HomeMy WebLinkAboutBLD1989-00058 Rr1111111111111P"WNW,"
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Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend , WA 9R38R
208-385-914 1
PFRMTT # - RT,DR9-OO5R DATE TSSt1FD. : O7/28/R9
STTF. ADDRF.SS : 9i RT,AZF TRATT,
PORT TOWNSFNil, WA 98388
OWNER •TTM EAGER PROW ! 385-1 7 1 3
MAILING ADDR - 4953 OT,T) OARDNFR Rfi
PORT TOWNSFND WA 98368
CONTRACTOR. . :NO CONTRACTOR PHONE
MATT,TNC ADDR :
CONTR . LTC #! FXPTRATTON DATF
PARCFT, NO. . . ' 902131005
f,F.GAT, T))FSC . . - STR 13-29-02 WWM. TAX #
LOT BLOCK
DFSCRTPTTON OF TMPROVFMFNT : mobile home installation
i ronti Set' cks (Shorelinein Sethack�'/rvinhi ie Rome Blocking.
�
( ) Foundation :
Underground Piumhinrr/ttndercrrnund Insulation
( ) Framing/Piumhinn/Chimney•
( ) Tnsulatinn :
( ) Sheetrock -
bed, ,k99,01,1
Sewage Disposal System Final • ert'�� a
t = loaf /Occnnancy Annrova'
CALL 385-9141 24 HOURS TN ADVANCF TO SCHFf3ULF INSPECTIONS .
Office Hours 9 a .m. to 5 n.m.
Tnsnectnrrs Hours 9 - 10 a . m.
24 Hour Recorder for inspections.
I 1-
BuILONGT0.,ERmIT APPLICATION
Jefferson County Building DepartmentmP .O . Box 1220mPo101Townsend . WA 98368
liocATION
SPECIFIC LOCATION SITE ADDRESS 4
POSTAL DISTRICT Plq i 1- ' 0, 7_0 ---Fryk r i
/SUBDIVISION
LEGAL DESCRIPTION LO-11-f-a& I BLOCK DIVISION TAX NUMBER 1
PARCEL NUMBER ci c.v._ IA 1 nocz; 1 / 4 SECTION
- ,---,
PLANNING AREA SECTION 1.3 TOWNSHIP .':(1 NORTH RANGE .21,f WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY tEl:' NEW BUILDING MAIN FLOOR
);4 monILE HOME 0 ADDITION 2ND FLOOR
'0\ MODULAR HOME 0 ALTERATION BASEMENT
0 DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL
SIZE_ 0 0 @ $35
O INDUSTRIAL
YEAR 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
MAKE , A @ $8
NUMBER OF UNITS
0 OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GPO orme',,, , $
SELECTED CHARACTE ISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED 0WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL :*1, GAS D COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) ' DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW , __?XVI/ run
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
14,47 00.,414rci 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS,-J.
b ili t Fl INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DAT7
/ 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
. PUB TYPE TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
p 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
NAME -T -,..---
MAILING ADDRESS ZIP TEL NO
.
0 W N E R , • .r
qS3 0 0 e7- tt-C 1 n e.C.21-rfa_______
CONT .
- - . -5IAFE Lrurmse NO
, .
ARCH
—4 --,
fHE OWN-R 7' THIS BUILDING _AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
Az,
SIGNA UR OF 2n-71. -1/1 APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
,---.
0--/ (•, a F' 6i 7 o ci
APP D BY PERMIT FEES
A TS.L() BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
JUL a
to filly ---C)
ENERGY SURCHARGE $ )--7q t,1-.) _
TOTAL
JEFFERson,
11,1kinv '''GOI/Nry
. &BLaGfiFP 911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFilCIAL 7 (-5
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