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HomeMy WebLinkAboutBLD1989-00042 m.... , --- BUILDING PERMIT APPLICATION • Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310 N E I. LOCATION: geographic name S W SIDE OF ROAD FEET NE S W FROM INTERSECTION OF ROAD AND ___ROAD other specific location or landmark: See M a p LEGAL DESCRIPTION: 13 Rondlklay Acres Lot Block Subdivision RP002-342-036 34 30 2 West Tax Number Y.Section Section Township Range II.TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY New building Cj Single Family ❑New County Resident ❑Addition ❑Multi-Family Is this structure to serve the residential number of units or commercial needs of those employed El Alteration El Hotel,Motel,Dormitory at either the U.S.Navy's Trident or El Repair,replacement number of units Indian Island Facilities? D Wrecking ❑Mobile Home • ❑Moving (relocation) El Other—Specify El YES NO IN Foundation only For Modular home only USE OWNERSHIP DI Full-time Residence Private (individual,corporation, El Second Home: Recreation Cabin,etc. nonprofit institution,etc.) ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: R-3 ❑Second Home: Future conversion to permanent residence COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food • Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary To be installed but not included school,secondary school,college,parochial school,parking garage for in the above cost department store,rental office building,office building at industrial plant. • a. Electrical If use of existing building is being changed,enter proposed use. b. Plumbing c. Heating,air conditioning d. Other (elevator,etc.) • TOTAL COST OF IMPROVEMENT $ (. III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS 1 Masonry (wall bearing) •Number of Stories ElPublic or Private •Total square feet of floor area, Wood Frame Individual (septic tank,etc.) all floors,based on exterior 1 45 6 Sf Structural steel dimensions TYPE OF WATER SUPPLY 211, 365 Sf ❑Reinforced concrete •Total land area,sq.ft. CI Public or private company El Other—Specify NUMBER OF OFF-STREET ❑Individual (well,cistern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE CI Gas Outdoors (]Oil RESIDENTIAL BUILDINGS ONLY Electricity Zei Number of bedrooms CI Coal TYPE OF MECHANICAL Number of Full ❑Other—Specify bathrooms Partial 3/4 IV. IDENTIFICATION- • • Name Mailing Address—Number,street,city and State ZIP code Tel.No. 1. Kozy, Fern 210 Old School House Road, Gardner, Wa. 98382 797-7005 Owner 2. Evergreen Modular 10720 26th Ave.So. , Tacoma, Wa. 98444 (2061 Contractor Homes Inc. State License No. EVERGMH243C7 582-3423 3 Architect The owner of this building and the undersigned agree to conform to all applicable laws. §ignature pplicant Address Application date Jv'J, k) 1.L9 ,J QJ j Szlilic as Coriiractor 6/16/89 PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT APPROVED BY JEFFERSON COUNTY HEALTH DEPARTMENT APPROVED BY: PERMIT FEE ISSUE DATE RECEIPT NUMBER BUILDING OFFICIAL .f (3UI_ ING 'ERMIT APPLICATION • Jefferson County Building Department®P .O . Box1220*Port Townsend . WA 98368 S P E C T I I N ^,�yl/+I } J�„� (�. J /A 1��C a.a.f �` dl SPEC I F [ G LOCATION S 1 TE ADD ( /�C.(� ..1s J�rfJ{, �//Ij POSTAL DISTRICT & SUBDIVISION • %,,,./`t fill 1'� LEGAL DESCRIPTION LOT / 3 BLOCK `�c/DIVISION TAX NUMBER#rW2 ��/� / PARCEL NUMBER -3 7 2—I36 1 / 4 SECTION f , 036 PLANNING AREA /( SECTION 3 4( TOWNSHIP ,Te) NORTH RANGE e}4) F WM BUILDING INFORMATION B ILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE _ /� SINGLE FAMILY it NEW BUILDING MAIN FLOOR lys6 _S ❑ ODILE HOME ❑ ADDITION 2ND FLOOR ® MODULAR HOME ❑ ALTERATION BASEMENT -- O DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT ! GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION ' COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS ❑ COMMERCIAL MOBILE HOMES SIZE -----0 a@ $35 ❑ INDUSTRIAL 6 ❑ HOTEL/MOTEL/DORMITORY MAKE �� I�IJ $�Q NUMBER OF UNITS ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 UBC OCCUPANCY GROUPR IMPROVEMENTS IT076/ S , 0IARKET VALUE SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAME • ELECTRICITY ❑ COLLECTIVE SOLAR ® MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL 0 GAS 0 COAL ❑ REINFORCED CONCRETE ❑ OIL ❑/ OTHER - SPECIFY O MASONRY ( WALL BEARING ) DIMENSIONS 2 4"X 6© r ❑ OTHER - - NUMBER OF STORIES I TOTAL LAND ARE12t/) , DEPARTMENTAL REVIEW • HEALTH PARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS Co PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ® INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED ATE ❑ INDIVIDUAL WELL NUMBER OF EX!ST 1 NG BATHROOM PUD TYPE OF WATER SUPPLY a PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE El PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY s' 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 : DDRESS ZIP TEL. NO OWNER , lli /� � /.I ��s IMP /fa. MI � ... • IMME1111111111111 _.-_ - HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. -F APP !CANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH iffilii e2 l— 3 osa . 311', • 3// - /0- APP-• pipit PERMIT F S A P w `-, ' ' BASE FEE INSPECTION UN ; 3.5 BLDG SURCHARGE PLAN CHECK JEFFERSSON COUNTY ENERGY SURCHARGE j�� ` TOTAL PIANNINt&SLOG DEPT $ _ 911 NUMBER REFUND DATE T I'S,S ED BUILDING OFFICIAL . ! U ! 27uu -cam- - ►c, I1 j .TFW F;.TRF-1C)T'F C77 TTTa'T'Y RT7T T.T)T 74C� 'P Tr.RMT T Jefferson County Planning and Building Department Courthouse, 3rd Floor PO Brix 1220 Port Townsend , WA 98368 206-3A5-9141 PFRMTT # •RLD89-0042 DATE TSSTJFT). -0fi/2Fi/A9 SITE ADDRESS - 21 0 OLD SCHOOL HOUSE RD -(=,ARDNER, WA 98382 OWNER -FERN KOZY PHONE: MATLTNU ADDR : 21O OLD SCHOOLHOUSE RD !GARDNER WA 98382 CONTRACTOR . . !EVERGREEN MODULAR HOMES TNC. PHONE ! 582-3423 MATLTNU ADDR! 10720 28TH AVE. S. !TACOMA WA 98444 CONTR. LTC #: EVER0MH243C7 EXPTRATTON DATE! / / PARCEL NO. . . ! 002342036 LEGAL DESC. . !STR 34-30-02 WWM, TAX # LOT 13 . BLOCK DESCRIPTION OF IMPROVEMENT- ( ) Footing/Setbacks (Shoreline Setback) /Mobile Home Blocking: ( ) Foundation - ( ) Underground Plumbing/Underground Tnsuiationr ( ) Framing/Plumbing/Chimney! ( ) Tnsulatinnr ( ) Sheetror:k ( ) Sewage Disposal System Final ! ( ) Final /Occupancy Approval CALL 385-9141 24 HOURS TN ADVANCE TO SCHEDULE INSPECTIONS . 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