HomeMy WebLinkAboutBLD1989-00078 Y
.i"F:Tr'TT'—.R:'a()TNT C} ()tTT'.T v Fit a'TT.i r i -NT -PF F T4Ti'
Jefferson County Planning and Hui i ci i nn department
Courthouse, 3rd Floor
PC) Rnx 1220
Port Tnwnsend, WA 98368
2O6-31-15-91 4.1
PF.RMT T# - RT.01-19-Ot0 t5 pI O55*ryt L ej DATE T SSt1F.11. : 09/1 1 /Rq
SITE.. AnDIZ- FSS 0-E96- S
: PORT T OWNSEND . WA 98368
OWNER •RTT,T. NIC HOTS PHONE.: 385-461 -2
MAILING AI111K :PO BOX 851
PORT HADT,00K WA 98339
CONTRACTOR . . -NC) CONTRACTOR PHONE.
MAILING ADfR :
CONTR . „T C #! EXPIRATION DATE !
PAKI:F.T, 'N'tl. 7 iltJ1 %u.-S-LJ 1 I
T,ROA T, DF.SC . . : STR t1-3n-i11 wwm . TAX # 5
LOT T BLocK
ur.:,(7rc I vT I uN OF IMPROVEMENT : single family residence
) Footing/Setbacks (Shoreline SethacK) iMohi i e Home Ri ock i ng:
) Foundation !
tinderccjround P i umh i nn/tindernrnund insulation :
_,4 Chimney:
J-=f7 -9 y v
EgFAMite
) Sewage Disposal System Final :
( ) Final /Occupancy Annrnva'. q•-00-00 -�
CALL 385-9141 24 1ORS TN AdVANCR TO SCHF.T)UT,R INSPECTIONS .
Office Hours 9 a . m. to 5 p. m.
Inspector ' s Hours 9 - in a .m.
24 Hour Recorder for Inspections.
, 'TIDING , 'ERMIT APPLICATION
Jefferson County Build epartmentsP .O . Box 122t Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS �"1 G-? , )0. /cle, i%1€ ✓`) a
POSTAL DISTRICT P/7? /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBERS—
PARCEL NUMBER'(`/"'c,O 3' ( /7 1 / 4 SECTION
PLANNING AREA SECTION c..T((--- TOWNSHIP 30 NORTH RANGE i` /LX,. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE)
'Q SINGLE FAMILY NEW BUILDING MAIN FLOOR / / 7W
❑ MOBILE HOME '❑ ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS ' MOBILE HOMES
❑ COMMERCIAL _,L2_24. /, ( 1
O) `) `25
❑ INDUSTRIAL SIZE .K� a� $3 5
❑ HOTEL/MOTEL/DORMITORY YEAR 0 @ $ 16
NUMBER OF UNITS MAKE 0 $8
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL7 FAIR MARKET VALUE
UBC OCCUPANCY GROU � $ $ /QQ
1
SELECTED CHARACTERISTICS OF BUILDING
P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME
g 0 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL GAS 0 COAL
❑ REINFORCED CONCRETE r❑ OIL 0 OTHER - SPECIFY 9)
❑ MASONRY ( WALL BEARING ) DIMENSIONS
/
0 OTHER - NUMBER OF STORIES ' TOTAL LAND AREA Z
DE
ARTMENTAL
HEPLT I DEPARTMENTEWTYPE OF SEWAGE BEDROOMS
, D I SPOSAL NUMBER OF PROPOSED
417
[l PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
P VED ATE INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM I
A ,14 INDIVIDUAL WELL NUMBER OF EX I ST I NG BATHROOM
eirmer
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
& NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH /
NAME OF PUBLIC ROAD -0;Sc ot/C �V /�.7)
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
L[ '1,,� ,o/ ems, /7 , LLii,_,K l a,a, 9J7
.. 32 3gS-/- Z
— ; i 5"CON T 040.1,172--
STAT!•. L I CE,NSE NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATU E OF APPL,±ICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPRED Y PERMIT FEES
p 'V l CD-1 t�p��� BASE FEE ,� INSPECTION
(�/ / ,50 BLDG
ryr 1. 84
t�� SURCHARGE PLAN CHECK
P l 1 ):Co ENERGY SURCHARGE U.l Q
't'SON COUNTY I ( 1 C� . ,� ' TOTAL
4: NCu141!?0DEPT
911 NUMBER REFUND DATE I DATE 1( }
BUILDING OFFICIAL ii t /60, 7
6 V i
To ft 0 08/3o/89
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