HomeMy WebLinkAboutBLD1989-00077r
AIOLDINGERMIT APPLICATION
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Jefferson County Building Departmentt1P .O . Box 12206Fort Townsend' WA 98368,
LOCATION
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SPECIFIC LOCATION SITE ADDRESS ( ,4;.1111 01. 4
POSTAL DISTRICT 1110. /SUBDIVISION .6), 4 /1 ,- - 1:
LEGAL DESCRIPTION LOT BLOCK DiyASION TAX NUMBER____
PARCEL NT7ER:777-7VT- TD/7 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP „--,2 NORTH RANGE tke wm
BUILDING INFORMATION
213!,JILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
, SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
. _
O MOBILE HOME \ : AUDITION iiodrill ZND FLOOR
____
O MODULAR HOME 0 ALTERATION BASEMENT -
O DETACHED/ATTACHED 0 REPAIR CARPORT ---
GARAGE 0 REPLACEMENT kGARAGE —
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
O MULTI - FAMILY 0 REL0c)%TION/MOvING INDUSTRIAL
NumBER OF uNITS - —
MOBILE 0 COMMERCIAL HOMES &e 4 V) @ $3 5 (= 040
SIZE
O INDuSTRIAL
O HOTEL/MOTEL/DORMITORY YEAR . --
mAKE 0 @ $8
NUmBER oF UNITS
O OTHER - SPECIFY OST OF —/ —0 @ $8
ESTIm ED C
IMP OvEmEUTS TOTAL Al RKET VALUE
UBC OCCUPANCY GROU / $ Z......L
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF NEATING FUEL
*:00D FRAME ELECTRICITY 0 COLLECTIVE SOLAR
0 ANUFACTURED U WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DImE7ONS
0 OTHER - . NUMBER OF STORIES2.--TOTAL LAND AREA50-
DEPARTMENTAL REVIEW
HEA TH D PARTMENT TYPE OF SEWAGE DISPOSAL ' NUMBER OF PROPOSED BEDROOMS
AD Y A,,/ 0PUBLIC OD PRIvATE
OF pRopOSED MMN.MOOM
_Cif‹„E.NDIVIDUAL ( SEPTIC ) NUMBER OF EXISTING BEDROOMS
NumBER
-- , 4:)<INDIVIDUAL WELL NumnER OF EXISTING WVrFTMM
PUD TYRE OF WATER SUPPLY
L) / //9.--'
0 PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPpLI
---- _
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
NAME
YES OF ADJACENT WATER BODY
,6 /el- 0 ... .0 NO . .
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
OL /9---
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO
06V '
CONT ..3W -- itr-fe..._ 1 C '7637,6 ,3 ,c45
1 _ / ____ . .
ARCH 1 /c1D
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
.......,. .....--......, .......*,,,.
OFcAP NT APILIND0410 E I R21- ll'T47td j CHECK NU,IBER OR CASH
APPROVED BY P RM I T FEES
2....-2 _,,.. BASr.z. FEE _ INSPECTION
......
SEp ,',,,:<- :
_
41 -
2 9 4 ° BLDG SURCHARGE PLAN CHECK
--, (--, - f< (.
NAN/ )
AFFEks.14, ENERGY SURCHARGE $ c __,..6<7:s`c)
m/12 r COuivry ' TOTAL
'tw 91.0G oEpT
9 I I NUMBER REFUND DATE: MT )S ED
BUILDING OFFICIAL ' 7 ,. "7
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IS
BUILDING PERMIT APPLICATION
Jefferson County Building Department• County Courthouse •Port Townsend, Wash.98368 • 385-1310
NE / _
I. LOCATION: geographic name S W SIDE OF VIJ fln E Socim S FEET
NE
S W FROM INTERSECTION OF ROAD AND ROAD
other specific location or landmark: ii. f,o• NI Dj
;r s) 'GAL DESCRIPTION: / C1 t i 0 ' '(e ,A kC1
Lot Block 1 Su v or
Tax Nu ber Y.Section Section Township Range
(..."-1 II.TYPE AND COST OF BUILDING
• CJ TYPE OF IMPROVEMENT BUILDING__D TYPE MOBILITY
New building M Single Family
�, T� ❑New County Resident
Addition []Multi-Family Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES- ❑NO
,, -1 ❑Foundation only
i.
