HomeMy WebLinkAboutBLD1989-00105 AIOLDING , 'ERMIT APPLICATION
Jefferson County Building Departments9 .0 . Box 1220sPort Townsend . WA 98368
,.......— _ -,
LOCAT J ON ,
SPECIFIC LOCATION SITE ADDRESS 7 i 0 /I-I---/,,2E/? 5 7, i i-ce/v -if/A. 0'914:
POSTAL DISTRICT /SU B D I V I S I ONC-WORC H/."- AP
LEGAL DESCRIPTION LOT I 6 BLOCK DIVISION TAX NUMBER 7
PARCEL NumBER(c(71---7722-1-1 CA)..;)---t/ 4 SECT I ON
PLANNING AREA SECTION 3:9 TOWNSHIP 1-6 NORTH RANGE ,,,i' fkV WM
BUILDING INFORMATION
BUILDING TYPE ' TYPE OF IMPROVEMENT SQUARE FOOTAGE
MfSINGLE FAMILY jki NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR ,
O MODULAR HOME 0 ALTERATION BASEMENT -
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING I INDUSTRIAL
NUMBER OF UNITS____ r —1
- MOBILE HOMES
O COMMERCIAL
SIZE, 2, $35 ci
O INDUSTRIAL
YEAR 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
MAKE 0 @ $ 8
NUMBER OF UNITS
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
UBC OCCUPANCY GROU ow
IT-13- IMPROVEMENTS
$ a/goo„..,,,
T -
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
X. WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED XWOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
O OTHER - NUMBER OF STORIES / TOTAL LAND AREAr000,
DEPARTMENTAL REVIEW J . a! ••_._t79 p c'etTi.
HEA TH D PARTMENT TYPE OF SEWAGE D I POSAL, ' NUMBER OF PROPOSED BEDROOMS I
LI 7
)
0 PUBLIC OR PRIVATE
V...J INDIVIDUAL ( SEPTIC ) NUMBER OF EXISTING BEDHOOfyiS
NUMBER OF PROPOSED BATHROOM /
APPROVED DATE
0 I ND I V I DUAL WELL NUMB ER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
X PUBLIC ( NAME OF WATER S UP P L Y)4f1;4/75 / Cea4"7/7".. '))(!5
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
X NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH 30 f.--7-
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD .41- 76A7 5,
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES X NO
--.
IDENTIFICATION
- ,
NAME MAILING ADDRESS ZIP TEL NO
0 WN E R 004,440 pcx raw
7,-36",-/ pr0.4,2,4,5 kei:-/ 04k, e-- .7.103' Pe‘., 6-log
.5..0,VA 'A5:
CONT
srAlL LIcr7T5T NO
ARCH
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
.- IGNATURE 0:72Peg7IT APP !CATION D 1.ATE RECEIPT NUMBER CHECK rqt..7fRoR CASH
APPROVE 13 P RM' ---''S
BASE FEE INSPECTION
N1010111 4.11 SD
BLDG SURCHARGE PLAN CHECK
8 19
ENERGY SURCHARGE d• ',TV-• e(---y'7--
JEFFERSON COUNTY 4,r:?.< v..i, , , ,(.:,1/4 TOTAL
PLANNING&SLOG DEPT 911 NUMBER REFUND DATE DATE ISSUED
..--..
— _
BUILDING OFF IC I AL 49Z/40 69
I). // OS SCp
— __
1
.1FF'F1F7RSC71J c C)TIT VV RT7T T,T7T DTC4 1 1r,RMT T
Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-385-9141
PERMIT # •RLD89-0105 T)ATE ISSUED. : 1.2/08/89
SITE AnnRFSS : 1 1 0 ALDER ST
:QUTLCENE, WA 98376
OWNER •DONALD POTTER PHONE: 776-2672
MATLTNG ADDR : 7304 192ND PT, SW
:LYNNWOOD WA 98036
CONTRACTOR. . :NO CONTRACTOR PHONE:
MAILING ATDR :
CONTR. LTC #: F.XPTRATTON DATE:
PARCEL NO. . . : 601334-02.2.
LEGAT, DESC. . :STR 33-26-01 WWM, TAX #
LOT 16 , BLOCK , CHURCHTLLS ADD
DESCRIPTION OF IMPROVEMENT: SINGLE FAMILY RESIDENCE
( ) Footing/Setbacks (Shoreline Setback) /Mobile Home Blocking:
( ) Foundation :
( ) Underground Plumbing/Underground Tnsulat.ion :
( ) Fr.a.m.ing/Plumbing/Chimney:
( ) Insulation :
( ) Sheetrock:
( ) Sewage Disposal System Final :
( ) Final /Occupancy Approval :
1 //�/1" i/ `3 -AW 1.6_
CALL 385-9141 24 HOURS TN ADVANCE TO SCHEDULE. INSPECTIONS.
Office Hours 9 a .m. to 5 p.m.
Inspector's Hours 9 - 10 a .m.
24 Hour Recorder for Inspections.