HomeMy WebLinkAboutBLD1989-00023 [3lDING 'ERMIT APPLICATION 40
efferson County Building Department.P .O . Box 1220•Port Townsend. WA 98368
LOCATION //(� i •
SPECIFIC LOCATION SITE ADDRESS ,- 7 . 6 40�/
POSTAL DISTRICT_ /SUBDI IS10 #
LEGAL DESCRIPTION LOT BLOCK } DIVISION TAX NUMBER
PARCEL NUMBER (Cc 2. /51 OO S 1 / 4 SECTION ' �}PLANNING AREA\ SECT ION/_ �/ s , TOWNSHIP 3D NORTH RANGE L J WM
BUILDING INFORMATION ***✓✓✓
BUDING TYPE TYP OF IMPROVEMENT SQUARE FOOTAGE//
gv'SINGLE FAMILY NEW BUILDING MAIN FLOOR
❑ MOE11 LE HOME 0 ADDITION 2ND FLOOR J 2 (j
.e,
❑ MODULAR HOME ❑ ALTERATION BASEMENT
0 DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES r / 0 q
0 INDUSTRIAL SIZE ��' � $35 /���
0 HOTEL/MOTEL/DORMITORY YEAR 16 G' f/
NUMBER OF UNITS MAKE VJ $8 J!(o
❑ OTHER SPECIFY ESTIMATED COST OF @ $8
IMPROVEMENTS $O�pL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ 1 GA. iJ�
SELECTED CHARACTERISTICS OF BUILDING
PR CIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME �❑ ECTRICITY ❑ C LECTIVE SOLAR
0 MANUFACTURED 1 W ODSTOVE PASSIVE SOLAR
❑ STRUCTURAL STEEL gvbAs 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW /
HEALTH DEPART E T TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS /
'` bk_ }j1 S(Z 2A vl ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
1 ND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM /
APPROVED DATE
❑ I ND I V 1 DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PkJBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE :0//PRIVATE ( NAME OF WATER SUPPLY
L,Zidi/j.(1Z.ai_A/V._)
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 ❑ YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
(Il.pe, 960
� coin l- Y /9()q
CO NT ,
3•r AT li
E L I CENS4 NO I
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S-j...CiL(„ATURE O PL I CANT) APP CAT TE RECEIPT N ER CHEC Uhl �R OR CASH
I/4i- ' /1 I E � I Z
AF�PROI• ` 1 7
Y\ FE J
1 1 4(i;
� � BASE FEE INSPECTION
1 I D BLDG SURCHARGE PLAN CHECK
Dr) ENERGY SURCHARGE $ 7)
JEFF MI BN 11GOOP NTY TOTAL
Pl'I PM�V`1R3GH1t3E--0er 911 NUMBER REFUND DATE j DA I
BUILDING OFFICIAL � (�y
I r ` BLi
A
_-T r.WF+-F F s C)1\T (CiTIN Pirr FViJT i.i )T 1VC1-1 rT'.iRMT T
.Tef ferson County Planning and Ru i i d i na Department
Courthouse, 3rd Floor
Pit Box 1 2 2 0
Port Townsend , WA 9R3AR
20f -3R5-9 141
PF.RMTT # • RT,fR9-Q023 DATR TSSURD. : t74/03/R9
S T TR ADIJRESS : 2 7 1 BAY R'I i1CF, CT
:PORT T OWNSFNV . WA 9R368
DWNF.R J1OHN T,TCZWTNKO PRONE :
'viAT T,T NC A DR : 3 i 97 CAPR GRORC F. RDJ
:PORT TOWNSENT; WA 9836R
";ON TRAC TOR. . :Nil CONTRACTOR PRONR •
4ATT,TNC ADDR :
ONTR . T,T Cs #: F.XP T RAT T OJIV' i)A i F.c
•
�ARCRT, NO. . . :OO2i31O03 •
_-....
%F.CA T, DRSC. . : STR i 3-3O-02 WWM. TAX #
',OT , BLOCK
)RSCR T PTTON OF TMPROv F.MF.NT: single family residence
i Footing/Setbacks (Shoreline Sethack) /Mobiie Home Rincking:
i Foundation :
i Underground P i umh i no/tindergrround insulation :
i Framing/Plumhincr/Chimney:
•
i Insulation :
1 Sheetrock:
i Sewage Disposal System Final :
r i na l uc.upancy A ar���'-_._
CALT, 3R5-9 i 4 i 24 HOURS TN ADVANCR. TO SCH DULF. T NSPF.CTTONS .
Office Hours 9 a .m. to 5 p.m.
Inspector ' s Hours 9 - 0 a .m.
24 Hour Recorder for inspections .
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ND 7-84