HomeMy WebLinkAboutBLD1989-00003 "'ILDING ;'ERMIT APPLICATION
Jefferson County Build „ DepartmentoP .O . Box 12201F
!g ort Townsend, WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS ?,et ik•Ut_.c� _. L.�-'
POSTAL DISTRICT /SUBD I V S I ON (0)110/Pa("J 1/4(% ,_
LEGAL DESCRIPTION LOT / ' BLOCK✓ DIVISION TAX NUMBER �'w
(PARCEL NUMBER 31O7 1 / 4 SECT I ON
12
SECTION - 1�� TOWNSHIP Cr NORTH RANGE /(.i ) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE/
Q. SINGLE FAMILY "
-- a NEW BUILDING MAIN FLOOR /O7 /
❑ -MODILE HOME 0 ADDITION 2ND FLOOR /0. 7 C/
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE .j
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL S MOBILE HOMES 3 5 ,7�� i 0
❑ INDUSTRIAL
6222„0❑ HOTEL/MOTEL/DORMITORY YEAR p� $ 16 / L
NUMBER OF UNITS MAKE S 7,5 �5 @ $8 ! alk" ,
❑ OTHER - SPECIFY ESTIMATED COST OF 0 a@ $8
IMPROVEMENTS TOTAL-,FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $ c7 r 37t
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
-`[T< WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) ! DIMENSIONS
•
❑ OTHER - NUMBER OF STORIES_ TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HE T DEPARTMENT ( TYPE OF SEWAGE DISPOSAL MBER OF PROPOSED BEDROOMS - '
0 PieB. . or: nR I v T_. ., 1
u •,..•, c •••• ;-... v... c �i. 5_ 7+1:.Jcrt OF cxe nT i:*.li ii LT/tiCsnnS
y
�9 ! N D 1 V 1 D UA L ( S E P T I C�v NUMBER OF PROPOSED BATHROOM !..
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
a.mmer
PUD TYPE OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY), 0.4 t410o _ -
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
10 YES NAME OF ADJACENT WATER BODY
/ //1\
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD f i;-?,e-e~ Z!i'ivC--
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME ' To %y-��,,� MAILING ADDR{ESSZpIPqTEL NO
OWNER 1 �\,., }�; `../'-' 48 1 1._ rs„ O 32 ( 7'3 Z.
IC to if .7_Inc''c
CONT I
STATE LICENSE NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S IGNAT OF AP ICANT.. APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH. ... .
e -0 7• --6- •3 _ l /l C
APP V D BY PERMIT FEES
Cr.r 5-7• -)BASE FEE INSPECTION
3: 5 U BLDG SURCHARGE PLAN CHECK
FEB 1 4 198' //C:CAD ENERGY SURCHARGE (./6SS�� 1 TOTAL
JEFFERSON COI. P L
MAt'NAr. &9l0 ,, _ . _ _, 9 1 1 NUMBER REFUND DATE DATE ISSUE
BUILDING OFFICIAL 02J 5
1 4
C 1 l / V
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Jefferson County Planning and Rui ininn T)Pnartment
Courthouse . Srd Floor
Pi) Box 1 220
Port Townsend , WA 548 388
206-3R5-q i 4 i •
PF.RMTT # •R n8q-0Ccy T)ATF T SSTTF.T). : 02 I i 4/Ra
STTF. AT);)rrr.» : 30 SPRTTCF T.N
:PORT HAFT SOCK. WA q)83:39
0WNF.R •RORF.RT KT ATT • PHONE! 732-4g0g
MAT I.1 NG AT)1)R : Pt) BOX 484
PORT" HAT)ocK WA 'r-1R3:39
CONTRACTOR . . :NO CONTRACTOR PHONE.!
MAT LING AI)fR :
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CONTR . T,TC #: FXPTRA"TTON T)ATF :
PARCRL NO. . . : ygRAOOOO7
T.FGAT, T)FSC. . : STR O2-2q-0 i WWM. TAX
TOOT 7 BLOCK
FSCRTPTTON OF TMPROVWMF.NT: single family residence
) FontinniSethar.ks (Shoreline Sethark) iMohi ie Home Blocking:
( ) Foundation :
) Underground Plumb i ng/TTndercrround insulation !
) Framing PIumhinniChimnev•
) insulation!
) Sheetrnr*
) SP.Wafge I1 i snosa l System Final !
( ) Final/Occupancy Annr C7a f C --,.-
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aim //5? _
CAL,L 385-q1 4 i 24 FOURS T N AT)V'ANCF TO SC- )TJT,F T NSPFCTTONS.
Office Hours q a . m. to 5 p. m .
inspector ' s Hours q - ill a .m.
24 Hour Recorder for inspections .
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