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HomeMy WebLinkAboutBLD1989-00125 ,WILDING PERMIT APPLICATION Jefferson County Building Gu'Srtment• County Courthouse •Port Townsenosh.98368 • 385-9141 N E , I. LOCATION: geographic name S W SIDE OF ROAD FEET NE S W FROM INTERSECTION OF ROAD AND O seurz.1I I Fs ROAD other specific location or landmark: LEGAL DESCRIPTION: Pal—CEA * Lot Block Subdivision Coo 23'� O 117 13 3�{ 02 6 ,Lei Tax Number '1%Section Section Township Range II.TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY • L New building ❑Single Family ❑New County Resident ❑Addition ❑Multi-Family Is this structure to serve the residential ❑Alteration number of units or commercial needs of those employed • ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or ❑Repair,replacement, number of units Indian Island Facilities? ❑Wrecking ❑Mobile Home ❑Moving (relocation) XOther—Specify ❑YES ❑NO ❑Foundation only PO[e— ;CY1,rn cCr/9P. � USE OWNERSHIP ❑Full-time Residence ❑Private (individual,corporation, nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc. ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP:AL__ ❑Second Home: Future conversion to permanent residence 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 proposedd use. ^ • lL b. Plumbing C9 3C) ''' }/2_l� E - 4(S = l . 'YoC c. Heating,air conditioning d. Other (elevator,etc.) • TOTAL COST OF IMPROVEMENT $ III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS Masonr •Number of Stories Ely •(wall bearing) ❑Public or Private •Total square feet of floor area, Wood Frame Individu (septic tank,etc.► all floors,based on exterior • ❑Structural steel / dimensions ❑Reinforced concrete TYPE OF WATER SUPPLY • Total land area,sq.ft. ❑Other—Specify ❑Public or private company NUMBER OF OFF-STREET ❑Individual (well,cistern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE ❑Gas Outdoors ❑Oil RESIDENTIAL BUILDINGS ONLY ❑Electric' Number of bedrooms ❑C TYPE OF MECHANICAL Other—Specify Number of Full bathrooms I • Partial IV. IDENTIFICATION- • Name Mailing Address—Number,street,city and State ZIP code Tel.No. 1. • Robert, t-f-a.ley n 3°5. C - I y,2 N 0 E Owner a ' a0mc r' -lQ `ln 2. IY 4 l,�.J cP),)I Irl ers 3 l O 0 L7 1 w y a ► ) B l C7z�3 r)ci to- Contractor State License No ()IC) W3*3q LI2ZIs) . 3. Architect The wner of this building and the undersigned agree to conform to all applicable laws. Si ature of app i ff t Address Application date -`�'`"' �X/Gac 1 IlS/88 PLAN ING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT APPROVED BY/1/4// JEF E SON V7Y HEALTH DEPARTMENT V 1,7 PERMIT FEE ISSUE DATE RECEIPT NUMBER El, CO AN 1 1 " 3. 5° __ bl L is 168 I lJ O�BUILDIt�V�C F ,L JEffERCS'� nt DEI T `'O pLAhNRNC,&Bl The Printery—Port Townsend AID kbo Escrow Inc c Susan Monroe, President Limited Practice Ofcer/DEO RETURN ADDRESS 686 Lake Street,Suite 500,Port Townsend, WA 98368 Phone: (360)379-1516—Fax: (360)379-1410 susan @ allaboutescrowinc.coln www.allaboutescrowinc.com //� WASNIN&TON STATE DEPARTMENT IF Manufactured Home \r!* LICENSING 0 TITLE ELIMINATION Application ❑TRANSFER IN LOCATION ❑REMOVAL FROM REAL PROPERTY Anyone who knowingly makes a false statement of a material fact is guilty of a felony,and upon conviction may be punished by a fine,imprisonment,or both. (RCW 46.12.210) D MANUFACTURED HOME TPO/PLATE NUMBER YEAR MAKE LENGTH/WIDTH(FEET) VEHICLE IDENTIFICATION NUMBER(VIN) 1989 Stratford 48/24 AB7SC5438 OR LAND LEGAL DESCRIPTION ON PAGE MANUFACTURED HOME WILL BE ®AFFIXED 0 REMOVED REAL PROPERTY TAX PARCEL NUMBER 602341017 LOT BLOCK PLAT NAME OR SECTION/TOWNSHIP/RANGE QUARTER/QUARTER SECTION S34/T26N/R2W Ptn NE ® GRANTOR(S)REGISTERED/LEGAL OWNER(S) ADDITIONAL NAMES ON PAGE COUNTY NUMBER NUMBER OF REGISTERED OWNERS NUMBER OF LEGAL OWNERS 2 1 NAME OF REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Robert Sturdevant,Jr. NAME OF ADDITIONAL REGISTERED OWNER DOL CUSTOMER