HomeMy WebLinkAboutBLD1989-00002 L�LDING , 'ERMIT APPLICATION
Jefferson County Buildi , DepartmentsP .O . Box 12201!"urt Townsend. WA 98368
LOCATION •
J SPECIFIC LOCATION' SITE ADDRESS :›W).7(n L" jl2 I 101 4 mil.
POSTAL DISTRICT r /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
'')
PARCEL NUMBER C I ' L} (') 1 / a SECT 1 ON
PLANNING AREA SECTION TOWNSHIP NORTH RANGE 1 (-i WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
XSINGLE
FAMILY '❑ NEW BUILDING MAIN FLOOR
MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME ❑ ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
0 COMMERCIAL MOBILE HOMES
❑ INDUSTRIAL SIZE �� X @ $3 5 /14) n( i
❑ HOTEL/MOTEL/DORMITORY YEAR 4 $ 16
NUMBER OF UNITS MAKE °ytJC . (�] $8 .
OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ ; $ ! 7) ���
SELECTED CHARACTERISTICS OF BUILDING 2g.„<._,yt ofg-y"a,1,p1` tea,,,
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
XWOOD FRAME 0 ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL Q GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES N TOTAL LAND AREA
DEPARTMENTAL REVIEW
HE4LTH ,DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS j
' � 0 PUBLICB OR PRIVATE NUMBER OF EXISTING BEDROOMS 'j
N I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM it
APPROVED DATE
,a INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . 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 MAILING ADDRESS ZIP TEL NO
OWNER ( ?�_
) 1�nn1,: 1 2,( 0 h .) , 1. n IP(1 L ri ) l - (-3,3 C») \732-
c--A'1 l P 1 A z ) a-1 1 8
CONT -- P1_
STATE LILENSE NO C
ARCH
THE OWNER OF TH S BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATUPIE OF A (CANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
Al, BY PERMIT FEES
iI: , C BASE FEE INSPECTION
A P
f ,/V -- 3. SO BLDG SURCHARGE PLAN CHECK
JAN 31989 //
1�� ,00 ENERGY SURCHARGE ) �.
JEFFER&Oil COUNTY4) `�s �' ( ) TOTAL
PLANNING &BLDG DEPT 9 I 1 NUMBER REFUND DATE 1 /D• cTE I S ED
BUILDING OFFICIAL
Q i 8/97
• - Ili
.3 FP T' -7:rr C7 Sri i 7 t 3 T 3 Ni f v r=s T i T i. ) T T c A 1R€P T.T c A°T- T C)i'
Jefferson County Planning and Rui lding department
Courthouse . 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-385-914 1
PERM T T it • RT,d8R-0002 DATE. RRCF.TVFT). - 0 i /24 fy 1
S T TF. AfDRFSS . 203E W VALT,R.Y RD
: HTMACUM. WA 98325
OWNER •TF.NN T S SH T FT,T)S PRONE.: 7324182 '
MA T T,TNC ADDR : 2036 WEST VALLEY Ri)
:CH i MACT1M WA 98325
CONTRACTOR . . :NO CONTRACTOR PHONE -
MAT T,TNO Adf•1R : .
•
CONTR. T,TC #- FXPTRATTON BATE -
ARCH T TR T/. . : PHONE:
f)FS T CNF.R
MATT,T Nil A nR -
PARCFT, NO. . . - 9O1 2240 i .1 HEALTH!
LFICAT, f)FSC. . : STR 22-29-01 WWM, TAX i RV: f)ATF -
LOT 05 , BLOCK SRORF.T,TNFS -
RV: T)ATF.:
fESCRTPTTON OF IMPROVEMENT ! single family shop/room over
RTiTT,DTNC TYPE •RFS BEDROOMS--- BATHROOMS-- MA T N FT, . . . . 0 sf
T Y PF. OF T MPRO VFMFNT-NFW FXTST. . 0 FX T:ST . _ f) 2Nf) FT. - 0 sf
GARAGE/CARPORT PROP. . • 0 PROP. . .• 0 3RT) FT, 0 sf
WOOdSTOVF • TOTAL. : 0 TOTAL. : O RAS F.MF.NT. . _ 0 sf
iiRC OCCUPANCY GROUP: SRWACE f)T SP. . -SRPTTC CARPORT. . . ! 0 sf
TYPE OF CONST WATER SUPPT,Y. •PWFT,T, GARAGE 0 sf
UNITS . : 0 STOR T F.S - 0 HEAT TYPES . . T)RCKS • U sf
T)T MF.NSTONS - MORTT.F HOME COrv1MF.RC T AT, . 0 sf
FRAME TYPE -WOOF) MAKE - YR : INDUSTRIAL ! 0 sf
FIST COST. $ - 0 S T%F.: RANK HT. . . : 0 ft
PRO.T CRP. . . 1 098 SR SETBACK: O ft
Owner/agent FFFS
Signature: type amount by date rerpt
None
Date:
Tssued By:
Date !
0 . 00 TOTAL
.3F. r+ t+W:Tic RC7,iv ,; C7,i.7i\i iT =1i7T i.i 3 i i'vC; R ;, rZ-iVi i -i
Jefferson County Planning and Riii iding Department
Courthouse; 3rd Floor
PO Box 1220
Port Townsend WA 9R388
206-3R5-9 i 4 i
PFRMTT # • RT,f89-OC)C)2 i)ATF T SSl1Ri). :O i i 23 i Fs9
STTF Ai11JRFSS : 2O3n W VAT,T,F.Y Rid
:CHTMACiIMi . WA 9R325
OWNER •T)F.NNTS SH T F.T,i)S PRONE! 7324182
MAT LTNC, AT)fR : 2036 WEST VALLEY Rn
:C R T MACiiM WA 98325
CONTRACTOR . . :NO CONTRACTOR PHONE !
MA'I IT,T NO AI)I)R 7
•
CONTR . LTC #: E PTRATTON T)ATF:
PARCEL NO. _ . : 90 i 2240 i . ,
T,F.CAT, T)F.SC . . -STR 22-29-01 wW'M. TAX #
T,OT O5 , RT.00K
T)FSCRTPTTON OF TMPROVRMFNT: single family shop/room over
) Footing/Sethac-ks (Shoreline Sethack) iMnhile Home Rinckinc:
) Foundation -
) Underground P i umh i na iiinderrrround insulation •
) Framina/PiumhingiChimnev:
( ) .Tnsulation -
) Sheetrock :
i ) Sewage T)i sposa i System F ^a i :
) Final /Occupancy ApprovalF-74) 71-z-
CAT,T. 385-9 i 4 i 24 HOURS TN ADVANCE TO SCHEDULE TNSPF.CT T ONS .
Office Hours 9 a .m. to 5 p.m.
inspector ' s Hours 9 - 10 a . m .
•
24 Hour Recorder for Tnspectinns.
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