HomeMy WebLinkAboutBLD1989-00004 BLODING , 'ERMIT APPLICATION
Jefferson County Building DepartrnenteP .O . Box 1220� 't Townsend. WA 983_68
LOCATION SPECIFIC LOCATION SITE ADDRESS 1 P)en I ^�
1 . 11 i(Otf e Cs d
POSTAL DISTRICT PT /SUBDIVISION p In-1-A(fl S P
Tx
LEGAL DESCRIPTION LOT 1 PARCEL NUMBERCK(��QI a 02)ot P,S DIVISION 1 / 4 SECTIONNUhIBER
PLANNING AREA SECTION cL) TOWNSHIP 30 NORTH RANGE ` l ,l ' WM
BUILDING INFORMATION
BUILDING TYPE ;TE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY EW BUILDING MAIN FLOOR
MOBILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE ,^f��}}K toy _____A @ $3 5
❑ INDUSTRIAL
YEAR VI AI( OF @ $ 1 6
O HOTEL/MOTEL/DORMITORY MAKE `P_P+-I nC)Od 0 a7 $8
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP] $ $
I i.,
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME XELECTRICITY ❑ COLLECTIVE SOLAR
/*MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
D. REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS �t �/�
• ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA A
DEPARTMENTAL REVIEW •
HEA TH DEffEfP TMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
l 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS .`1
5X I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE /❑ INDIVIDUAL WELL WADER OF EXISTING BATHROOM ,
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)__ __...- ate+
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
$.140
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 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER \�e P �' C11
R e,,,I : r,, r c . I a'3 r�Cif i n n c, „
CONT
STATE LICENSE NO ( .....
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
✓$1 TORE OF APPLICANT APPLICATION. DATE I NUMBERMBER I
CHECK NUMB R CASH
i I9 ���� �
APPROV D Y PERMIT FEES
A P Q ' 75 (00 BASE FEE INSPECTION
EB r —._.iR,� I 50 BLDG SURCHARGE PLAN CHECK
__6±2_
JEFFERSON C.OUNTY ENERGY SURCHARGE $ ) e) , SO TOTAL
N.ANM,ING &BLDG DEPT 911 NUMBER REFUND DATE 1 DATE ISSUE
BUILDING OFFICIAL /" -
`ro Hi3 (./i '7/43 `
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Jefferson County Planning and Hui idincr Department
Courthouse,, srd Floor
PC i Box 1220
Port Townsend, WA AR.SAR
20f -:385-9 1 41
Pr,RMTT # • Rr nRq-0004 DATM. T SS ED. :O2 %24%Rq
S T Tr. ADJDIRF.SS : 1 RR1 S DJ'I SCOV M.RY Rn
: PORT TOWNSF.ND . WA 9R3AR
OWNER •RANT)AT, THOMAS PHONE !
MATLINO AD)T)R : 1RC71 S DTSCOVF.RY Rf7
:PORT TOWNSEN) WA 9R3fR
CONTRACT(TR . . :NO CONTRACTOR PHONE:
MAT T.T NC ADDR •
•
CONTR . T,T C St! FXP T RA"I TON DATE :
PARCEL NO . . . : O0 i 2O3O1 R
LEGAL, DF.SC. . : STR 2O-3O-O 1 WWM. TAX
LOT 1 . BLOCK' , MATSON SHORT PLAT
i)fSCR T PTTON OF T MPRC/VH,MI+.iVT mobile home installation permit
) Footing/Setbacks (Shoreline Setback) /Mobile Home R i nck i ng:
i Foundation !
) Underground P i umh i ngi Tindernround insulation !
i Framing/Plumbing/Chimney!
t ) insulation !
) Sheetrncir .
) Sewage Disposal System Final :
) Final /Occupancy Approval !
CALL 85-9 1 41 24 FOURS TN ADVANCE TO SCHEDULE TN;Irr.c;'r i uNS .
Office Hours q a . m . to 5 n. m.
• inspector ' s Hours y - 10 a .m.
24 Hour Recorder for inspections.
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