HomeMy WebLinkAboutBLD1989-00046 '•LDING`, 'ERMIT APPLICATION 411
•
Jefferson County Building Department•P .O . Box 1220.I'ort Townsend. WA 98368
rLOCATION
SPECIFIC LOCATION SITE ADDRESS r� cam' 22(' �
POSTAL DISTRICT k i /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVI SI9N TAX NUMBER
PARCEL NUMBER 47
l O Lf 1 / 4 SECTION
PLANNING AREA SECTION C7 TOWNSHIP t-9 CY NORTH RANGE 1 WM
BUILDING INFORMATION •
B ILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
* ' SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
!II ODILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
0ETACHED/ TTACHED ❑ REPAIR CARPORT //
GARAGE c 5�_ t)(,Skf L.
' 0 REPLACEMENT ` GARAGE rQ '
❑ WOODSTOVE 0 WRECKING/REMOLITION ICOMMERCIAL
❑ MULTI - FAMILY 0 RELOCATI N/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE H MES
❑ COMMERCIAL SIZE
t], @ $35
❑ INDUSTRIAL YEAR Q{J q� $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE r kk)ICI a@ $8 /(nth
NUMBER OF UNITS
❑ OTHER - SPECIFY CS IMATED COST OF 0 @ $8
I PROVEMENTS TOTAL ',FAJ I MARKET VALUE
UBC OCCUPANCY GROt /" $ 14/1�UU J
/ -
SELECTED CHARACTERISTICS OF BUILDING
P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 AS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 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 EX STING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ I ND I V 1 DUAL WELL _ NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME,. 'O WATER SUPPLY
eaes��iee�aw�esie�emee
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
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APPROVED DATE / BANK HEIGHT SETBACK
PUBLIC WO S DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
PPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION - &5/ ,' 6(� JA�� ='gy p iL_e6
NAME MAILING ADDRESS ZIP TEL NO
OWNER Qc)ctirv2
CONT .. /+
bTAlk.. LICENS . NU 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
§IGNATURE OF APPLICANT APPL CATIO ATEkw '
CEIPT MBER CHECK NUMB OR CASH
41_ 13r, l' S :mil J I 4I3/
APPrO D BY PERMIT FEES
1 Lt;�� j
A P 1� O . E t, 171 , BASE FEE INSPECTION
A A 3,�� BLDG SURCHARGE PLAN CHECK
G�n? : 119@9 ��
' ENERGY SURCHARGE $ / / fr S L TOTAL
PLANNING&BLDG DEPT
911 NUMBER REFUND DATE 1 DA % 1 ZSU�F},D
BUILDING OFFICIAL (O (�J, c:i-
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Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend , WA 9A368
206-38.5-9141
PFRMTT # •RT,DA9-0045 DATE. TSSTTF.D. - 0Fi/01 /A9
STTF. ADDRF.SS : 651 R MARROWSTONF. RD
NORDT.AND . WA 9A358
OWNER DTTANF. HA(;FRTY PHONE: 385-7294
MATLTNG ADDR - Fi51 F. MARROWSTONF RD
-NORDT.AND WA 9835A
CONTRACTOR . . -NO CONTRACTOR PHONF.-
MA T L T NC A DDR -
CONTR . LTC #: F.XP T RATTON DATF.
PARc FT. NO. . . -921 092024
LEGAL. DFSC . . - STR 09-29-01 FWM, TAX #
LOT . BLOCK
DRSCRTPTTON OF TMPROVF.MF.NT- detached naraae
( ) Fonting/Sethacks (Shoreline Sethack) /Mohile Home Blocking-
( ) Foundation -
( ) TTnderaround Plumbing/Underground Tnsulation -
( ) Framing/Plumhinn/Chimney-
( ) Tnsulation -
( ) Sheetrock -
( ) Sewage Disposal System Final -
( ) Final /Occunancv Annr val -
CAT,T. 385-9141 24 HOURS TN ADVANCF TO SCHEDULE TNSPFCTTONS .
Office Hours q a .m. to 5 n.m.
Tnsnector ' s Hours q - 10 a .m.
24 Hour Recorder for Tnsnections.
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