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HomeMy WebLinkAboutBLD1989-00031 .TF: r-F:RF;i,T\3' C77 (73T31Ni `T v i�iTr i T.i)T TTC r'�- F.F TviTI -i- Jefferson County Planning and nii i i d i nor Department Courthouse,. 3rd Floor Pi) i=Sox 1 %%11 Port Townsend, WA 98368 20 -3R5-q 1 4 1 PF.RMTT 7' • r')LIJ89-O031 DATF TSS JFD. : 07/09/M9 STTR AIJIJttr.nn - %340 F MARROJWSTOJNF. RI) •.iORDLANf . WA 98358 OWNFR .JOHN nONFY PHONF: _. MA'I T, I Nh Ai1DR.,: 2-340 F. TVIARROWSTONF RD N11R LAN1) WA 98358 CONTRACTOR . . -NO CONTRACTOR PHONF TVIA TT, INC ADDR : • CONTR . T.T C: #: FXPTRATTON DATF PART;FT. NO. . . - a76200)70 T.F.OA T nFSC . _ :STR 33-30-01 FWM TAX # LOT 4ti oC:K , DFSC;R T PT T O N OF T J•IPROV RMF.IY T ' single family residence Foot i no/Sethac-ks (Shoreline Setback) /iVloh i i e Rome. 1S i ock i nci : i Foundation : 1 Underground Plumbing/Underground insulation : i ) r minor/Piumhincr Chimney: 62A, 2r 1 • 3--1(e'C� Ot''.' Va.? trboi.,nr�. i Sheetrock- -- � � 1 Sewage Disposal System Final : i r i na i /Ciccunancv Approval CALL 385-91 4 1 24 HOURS TN ADVANCF TO SC;HRDUT,F. TNSPRCT T ONS . Office Hours 9 a .m . .to 5 p.m. inspector ' s Hours 9 - 10 a .m. 24 Hour Recorder for Inspections_ r 1 f3U]•ING` 'FRMIT APPLICATION fferson County Building DepartmentoP .O . Box 1220'Port 1 id. WA 98368 LO AT I(IN � � SPECIFIC LOCATION SITE ADDRESS /40 _. 1b }17Cra)S POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT 1BLOCQK ` DIVISION TAX NUMBER PARCEL NUMBER -(7LY eD 706 1 / 4 SECTION PLANNING AREA SECTION TOWNSHIP �& NORTH RANGE WM BUILD G INFORMATION BUI ING TYPE TYP OF IMPROVEMENT SQUARE FOOTAGE >` SINGLE FAMILY EW BUILDING MAIN FLOOR �` ` ❑ MOBILE HOME 0 ADDITION 2ND FLOOR / 12 ❑ MODULAR HOME 0 ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE 7(,,-) 4 ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES p ❑ COMMERCIAL SIZE 6 =-71Li @ $3 5 53�C?n ❑ INDUSTRIAL YEAR P-`// @ $ 1 6 �o7-Y� ❑ HOTEL/MOTEL/DORMITORY MAKE `{ ,-f, @ $g NUMBER OF UNITS ��f!'/� ❑ OTHER SPECIFY ESTIMATED COST OF t a1 $8 0 g IMPROVEMENTS TOTAL FAIR ARKET VALUE UBC OCCUPANCY GROUP $ $ `, ly SELECTED CHARACTERISTICS OF BUILDING PR CIPLE TYPE OF FRAME PRI IPLE TYPE OF HEATING FUEL WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR ❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS 0 COAL ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE O SEWAGE DISPOSAL NUMBER OF PROPOSED BEDi400MS3 O P LIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 1 L V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPR VEi DAT INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY O PUBLIC ( NAME OF WATER SUPPLY) -__,. APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WI IN SHORELINE JURISDICTION YES NAME OF ADJACENT WATE 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 ti ..ja.)n i I I , ,,2--2-3/.G 644 0A-f-- a de2_0 , . CONT r 7 T ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. OF PLICANT _ APP ICA 10 ATE RECEIPT NUMBER CHECK NUMB OR CASH 416 . r t ire• MI ( 7a R APPROVED BY P MI FEES �� A P ® , o�a BASE FEE INSPECTION Y 8 �� BLDG SURCHARGE PLAN CHECK ' / a ENERGY SURCHARGE ..C5(p//' �-6 TOTAL Etdli fit, ,;I's� er"DEFT 9 1 1 NUMBER REFUND DATE I g ( jS/(BUILDING OFFICIALIlk 7� ' �4 /6)9 + SHORELINE SETBACK EVALUATION APPLICANT : ADDRESS: �� `(0 41/1.t4 7 TELEPHONE: (home ) (business ) PROPERTY DESCRIPTION PROPERTY SITE NUMBER: LEGAL: Owner : Address : Tax ParceL Number: ReaL Property Description: ADJACENT WATER BODY: EVALUATION i BLUFF HEIGHT: _ SOURCE: / BLUFF STABILITY: S l_f__ SOURCE: CZ if D STANDARD SETBACK: feet This minimum setback shaLL be measured from the ordinary high water mark to the most waterward edge of the proposed structure . BLUFF SETBACK: feet This minimum setback shaLL be measured from the bank' s edge to the most waterward edge of the proposed structure . 0 AVERAGE SETBACK: feet This minimum setback shaLL, be measured from the bank 's edge to the most waterward edge of the proposed structure . This setback is based on the foLLowing caLcuLations of adjacent residentiaL structures . Right House (facing waterward) : • Setback from bank or ordinary high water : feet • Distance to the proposed structure: feet Left House (facing waterward) : • Setback from bank or ordinary high water : feet • Distance to the proposed structure: feet 0 SUBDIVISION SETBACK: feet This minimum setback shaLL be measured from: This setback was estabLished by the approvaL and fiLing of the pLat. VARIANCE REQUEST: 0 APPROVED 0 DENIED DATE: ACKNOWLEDGEMENT The above evaLuation was determined on information provided by the appLicant. 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