HomeMy WebLinkAboutBLD1989-00044 AWING '`'ERMIT APPLICATION 411
County BuildingDepartmt'nt0P .O . Box 1220ePurt Townsend . WA 98368
Jefferson Cou y t
LOCATION /�
SPECIFIC LOCATION SITE ADDRESS LO I :�jOct-- a!'ar-(-) t� gdd
POSTAL DISTRICT ->T- /SUBDIVISION
LEGAL DESCRIPTION LOT
BLOCK DIVISION_ TAX NUMBERS.
OO ,
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PARCEL NUMBER I -2gL-1 � h`m 1 / 4 SECTION ,, , tt
PLANNING AREA SECTION .< IW
TOWNSHIPir NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY E NEW BUILDING MAIN FLOOR
❑ MOL7ILE HOME ❑ ADDITION
2ND FLOOR 1.0F - ,9C X . -1
❑ MODULAR HOME ❑ ALTERATION BASEMENT
�X PETA EPJATTACHED ❑ REPAIR CARPORT
7� GARAGE OOf2K.SHOf ❑ REPLACEMENT GARAGE c 4 X ,,,01
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES ,-�
❑ COMMERCIAL SIZE _.___y� @ $3 5
❑ INDUSTRIAL YEAR T� A@ $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE 54-1 0 4 @ $8 _7 r' '2G
NUMBER OF UNITS
(��(� /
❑ OTHER SPECIFY ESTIMATED COST OF y a $8 '`nI
IMPROVEMENTS TOTA FAIR MARKET VALUE i
UBC OCCUPANCY GROUP $ $ ��� �O !� -
11)..,1
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 12. WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL 'REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
O INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PR I VATE ( NAME OF WATER SUPPLY��
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 OF1MRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
MAILING ADDRESS ZIP TEL NO
NAME p'� T aa
OWNER `�, > f �9 (O8 -1, ,)'
L 4� - \1
1
CONT 5 -" ,
STATE LICENSE ND i r
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF APPLICANT APPLICATIO DATE j
RECEIPT NUMBER CHECK/NUMBER OR CASH
l -4 \K. OH i i '7" ,5 :3'rq 1 .' _/ (Q) %.
APPRO BY PERMIT FEES
A rAil:iv 0 E 0 .7 { to,; O BASE FEE INSPECTION
� . _1 . BLDG SURCHARGE PLAN CHECK
- FF'i., .
ENERGY SURCHARGE L
i ` � , ,l( , TOTAL
JEFFERSON COUNTY
piANNtN6&BLDG DEPT DATE REFUNDATE I TSU9
9 1 I NUMBER I � jj((�A,""--JJ�J�\
BUILDING OFFICIAL #
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_TFFF1~:R54C)74 C C)tTTI'V'ST r1 tTT T.T)T 1itc V 1F:RDAT f
Jefferson County Planning and Building Department
Courthouse, 8rd Floor
PO Box 1220
Port Townsend, WA 98368
20A-385-9 i 41
PRRMTT # •RT,f89-0044 DATF. T SSTTET). -tiff/01 /89
STTF. ADDRESS! 5fi 1 BLACK REAR RT)
PORT TOWNSRNT). WA 98368
OWNER -MATTR T CE LTNT)ELT, PHONE
MAILING AffR - 1 fi0 WTNT)SHTP T)RTVF.
PORT TOWNSENT) WA 98368
CONTRACTOR. . :NO CONTRACTOR PHONE-
MATT,TNO ADDR
CONTR. LTC #: FXPTRATTON DATE:
PARCF.T, NO. . . -O01 29401 5
LEGAL T)F.SC. . !STR 29-30-01 WWM, TAX # 32
LOT , BLOCK
T)ESCRTPTTON OF TMPROVEMENT: detached garage and workshop
( ) Fnoting/SPthacks (Shoreline Sethack) /Mohiie Home Rlnckincj-
( ) Foundation !
( ) Underground Plumhing/tlndPrcrrnund Tnsuiatinn -
( ) Framing/Piumhing/Chimney:
( ) Tnsulatinn •
( ) Sheetrock-
( ) Sewage Disposal System Final
( ) Final/Occupancy Approval :
ri/VA , .47// I77qf
02'2
CALL 885-9141 24 HOURS TN ADVANCE TO SCHEDULE TNSPFCTTONS.
Office Hours q a .m. to 5 p.m.
Inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Tnspectinns.
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