l / 6c
vii m - f( r-��`) arms
2.
Contractor State License No.
3. —` —
Architect — —
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant... Address
!t yylrys) Applica 'on di.,te'
y
7/9740411<
'CANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
PPROVED BYc::-.3-L G /3 B/
,S'
F.FFER 'N COUNTY HE' TH DEPARTMENT
'ROVED Y: PERMIT FEE ISSUE DA E RECEIPT NUMBER
A • • - • V . .;`, 76,�
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JEFFERSON COUNTY The Printery—Port Townsend In H 0 (p/Q 2_
PLANNING&BM DEPT
• JEFFERSON COUNTY
FLOOD AREA CERTIFICATE
Federal Emergency Management Agency
National Flood Insurance Program .
DIRECTIONS
The responsible official shall complete those portions of
Section 1 where necessary information is available in the county
records. In the absence of sufficient data, a registered
professional engineer, architect, or surveyor shall complete this
section. Section 2 shall be completed by the responsible official .
Section 3 shall be completed by the building official .
SECT ION . 1 I
APPL I CANT: I _,__ (gam.
ADDRESS: : C- ,' 0,L J TA" �1'
TELEPHONE: (home) ?i Z--Z Z z. (business)
REPRESENTATIVE (contact) :`
ADDRESS:
TELEPHONE: (home) (business)
PROPERTY D SCRIPTION
ir
GENERAL LOCATION ( ��,+ ,-c 4;. ,,( P047-17
LEGAL:
Identifier Number:
Tax Parcel Number (from property tax statement) :
Real Property Description (from property tax statement) :
S c' —1 Zl( Ai , ie / z tom''
SITE'S DISTANCE FROM MIDWAY: 1' 1S tea 1
BASE FLOOD ELEVATION ( 100 year flood Level ) : A/a..3 i_ cY lFC
SITE'S ELEVAT I CN (grade Level ) : /V107--
A'
SITE ViITHIN FLOODV'JAY: /E- )Eta i c.h4 d ,e4-4 5 of--
PROPOSAL
' PROPOSED USE: ❑ Residential 0 Mobile Home 0 Commercial ❑ Industrial
0 Agricultural ❑ Storage ❑ Other (identify:
FLOODPROOFING MEASURES: YES NO
Landfill 0 0
Pole, pier, or pile 0 0
parallel foundation walls ❑ ❑
Extended walls and basement ❑ 0
Alternative ( identify) : ❑ ❑
i s-`'7C,"` or cG‘_)at eq.-3TA 'To R 3 Lv 4 c-rL L. cr
C k4ei-J v-04A, A/.fC..,.s.c,,___ a 1rA C- NJ k ;,,,c/g y K4 •�-04 N
"Jai- ..f ''fc,-r- re? r A,. ..
• 411
F. I .A. MAP
PANEL AND FLOOD SOURCE: ( ..),f y&L 4 `"- 1 G
ZONE:
ACKNOWLEDGEMENT
I verify the information provided in Section 1 is true and
correct.
(signature) (date)
REGISTERED PROFESSIONAL:
TITLE: LICENSE NUMBER:
SECTION 2 I
CONDITIONS OF APPROVAL
1 . The height of the Lowest floor shall be feet above
grade.
ACKNOL"JLEDGEMENT
The degree of flood protection required by this certificate is
considered reasonable for regulatory purposes. This certificate
approval shall not create liability on the part of Jefferson County
for any -FL damage that results from reliance oh this certificate.
te
z-e/ere
(signature) (d )
RESPONSIBLE OFFICIAL: /94-41-r4---+ V7--e' an (
TITLE: DEPARTMENT:
SECTION 3
AS-BUILT CERTIFICATION
. 1 verify that the structure complies with the conditions of the
flood area certificate.
(signature) (date)
BUILDING OFFICIAL:
rcI
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du
C/AZ 8 _
APPA0VEo
PAN JEFFEG ON COUNTY
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