ACCOUNT NUMBER Lori M.Sturdevan ADDRESS CITY STATE ZIP CODE NAME OF LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER First Federal NAME OF ADDITIONAL LEGAL OWNER DOL CUSTOMER ACCOUNT NUMBER ADDRESS CITY STATE ZIP CODE GRANTEE NAME Robert Sturdevant,Jr.and Lori M.Sturdevant I DO SOLEMNLY ATTEST UNDER PENALTY OF PERJURY THAT I/WE AM/ARE THE REGISTERED OWNER(S)OF THIS VEHICLE AND THIS INFORMATION IS ACCURATE: Signature of Registered Owner and Title,IF APPLICABLE Signature of Additional Registered Owner and Title,IF APPLICABLE NOTARY SEAL OR STAMP NOTARIZATION/CERTIFICATION FOR REGISTERED OWNER(S)SIGNATURE State of Washington Signed or attested County of Jefferson before me on by Signature PRINTED NAME OF REGISTERED OWNER NOTARY OR AGENT by PRINTED NAME OF REGISTERED OWNER PRINTED NAME OF NOTARY County/Office No.OR Title AND: Dealer No.OR DEALERSHIP POSITION/AGENT/NOTARY Notary Expiration Date ® TITLE COMPANY CERTIFICATION I certify that the legal description of the land and ownership is true and correct per the real property records. NAME(TYPED OR PRINTED) TITLE COMPANY/PHONE NUMBER SIGNATURE/POSITION DATE Finalize this application with a Licensing Agent within 10 calendar days of the date Title Company Representative signs. © BUILDING PERMIT OFFICE CERTIFICATION I certify that' ❑ the manufactured home has been affixed to the real property as described. ❑ a building permit has been issued for this purpose and the attachment will be inspected upon completion. NAME(TYPED OR PRINTED) BLDG PERMIT OFFICE/PHONE# (3(o p) BLDG PERMIT# ( htet\ Schenk communik j prvelbpmen-t- -V79.445 'FAD`9 -I SIGNATURE/POSIT1% DATE Q Dry 7C\1>✓Q ,e- ce,rm t4- -cc_1n n►c_ 1 aurti 11 I l 3/® j TD-420-729(R/6/06) Page 1 of 2 BUILD G ( 'ERMIT APPLICATION Jefferson County Building Department'P .O . Box 1220*�Port"fownsend. WA 98368 r LOCATION • SPECIFIC LOCATION' SITE ADDRESS E47 C) DC`)'''')("�.u.( )(bt 1 .) RQ, POSTAL DISTRICT j /SUBDIVISION rr LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER 1 PARCEL NUMBER (5,�.7, Lf ( 0}-7� 1 / 4 SECTION PLANNING AREA SECTION _"l TOWNSHIP o\LD NORTH RANGE cZ.Lu WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE -0 .SINGLE FAMILY * NEW BUILDING MAIN FLOOR MOBILE HOME ❑ ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES/� ❑ COMMERCIAL SIZE '1 a $35 ❑ INDUSTRIAL YEAR V' 0 a $ 16 ❑ HOTEL/MOTEL/DORMITORY MAKE • h'^ $8 NUMBER OF UNITS ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROU� $ $. SELECT4'P CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL 0T'3// WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR STRUCTURAL STEEL 0 GAS 0 COAL ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) ' DIMENSIONS ❑ OTHER - - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH D PARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS � ,a/I/ lVV �K. ❑ PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM c771 APPROVED DATE INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM___ PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION O YES NAME OF ADJACENT WATER BODY N O APPROVED DATE ' BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REc 'JIRED ❑ YES ❑ NO IDENTIFICATION -__-_ NAME MAILING MAILING ADDRESS ZIP� I TEL NO OWNER � „�h 0 T S., i 1 '� JC _i -6) i,66 1 1 1`,p_g> i _F ( �l O, (t2 '- � CONT ER` 'M Ro T l r ARCH - T THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. SIGN RE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH X ",,�- e ,mac _f = '�`� ..c. 0( 436/ 9 , 0 9 (.3. 04,.._, AP 0 ED BY % PERMIT- FEES i' \ 7 c }cCA BASE FEE INSPECTION A P V_ c- , -3 o BLDG SURCHARGE PLAN CHECK L 2 1 1989 ENERGY SURCHARGE $ g � TOTAL JFFFFR$)N CoUNTy 8 1 1 NUMBER REFUND DATE I 77E18SUED , 7b H-10 06(3O/8? • Se ICI w ��, sir�� l pv0v ) : '4 W- a j . w {-- "t E,;_, /1O L S/a,S ? (Al r • j o, ` • • i k c 200 ' U - / 7- F-1( Vfribb 2-1 43 F-(- 541-;) Z 8g JEFFERSON COUNTY PLANNING&BLDG OEPT - s 5 7 c=5