HomeMy WebLinkAboutBLD1989-00057 46
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Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend , WA 98358
206-385-914 1
PERMIT # • RT.fR9-005 7 DATF. TSST1FTi. - O7/On/S9
STTF. ADDRESS : 9 i BLAZE. TRATT.
PORT TOWNSF.ND, WA 9836A
OWNER • TTM FAIOR PHONE. ' 385-3895
MATLTNO ADT)R :4953 OLD (IARDNF.R
: PORT TOWNSEND WA 98368
CONTRACTOR . . :NO CONTRACTOR PHONE-
MAT T.'I NG AI1T3R
CONTR . LTC #r F.RPTRATTON T)ATF
1='ARCF.T. NIL . . : q02 1 3 1 005
LEGAT. TlF.SC . . : STR 13-29-02 WWM. TAX #
LOT BLOCK
T)F.SCRTPTTON OF TMPROVRMF.NT ! single family residence
i i Footing/Setbacks (Shoreline Sethack) /Mnhile Home Blocking!
( ) Foundation !
i Underground Plumbing/Underground Tnsulatinn !
Framing/Plumbing/Chimney!
) Insulation !
i Sheetrock !
( ) Sewage Disposal System Final
( ) Final /Occupancy Approval !
CALT. 385-91 4 1 24 HOT)RS TN ADVANCE TO SCHEDULE TNSPF.CTTONS .
Office Hours 9 a . m. to 5 n.m.
Inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for Tnsnectinns .
'JILDING 'ERMIT APPLICATION
Jefferson County BuiLaing Departmen°t*,PA: Box 122111,Port Townsend. WA 98368
LOCATION ' ,7 ko
i
SPECIFIC LOCATION SITE ADDRESS
POSTAA`Lu/ DISTRICT —r— /SUBD !S I ONE
LEGAL DESCRIPTION LOT {/c "� BLOCK DIVISION TAX NUMBER 1/
PARCEL NUMBER OcZ C9Q 1 / 4 SECTION
PLANNING AREA SECTION j ;; TOWNSHIP 9Cr NORTH RANGE c WM
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE
• 'SINGLE FAMILY YEW BUILDING MAIN FLOOR15
❑ MOfJ 1 LE HOME 0 ADDITION 2ND FLOOR 7&5
_
❑ MODULAR HOME 0 ALTERATION BASEMENT 0 0 C /(G.
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS I MOBLE HOMES /� q
O COMMERCIAL S1 / U/ a $3 5 ! (� ,�--
❑ INDUSTRIAL YEAR 6 a $ 16 c�C �
❑ HOTEL/MOTEL/DORMITORY MAKE f 00 dJ 01. 4,96, r (000
NUMBER OF UNITS ���
O OTHER - SPECIFY ESTIMATED COST OF $8
1 IMPROVEMENTS TOTAM. FO 7MARKET VALUE
UBC OCCUPANCY GROUP I --I ( /
SELECTED CHARACTERISTICS OF BUILDING
P NCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
OOD FRAME a` ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED A WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREAN 5
DEPARTMENTAL REVIEW • `�
HEILTH PARTMENT TYPE OF SEWAGE DI SPOSMBER OF PROPOSED BEDROOMS mot" inV ki
� � f� � 0 PUBLIC OR PRIVATE 1 NUMBER OF EXISTING BEDROOOOMS U
CI ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM A--
APPROVED DATE 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHTROCM___, .` 0-__
PUD T PE OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY) A
APPROVED DATE , ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
ti ❑ 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 0 YES 0 NO
IDENTIFICATION 4it,'f�
NAME MAILING ADDRESS ZIP TEL NO
OWNER ...1-, r/ ( T�' 0,t_ 753 � 38
L
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C O N T C}-1/ G U, C
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
LL ``NAtURE 0 APPLICANT AP LICATI N DATE RECEIPT NUMBER CHECK NUMBER OR CASH
J _ j i-�- 1 a5l 13C3 a 0�3
APPR• �y ERMIT FEES �-�\
BASE FEE INSPECTION
A , „ . 7,5 ) BLDG SURCHARGE PL CHECK,.,
3.14 �►��� //^�, ^ ENERGY SURCHARGE rC Itir� i. TOTAL
ATFNN;¢ ` v ,�J `9 9 1 1 NUMBER REFUND DATE , DA f IS
BUIL�ICI "��� 1 ;;
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0 CLM- 67 i / °-
AP OVED•
19
JEFFERS° 0
PLANNING&BLDG OEPT
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