HomeMy WebLinkAboutBLD1989-00019 1
' 'ILDING , 'ERMIT APPLICATION
Jefferson County Buildl� lg Department�P .O . Box 1220 ort Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS.. f `i
POSTAL DISTRICT /SUBDIVISION u iL`"tLJ. , _
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER civ ,•S>`-R(o(, (e' 1 / 4 SECTION
SECTION TOWNSHIP NORTH RANGE / WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOOILE HOME 0 ADDITION 2ND FLOOR
O MODUT:A'R,\HOME ❑ ALTERATION BASEMENT
DETACHED'/ATTACHED ❑ REPAIR CARPORT
ACE 0 REPLACEMENT GARAGE (0 .
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL
0 INDUSTRIAL SIZE ,�� @ $35
❑ HOTEL/MOTEL/DORMITORY YEAR ] `� $ 16
NUMBER OF UNITS MAKE /r}^�^�'�]'(�] a $8 C../??
O OTHER - SPECIFY ESTIMATED COST OF `� @ $8
IMPROVEMENTS TOT toMARKET VALUE
UBC OCCUPANCY GROW, $
/ $ � y
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SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
OOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR �..-
❑ MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLA
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ Q.*rER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSION --"'-- -"
❑ OTHER - NUMBER- STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS'
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXIST)-NG-BATHROO�...l
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER- SUPPLY1_
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 0 YES 0 NO
�.- IDENTIFICATION
+�-� N/ApM�E11 nn � 33''F� /`�, MAILING ADDRESS ZIP TEL` NO
OWNER \ "t//v 4'ls� 0 ,a`) g `3 le0 ( 2 l 7
CONT
ffTATE LICE NO I
ARCH
OWNER OF THIS BUTA.DING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
\',(G TURE OF AP ICA T APPIJICA]f?Q ATE RECEIPT NUMBER CHECK NUMBER OR CASH
/ A RO D BY PERMIT F ES
1 , BASE FEE I NSPECT I ON
N8 3/ SU BLDG SURCHARGE PLAN CHECK
JEFFERSO COUNTY ENERGY SURCHARGE s S , 5Z:) TOTAL
PLANNING&BLDG DEPT
8 1 1 NUMBER REFUND DATE � DAT���� ()�D
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BUILDING OFFICIAL I
_3F r r P C T\T C C t7Tvm V RT7T T",RT TV CII r=-FRT..7T 9'
Jefferson County Pinning and Building Department
Courthouse, 3rd Floor
PO Rnx 1220
Port Townsend, WA 98.16R
206-3R5-9141
PFRMTT # • RT,ilis9-001 9 DATF. T SSUF _ :0 i i 09IR9
S T TF ADDRFSS - 50 TALA SHORE DR
-PORT T,UT)T,0W. WA 9R385
OWNER • JAMF.S WASTTNCS PHONE: R59-2784
MATT,TNG ADDR : 20105 93RD PT. S
KFNT WA 95031
CONTRACTOR. . :NO CONTRACTOR PHONE :
MATT,iNC ADDR
CONTR . T,TC #: FXPTRATTON DATE
PARCFT, NO. . . : 99820012O
T,FCAT, DF.SC. . :STR 22-2R-01 FWM. TAX #
LOT 22 BLOCK
DFSCRTPTTON OF TMPROVF.MFNT: detached garage
( ) FontinglSethacks (Shoreline Sethack) Mnhiie Home Blocking
( ) Foundation :
( ) Underground PiumhinglUnderaround Tnsulation :
( ) Framing Plumhing/Chimney.
( ) Tnsuiation •
( ) Sheetrock:
( ) Sewage Disposal System Final :
( ) Final /Occupancy Approval :
CALL 385-9141 24 HOURS TN ADVANCE TO SCHEDULE. TNSPFCTTONS .
Office Hours 9 a .m. to 5 p.m.
Inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Tnspections.
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