HomeMy WebLinkAboutBLD1989-00072 .f
ILDINGfr1ERMIT APPLICATION
Jefferson County Buildig Department*P .O . Box 122G ort Townsend, WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS TY, - = CiS.T /,t,/4� 4.
POSTAL DISTWCT 1 /SUBDIVISION
ii.�s7/ft, 4'2</
LEGAL DESCRIPTION LOT _i. BLOCK. _ -- DIVISION TAX NUMBER
,E'.R.T .4-<ZAI.ei,- / FARCE NUMBER S:° >�::2 _,1 / 4 SECTION
PLANNING. AREA _ SECTION rOWNSH I P�?F���;, NORTH RANGE /27✓�',5 WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE , -- .,
❑ }SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOIIILE HOME W ADDITION 2ND FLOOR
• MQDULAR HOME - _----.-. ~ ❑ ALTERATION BASEMENT -°-.:--,
�.'6ETACHED/ATTACHED ` ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE � � T;L_1
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS '
MOBILE HOMES
❑ COMMERCIAL ----0 @ $35
SIZE
O INDUSTRIAL �- �
YEAR YJ p@ $ 1 6
❑ HOTEL/MOTEL/DORMITORY / J�
MAK 0 @ $8 .`i7'°t C
NUMBER OF UNITS
❑ OTHER SPECIFY ESTIMATED COST OF - � a7 $8
�T IMPROVEMENTS TOTALFA MARKET VALUE
UBC OCCUPANCY GRO%'�/// �/ $ 4. i.'4.'6' '� $ .b
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
i❑ WOOD FRAME ,..❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - ,->
NUMBER OF STORIES -- ... TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE F" SEWAGE DISPOSAL NUMBER OF PROPOSED BE OOtJIS--
yi
/�/1 ❑ P BLIC OR PRIVATE NUMBER OF #-ST/OG BEDROOMS
INDIVIDUAL ( SEPTIC ) NUN OF PROPOSED BATHROOM
APPROVED DATE
0 INDIVIDUAL WELL MBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
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 ❑ NO
IDENTIFICATION
�/}(J�/NAME MAILING ADDRESS ZIP TEL NO
OWNER 11/f / i .. .> a
�' L (3
CONT
SPATE LICENSE ND
m e' ---- . r.2 .s cal c. a4' ; Z
ARCH I^ F
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
)(SIGNATURE OF APPL ANT PL I;CAT TE [ nETuuMaEn [ CHECNUMBEfR CASH
AP OV D T
I P ES
A P V ' _`
BASE FEE INSPECTION
' BLDG SURCHARGE PLAN CHECK
���- SO
JEFFERSOp COUNTY ENERGY SURCHARGE i TOTAL
PLANNING&&pc DER;
9 1 1 NUMBER REFUND DATE 1 7,2"
BUILDING OFFICIAL i11
r
.TTr.WFFI�SC)T'3 (TC)tJT T Y F;riTT T.T)T T,Tc; F3FRNiT `i
Jefferson County Planning and Rui ldina Department
Courthouse .�rd Floor
PO Box 1220
Port Townsend , WA 98368
206-3R5-9141
PF.RM T T # • RT,ilis9-OO72 DATF. TSSUF.T1. - 08/0 1 i 8a
S T TF. AIJummnn : 21 TYRE T.ANF.
:PORT f.UDLOW. WA 98365
OWNF.R •PFGGV MTTC HF.f,T, PHONF 437-262R
MAT 1L'1 N( AnnR ' 40 K F.LT,FR LANF.
!PORT LUDLOW WA 98365
CONTRACTOR. . :NO CONTRACTOR PHONF. !
MAILING AflfR -
•
CONTR . LTC C #: FXP T RA T T ON DATE :
PARCFT, NO. . . : 990400-329
f F.CAT. DF.SC . . :STR 08-28-O i FWM. TAX #
f,OT 29 BLOCK
"FSCRTPTTON OF TMPROVRMF.NT: single family addition
i Foot i na i Sethac:ks (Shoreline Setback) /Moh i i e Home R i oc-k i na:
i Foundation
i Underground Plumbing/Underground insulation :
) Framing PiumhingrrChimney
f ) Insulation :
1 Sheetrock:
Sewage Disposal System Final !
•
) Final/Occupancy Approval •
CALL 385-9 1 4 1 24 HOURS TN ADVANCE TO SCHEDULE INSPECT T ONS.
Office Hours 9 a . m . to 5 p. m .
inspector ' s Hours 9 - 10 a .m.
24 Hour Recorder for inspections.
,. • .
AP ?' E
I
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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