HomeMy WebLinkAboutBLD1989-00016 BUii )G 'ERMIT APPLICATION
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Jefferson County
BuildingD artment•P .O . Box 1220•Port Townsend. WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS /h / _Sr"�/.<j" `T Z
POSTAL DISTRICT_, 4 /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER f7-'/ 0/0// 1 / 4 SECTION
PLANNING AREA SECTION <, TOWNSHIP `'s. NORTH RANGE - WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
' SINGLE FAMILY 13- NEW BUILDING MAIN FLOOR /S/.>
❑ MOP. I LE HOME 0 ADDITION 2ND FLOOR S-9/
O MODULAR HOME 0 ALTERATION BASEMENT /JCS
O DETACHED/ATTACHED 0 REPAIR CARPORT �
GARAGE ❑ REPLACEMENT GARAGE �' 2.6C
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES /p /
❑ COMMERCIAL SIZE ✓C�>, i-� f�1 '�, $3 5 L 3,I/5
O INDUSTRIAL
YEAR S/ V Li a@ $ 1 6 79SOV
O HOTEL/MOTEL/DORMITORY MAKE /W8 $8� 6 66V
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF �* 0 @ $8 Z Z VOil
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU $ $
-3 {3 z6_.
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME r
1101 \WOOD FRAME b LECTRICITY 0 COLLECTIVE SOLAR
❑MANUFACTURED A WOODSTOV , , 1 ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS Li
O REINFORCED CONCRETE ❑ OIL T ❑ OTHER SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES �" TOTAL LAND AREA /6( tCaS -
DEPARTMENTAL REVIEW L,' ` C
HEALTHWPAR MENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
6 ❑ PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DAT I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD 'TYPE OF WATER SUPPLY
❑ PUBLIC `( NAME OF WATER SUPPLY]_
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY }rw ' we.
14
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PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O 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 0 YES ❑ NO
IDENTIFICATION
NAME , MAILING ADDRESS ZIP TEL NO
OWNER O ' - I t=/10 L0.n•Sy [Y 3 S U -3 c.
CONT
,- "STATE Li-CEASE N-6
ARCH Il
f
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA Uir2E OF P L ^
ANT APPLICATION DA " RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED II3Y PERMIT FEES
4:1 ' ���- BASE FEE INSPECTION
E �1(1All , ____ -0-(-) BLDG SURCHARGE PLAN CHECK
1[ ' ' 89 �.� " ° ENERGY SURCHARGE 2 ,� P6 Q- TOTAL
JF. QUNty P PLANAIIhGFFFRepN$`L:C&jrP7 9 1 1 NUMBER REFUND DATE DAT IS
BUILDING OFFICIAL y /
24 Hour RPr.nrdeT for inspections.
.TF. r+F F.R: C?rN t-)TT1 m-Sr 'FITTT T.f3T TJC . F.F?T'1T
Jefferson County Planning and Building Department
Courthouse, 3rr3 Floor y
PO Box 1220
Port Townsend, WA 98388
208-385-9141
PFRMTT # -RT,i1R9-OO1 A DATE TSSURD. -04/1 1 /89
S T TF A DRESS : 1 On 1 SCHWARTZ Rn
-NORDT,AND. WA 98358
OWNFR • fAVTf PRATT PHONE.: 385-4f 99
MATT,TNO AnnR , PO rBOX 122
NORDT,ANil WA 9835R
CONTRACTOR . . -NO CONTRACTOR PHONF -
MA T T,TNC AffR
CONTR . LTC #: F.XPTRAT T ON flATF •
PARCFT, NO. . . - 021 04O1 1
T,FGAT, fF.SC. . -STR WM, TAX #
LOT RT,OCK
7FSCRTPTTON OF IMPROVEMENT- single family residence
( ) Footing/Setbacks (Shoreline Setback) /Mobile Home Blocking:
( ) Foundation :
( ) underground Plumbing/Underground Tnsu l a t i on :
( ) Framing/Plumbing/Chimney:
( ) Tnsulation :
( ) Sheetrock-
( ) Sewage 'Disposal System Final :
( ✓) Fi na i /Occupancy Approval : � _� 4e_a y- c't
CALL 385-9 1 41 24 HOURS TN Ai)VANCF TO SCHFfUT,F T NSPFCTTONS .
Office Hours 9 a .m. to 5 p.m.
Inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Inspections.
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