HomeMy WebLinkAboutBLD1989-00083r . , illILDINGERMIT APPLICATION .
Jefferson County Building DepartmentP .O . Box 1220‘Nort Townsend. WA 98368
r . LOCATION
SPECIFIC LOCATION SITE ADDRESS R alb 6'105 R nevi
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POSTAL DIS-TRICT 14... /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER CIZIOCI-3C:0 1 / 4 SECTION
PLANNING AREA SECTION
TOWNSHIP ,-Z NORTH RANGE r, wm
BUILDING INFORMATION
BUILDING TYPE TYPE OF ImPROvEMENT SQUARE FOOTAGE
O SINGLE FAMILY NEW BUILDING MAIN FLOOR ,
O MOBILE HOME 0 ADDITION 2ND FLOOR
0.MODULAR HOME 0 ALTERATION BASEMENT
yOETACItEDATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT iGARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS____ MOBILE HOMES
O COMMERCIAL
- ,
SIZE ,w 0 a $35
O INDUSTRIAL
YEAR 0 @ $ 16
O HOTEL/mOTEL/DORmITORY _
MAKE 44n0 @ $8 73 92.0
NUMBER OF UNITS i
O OTHER - SPECIFY __O @ $8
ESTIMATED COST OF ___
IMPROVEMENTS TOTAL FAIR ARKET VALUE
UBC OCCUPANCY GROUP $ -..)
-, i-
--
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
' WOOD* FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARiNG ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEL__3210446AiAggpP Plautke_
EALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM
S
/?"-- C) --/ls----- B 0 PUBLIC OR PRIVATE
INDIVIDUAL ( SEPTIC ) NUMBER OF EXISTING BEDROOMS
I
NUMBER OF PROPOSED BATHROOM
APPROVED DATE INDIVIDUAL WELL NUMBER OF EXI STI MG BATHR<XN
PUB TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
XNO
APPROVED DATE BANK FEIGHT SETBACK
- - _
PUBLIC woRKS DEPT ROAD RIGHT-OF - ?AY 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 --,-- 7 C)
0 400V ee 9C339- -37 ta, or
8eam V V -2.35-5
CONT ,C3c4
g-1-71-17 L 1 rz fl s L.---ri u---1
ARCH
_I -,---
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S.i ATURE OF AZL71- APPLICATION DATE RECEIPT RUNNER CHECK NUMBER OR CASH
D/2-°1 Bc1 `11.___ It '16
APP 0 D BY PERMIT FEES
APP _62a1J2- BASE FEE INSPECTION
•
-, 4 450_ BLDG SURCHARGE PLAN CHECK
1
ENERGY SURCHARGE $ (0,7,5C)
JEFFERSON COUNTY TOTAL
PLANNING&BLDG DEPT 911 NUMBER
[REFUND DATE .D^WE ISSel
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BUILDING OFFICIAL PP-41
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.Tra.FTFTF: R'53, C7)T3 C7;Citii,J9 7 %i T i.T)T i\TC 3RF TZINFT m
Jefferson County Pianninn and Rui ininn Department
Courthouse, 3rd F i nor
PO Rox 1 220
Port Townsend , WA !at-Lit-5m
206-385-91 41
PFRM T T # - RL(1R9-00 53 T)ATF, i SSUFD. _ 1 Ci%24 899
'I T F. A Dl—RFsS ' 61 t1 RORR T NS RD ,
IV'11RD)I,MNU. WA 98358
OWNF.R .TOF REAM PHONF : 355-37 i 2
MA T I` T Nc AD)DJR : 6 1 n RORR T NS RD
. IVuRl)t.Mnn) WA Mtf.'Snm
CONTRACTOR . . :NCJ CONTRACTOR PHONF.
ILIA T ,TNC AD)D1R
CONTR . LTC #: FXPTRATTON DATE:
PARC F.F. NO . . . : 92 i O93-OOS
LF.CAT. DIRSC. . : ST'R 09-29-0I F.WM. TAX #
LOT BLoc <
I Jt'.St:hC I P-r TON OF T IV1rROVM.IV1FlNT: detached narane
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Foundation !
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t ) insulation !
> SheetrncK :
SPWane Disposal System Final :
; Final/Occupancy AnnrcT /i
CALF. 355-9141 24 HOURS TN AIIVANCR TO SCHFDULF, Ti'VSPr.CT ONS .
Office Hours 9 a . m. to 5 p.m.
inspector ' s Hours - 10 a .m.
24 Hour Recorder for Tnsnectinns.
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