HomeMy WebLinkAboutBLD1989-00071 •
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Jefferson County Planning and Ruildina Department
Courthouse, 3rd Floor ✓
PO Box 1220
Port Townsend , WA 98368
206-385-ci i 4 1
PFRMTT -RT.Tl89-0071 DATE. i SSUF . : 08!3 i /R9
S T-T F. AT1T)RF.SS - 8 1 F. C;F.)AR ST
:PORT T.tiDT.C)W. WA 98365
i)WNF.R •T.AT)R T F. HAT.VORSEN PHONE
4ATT.TNC ADT1R : 81 F CFDAR S'1RFFT
: PORT T.TTT)T.i1W WA 98385
.:C INTRACTOR . . :NO CONTRACTOR PHONF
MAILING AlfR
•
CONTR . T.T C #: FXP T RATTON
'AKC;F.T. NO. . . : `It534i)C1-41 9
-.FLAT. T)F.SC . . : STR 23-28-01 FWM, TAX
MOT BLOCK
DESCRIPTION OF TMPROVFMF.NT : pe,), `y
FootinaiSethacks (Shoreline Sethack) /Mohiie Home Rlnckingr:
) Foundation :
) underground Plumbing/Underground Tnsu l at i nn
Framing/Plumhino Chimney:
) Insulation :
i Sheetrock
1 Sewage Disposal System Final :
i Final /Occupancy Approval :r
CALL 385-91 4 1 24 HOURS TN ADVANCE TO SCHEDULE T NSPFCTTONS.
Office Hours 9 a . m. to 5 p.m.
Tnsnector ' s Hours 9 - 10 a .m.
24 Hour Recorder for inspections.
- ,
'WILDING ‘0-'ERMITs APPL!ICATIOria
Jefferson County Building DepartmentTP .O . Box 12Mg'ort Townsend, WA 98368
r....,..........—
tiOCATLOB___
SPECIFIC LOCATION' SITE ADDRESS 1E. C.:edar ,St:
POSTAL DISTRICTUAW)LEGAL DESCRIPTION DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 9-77.75-6.24 (C1 1 / 4 SECTION
PLANNING AREA SECTION ,3 TOWNSHIP ,.2?-, NORTH RANGE I : _. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT Pcc4t. GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS_ MOBILE HOMES
O COMMERCIAL
SIZE 0 @ $35
O INDUSTRIAL
YEAR ----7 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
MAKE .Z) 0 @ $8
NUMBER OF UNITS
O OTHER - SPECIFY _Iaa_o @ $8 H (90
ESTIMATED COST OF
(14cv, ( yc. IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GRO
7771 ___
SELECTED CHARACTERISTICS or BUILDING
- --- . .PRINCIPLE TYPE OF FRAME ---
PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED U WOODSTOVE n PASSIVE SOLAR
O STRUCTURAL STEEL n GAS 0 COAL _
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
_ ...
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPAR MENTAL REVIEW
HEALT DEPARTMENT TY E OF SEWAGE DISPOSAL NUMBEiiOF PROPOSED BEDROOMS PUBL I C OR PR I VAT E NUMBER OF EXISTING BEDROOMS
Et 1 ND I v 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM
APP ED DATE
C] I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM____
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLYWAR) WI
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY _
-------
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O 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
. _
NAME MAILING ADDRESS ZIP TEL NO
OWNER-
1..si VI I t:' ..i - 0 j I VI:,I'..x_ • : I ' I' c ( jt• ' ' 4z[ C L'- , - e'--,- S 36 c:-/ A 31")-7) ,
--.:---
CONT
STAPM—rTLE=E7U
ARCH
-- —
m-- --- ---- .
THE OWNER OF THIS BUILDING AND THE UNDERSIGWLD AGREE TO CONFORM TO ALL APPLICABLE LAWS.
.------- . ---- ----- .---.-- -
SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH -
APP 0 D BY PERMIT FEES
APP V D (.-27. CDO BASE FEE INSPECTION
AUG 3 1 1989 1-1 • 30 BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE $ )..i / I SC)
TOTAL
PLANNING&BLDG DEPT
9 1 1 NUMBER REFUND DATE DATE ISS D
.-............ AI*
BUILDING OFFICIAL 4/ / dir
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