E1/4...._.) OWNE SHIPUSE
�/� ull-time Residence
UQPrivate (individual,corporation,
�� ��ii onprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
`.,-- V permanent residence
ti COST (Omit cents)
Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter proposed use.
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b. Plumbing 7 d1n ..... .-,:at/ a.
c. Heating,air conditioning
d. Other (elevator,etc)
• TOTAL COST OF IMPROVEMENT $ -:3`6:::
III.SELECTED CHARACTERISTICS OF BUILDING - D_`-i ` C
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑ •Public or Private
•Total square feet of floor area,
X.Wood Frame lIndividual (septic tank,etc.) all floors,based on exterior ,�• I
7--❑Structural steel dimensions `f`�.'.1�
CI Reinforced concrete TYPE OF WATER SUPPLY • 5 A
Total land area,sq.ft.
❑Other—Specify ❑Public or private company
Individual (well,cistern) NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL I
1 34Other— pe ify Number of Full
bathrooms
IC% / Partial �f
IV. IDENTIFICATION- I3Q / /2'h/,.-, J 95/ . /),9;, J f�?/7
Name
Mailing Address—Num/bferr,,'street,cityty anddSStaCtee ! /`ZIIP^code Tel.No.
,. , _ ,,6'---
Owner 6- Q 1 ( err / C t/A- CFI 7(, ?.)-nS
2. L/`�1(11 ��
Contractor �� w `n /J _ State License No.
3. �"� ( �(f f�/V
Architect
The owner of th's bui ding and e undersigned agree to conform to all applicable laws.
Sign ur f ap ant Address Application date
1 7
c f
y PLANN G AREA TRICT _ j _.. SCHOOL DISTRICT �t rf WATER DISTRICT
o APPROVED BY
JEFFERSON COUNTY HEALTH DEFTQ. �F cm'
\-\,..
I APPROVED BY: PERMIT FEE ISSUE DAT PERMIT NUMBER
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ti DING OFFICIAL /3_• r�� 3
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1"r.S C)-NT C-7:Iv i-`v' F t T i.Ti 1- TNT r=-� e R• i -r •
Jefferson County P i ann i nc7 and Ru i l ci i no Department
Courthouse✓ 3rd F i nor
PO Rnx 1220
Port Tnwnsend , WA 9R26R
20 -36 -9141
PFRTVTTT # • RT,7R9-0077 i1ATF T SSUFD. : 09/29 i R9
S i TF. Ai171rcr. : 1 3 1 T1AROR POST OFFTCF RT/
COt T T,CF.NF . WA 9R376
OWNFR .TFFrF T)FT.TA PHONE.: 765-3 7 95
MAT T,I NO AT7i1R : 1 3 1 I/AR(1R PC1 in
CI T T,t:F.IVF. WA 96.576
CONTRACTOR . . -NO CONTRACTOR PHONF.
IVIATT,TNG ADT)R7
•
CONTR . LTC #: FX'P'I RAT'I ON 7ATF. -
PAR(:F.T, NO . . . : 7O1 O44-0 1 4
•
LEGAL TIF.SC. . : STR 04-2 7-0 1 WWM. TAX #
TOOT RT HOC;r< C .W. ANTIF.RSON SP
um: t;rcTt- rTON OF TMPROVFMFNT: sinnie family addition •
•
•
) Fnnt i nn%SPtnacks (Snore l i ne Set hack) iivinn i l e Home Ts'nc-ir i nc7-
•
•
) Foundation
) Underground P i umh i not iinderrrrnund Tnsu l at i n
l Framinc7/Plumning/ nimney: \J
Tnsuiatinn
•
•
) Sheet-rock: •
) Sewa..e Disposal System Final :
Af
) Final /Occupancy Approva7 Z914or G ///' �/ •
CALL 2R5-9141 24 HOURS TN AT)VANCF TO SCHFi1i7 F TNSPF.CTTONS .
Office Hours 9 a .m. to 5 p.m.
Tnsnectnr ' s Hours `1 - 10 a .m .
24 Hoer Recorder for Inspections.
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