HomeMy WebLinkAboutBLD1989-00081r ,
tbUILDING e'ERMIT APPLICATIO0
Jefferson County Building DepartmentPF .O . Box 12iliTTort Townsend.. WA 98368
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LOCATION . .
1 )
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT • /SUBDIVISION
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LEGAL DESCRIPTION LOT _ BLOCK DIVISI N TAX NUMBER
PARCEL NUMBER _..) 1 / 4 SECTION
PLANNING AREA SECTION /6 TOWNSHIP E .:: NORTH RANGE ____ WM
BUILDING INFORMATION
ING TYPE TYP- OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY NEW BUILDING MAIN FLOOR X I
O MOBILE HOME 0 ADDITION 2ND FLOOR . I
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION 1COMMERCIAL
D MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL SIZ $35 (-21 .a%' C-)
E @
O INDUSTRIAL . ,_„___..,*______
390
@ L;)1,, ,,k .
O HOTEL/MOTEL/Don YEAR $ 16.. T.Ry
NUMBER OF UNITS . . • -
-- -----***
O OTHER - SPECIFY 0 @ $8
ESTIMATE COST OF
TOTALt,180ATET VALUE
UBC OCCUPANCY GRO T1II
,.. I
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
TENCIPLE TYPE OF FRAME
WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL D OTHER - SPECIFY
O MASONRY ( WALL BEARING ) .
DimENsious
0 OTHER - NUMBER OF STOR I ES TOTAL LAND AREA
_
DEPARTMENTAL REVIEW .
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS /
D Fi6BLIC OR PRIVATE NUMBER OF EX I ST I riG BEDROOMS
I Ni)I V I DUAL ( SEPT I C ) NUMBER OF mor-aor,.:7! BA T HROQI\.:1: :;."-•--•
APPROVED DATE U I N D I V IDUALELL NUMB ER OF EXIST ING BATHncom
PUD TYPE OF WATER SUPPLY
- 0 P BLIC ( NAME OF WATER. SUPPLY1
APPROVEDEPE! - . - PRIVATE ( NAME OF WATER SUPPLY)„
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PLANNING DEPT . IWIi4IU SHORELINE JURISDICTION
YES NAME OF
( NO A7.34771061ATr, BODY,
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APPROVED
.p,,,, I r""--'-' '''60-k- 0)-6J-12-17- -
BANK HE SETBACK .r .
-*-.. *-----
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD *.*,..-.... *--.....-.....-
NAME or PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
-...........*
NAME NAILING ADDRESS ZIP TEL NO
A -
R --, ...*,,.....,m-
UWNE
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4 41147114. 0411604,4 ' / '
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e i of A ) j._ 4041 twild6404iNJW . _
CONT 111" ler
- . .
ARCH -.....--
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
, • ...,--.*-*-,---...........-m.-.,...-.-...,.....m--.*-..m-....,.....m..-. ,
j SI ATURE I OF APPLICANT .,APPLII77ATE 71:- NU 7, 1cHac Ull . .R OR CASH" de-7 _ . ...i
OVED Y PERM T r7g)
CD rilss". FEE. INSPECTION
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A P P 0 I-DG S UR CHAr?GE .----•••, FLAN CHECK
_,. TOTAL
.- ENERGY surcr- ..,E; s
S 2 9
_
JEFFERSON COUNTY --- •
g.t ; NUMBERREFUNO* DATE ID Ii1E ISS- 0,m,
pi iwit,p imfw g oF 1 c I AL CS25 WV.
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SHORELINE SETBACK EVALUATION
APPLICANT : , L5(COtutC3
ADDRESS:
TELEPHONE: (home) c(67 (business)
PROPERTY DESCRIPTION
PROPERTY SITE NUMBER:
LEGAL:
Owner : ck, S ���
Address : ( 1 �- CV a
Tax ParceL Number: -766 dC7y
ReaL Property Description:
i `-1 J l i� c+t-: 2 —
ADJACENT WATER BODY:
EVALUATION
BLUFF HEIGHT: l c-i S /CJ' _ SOURCE:
BLUFF STABILITY: SOURCE:
❑ STANDARD SETBACK: feet
This minimum setback shaLL be measured from the ordinary high water
mark to the most waterward edge of the proposed structure .
❑ BLUFF SETBACK: feet
This minimum setback shaLL be measured from the bank' s edge to the
most waterward edge of the proposed structure.
h0„D,ore„u cip 40-ricr L,e 1 C,.tea
47-y__ 1,,
x, AVERAGE SETBACK: feet
This minimum setback shall be measured from the bank' s edge to the
most waterward edge of the proposed structure. This setback is
based on the foLLowing calculations of adjacent resid ntiaL
structures . ,
_( ( . L
Right House (facing waterward) : 1 pie 4c
• Setback from bank or ordinary high water : feet
• Distance to the proposed structure: feet
Left House (facing waterward) : 1 �C kb(4,f6/(
• Setback from bank or ordinary high water : feet
• Distance to the proposed structure: feet
❑ SUBDIVISION SETBACK : feet
This minimum setback shall be measured from:
This setback was established by the approval and filing of the plat .
VARIANCE
REQUEST:
❑ APPROVED 0 DENIED DATE:
ACKNOWLEDGEMENT
The above evaluation was determined on information provided by the
applicant. Should any of this information be found inaccurate, the
setback requirement may be re-evaluated .
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Jefferson County Pianninc and Rui iciinn Department
Courthouse, 3rd Floor
Pi/ Rnx 1 220
Port Townsend , WA cR36R •
206-385-y i 4 i
PFRivS T T # • RT.ilR9-OOn i T)ATF TSSiiFD. - oq/25/5y
S T TF. AIII)mm:-):-1 - 1 46 NORTH SRA H RD
PORT T.tifl .(1W'; WA 98365
, OWNER •CHAR F..S Hi1T.ComR
_ Pi-i�1i3F. - 4,�7-i7it=s
MATT.T NC A T)R :1. �' "T. I�Ho _ s ��J�JJ' fvJ 7j��
Lii
- PORT T' II.OW WA. - -365
CONTRACTOR - _ _ NO CONTRACTOR PROW. :
MA T i.TNC ADDR :
•
CONTR. i.iC #- F.XPTRATTON fATF.
PARCF.T. NO. . . f 935 7OO-OO4
T.FGAT. i1F.SC. . : S TAR 1 f-2.7-01 i RWM; TAX
LOT 4 RT.00;K
DFSCRTPTTON OF TMPROVF.MFNT: single family residence
Fontina/Sethacks (Shoreline Sethack) /Mohiie Home Riockina•
) Foundation :
- ---_— _
i iincierornunci P i umh i nca/iinciernround insulation :
( i Framino/Piumhingr/c^,himney:
) insulation : _.._.
ShePtrnck • --
Sewage Disposal System Final :
Final/Occupancy Approval !
CALL 385-9 i 4 1 24 HOURS TN ADVANC;F. TO SCHF DULF TNSPFC;TTONS .
Office Hours q a .m. to 5 n. m.
Inspector ' s Hours 9 - 10 a . m.
24 Hour Recorder for inspections.
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