HomeMy WebLinkAboutBLD1989-00007 [•DING 'ERMIT APPLICATION ill
Jefferson CountyBuilding Department•P .O . Box 12204wort Townsend . WA 98368
_
LOCATION '
SPECIFIC LOCATION SITE ADDRESS 7t3 ( `! C}ICC tf� •
I .).(tt j
POSTAL DISTRICT V1 /SUBDIVISIO
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER ( )( (`)7L4 (12L4 1 / 4 SECTION
PLANNING AREA '7-,^ SECTION TOWNSHIP 3C5 NORTH RANGE 1 Li. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ( ' NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
DETACHEDi/ATTACHED ❑ REPAIR CARPORT
GARAGE ( PLUv�\0l.. `+-- 0 REPLACEMENT GARAGE 2,2 '`���
❑ WOODSTOVE ( -Gti� 7' 0 WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES SIZE _____16 $35
a
❑ INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY $8
NUMBER OF UNITS MAKE - `1
'
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL,., FAIR, MARKET VALUE
UBC OCCUPANCY GROUP) $ $ Li Cj'f-;9
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
Q� WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
1 ❑ OTHER NUMBER OF STORIES TOTAL LAND AREA `-,y ,
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS
�/" 2k. `�J� ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
""--- I ND 1 V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BAT(#ROOM '
APPROVED DATE r{ I ND I V I DUAL 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
QL 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
�l NAME Lc
� 1 �p 1 MAILING ADDRESS �/''(�, ZIP P T E��LyC�,{yN O
OWNER (`^)E:ne ��,yy�'� �fQ ( 1O La WI-E,11Ce ) {.�_— 1`' 563(-)�.- I F��
AfrowiF
CONT &_rlc,IvrPir O IJ �f) 94t P -53'1 I
S ATr' L 1 SE
1UeKSCAE ia.1(-.
ARCH
THE OWNER 0 THIS BUIL N •• THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA OF APP CANT APPLICATION DAC�T'E RECEIPTy'NUMBER CHECK N`U�{M/BER/OR CASH
.....----e-------- O---3 i 1 .(' / ,--3 , •
APPR�VE•���BP j PERMIT FEES„
p p�• � 1 II 7•I V�BASE FEE INSPECTION
---� 3 . ,L5O BLDG SURCHARGE PLAN CHECK
AR 2 1989 ` ENERGY SURCHARGE $ 1 aC_ L C\ TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEPT
-
911 NUMBER REFUND DATE DAT4YISS
BUILDING OFFICIAL
Z W/D 3 /a0/ ,
# •
I\..)CY-/6-- -1-----i
<----- bufi/
, : `•
.5-
,...
..., , ,.,
,--3/•4 4‘ ‹-e "-0-.. Cir,..
4' `*- *-r• --r• •
-70.-
•,5 a v
3a
lif \
I 1
l'A
!-3 1 $ ,
, ,••• ' \.%
005A?,05-,i 7-
!1. r
I
..
11
8ee_i _. i
. .
. i
. I I
1 :
I I
I
I '
I ,
I
I ! .
1 i
I I
i 1
. f
i I
I 1
• I I
1 !
I ;
I 1
. I
i 1
i
i
i
I
I I
. I
I -1,
i/ -------
et'ei
_TF.FFFF?SC77V C;C)T71V977.1r FRTIT T.TDT 1VC.3 PF.RIVPT 'V
Jefferson County Planning and Ruiiding Department
Courthouse; 3rd Floor
PO Box 1220
Port Townsend, WA 98368
20f -3R5-91 41
PFRMTT # -RT,DR9-0007 DATE TSSIIFD. 7 03/24/r39
STTF ADDRESS - 1 90 T,TNDSEV T,N
! PORT TOWNSF.ND. WA 98388
OWNER -GFNF AMUINDSON PHONE. • 385-3993
MATT,TNO ADDR- 21 40 LAWRF.NCF
PORT TOWNSFND WA 9836R
CONTRACTOR . . !FRTC TVFRSON PHONE• 385-5344
MATLTNO ADDR : 420 24TH ST
PORT TOWNSF.NT) WA 953fi5
CONTR . LTC #: TVF.RSC*1 21 T,2 FXPTRATTON DATE ! / /
PARCEL NO. . . - 001074024
LEGAL DFSC. . : STR 07-30-01 WWM, TAX #
LOT . BLOCK
T)F.SCRTPTTON OF TMPROVRMRNT- detached garage plumbing and laundry
( ) Footing/SPthacks (Shoreline SPthack) /MohilP Home Blocking!
( ) Foundation !
( ) Underground Plumbing/Underground Insulation :
( ) Framing/Plumhi.na/Chimney:
( ) Insulation :
( ) Sheetrnck-
( ) Sewage Disposal System Final !
( ) Final /Occupancy Approval :
CAT,T, 355-91 41 24 HOURS TN ADVANCE TO SCHEDULE INSPECTIONS .
Office Hours 9 a .m. to 5 p.m.
Tnsnectores Hours 9 - 10 a .m.
24 Hour Recorder for Tnsnectinns.
JEg-fERSuN COUNTY
PLANNING&BLDG DEPT
1..\\a\
�tqf
S/sue
tcOaTavvvtar
Et8
gs't 1
A) A