HomeMy WebLinkAboutBLD1989-00441 .
II FAIRWAY VILLAGE 4-
BUILDING 'ERMIT APPLICATION Flex
Site 17-B
Jefferson County Building DepartmentoP . O . oox ia0sPort Townsend . WA 98368
,
r------------700 feet south of Teal Lake Road
____12.2Ailgu Balicthi ---44L, _
,
SPECIFIC LOCATION SITE ADDRESS .
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT- , BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 821 -212-00J 1 / 4 SECTION NW
PLANNING AREA SECTION 21 TOWNSHIP 28N NORTH RANGE 1E VIM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 031, NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION -1341;azwr3F0
- toor 0
O DETACHED/ATTACHED 0 REPAIR Q.A-R-PdBfrnc,
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
p( MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS4
MOBILE HOMES
$ I 3 5 A
.5 p
O COMMERCIAL
SIZE ?. $
S-c2\
O INDUSTRIAL ----
O) a?, @ 6 ' (
O HOTEL/MOTEL/DORMITORY YEAR 3 OVi
NUMBER OF UNITS MAKE
----
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOT , FAIR MARKET VALUE
UBC OCCUPANCY GROUPri- , $
--
SELECTED CHARACTERISTICS OF BUILDING /
, ..---...
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
V WOOD FRAME X1 ELECTRICITY D COLLECTIVE SOLAR
p MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL D OTHER - SPECIFY
O MASONRY ( WALL BEARING ) •
DIMENSIONS ("1-0+10 TIC
p OTHER - NUMBER OF STORIE 3 TOTAL LAND AREAW, j>U(/14,...
DEPARTMENTAL REVIEW CSC
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL. NUMBER OF PROPOSED BEDROOMS c,Z.....
IX PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS_ . ---....
0 INDIVIDUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE D INDIVIDUAL WELL NUMBER OF EX I ST I NG E3ATHROOM _
'-' PUD TYPE OF WATER SUPPLY
x PUBLIC ' ( NAME OF WATER SUPPLY) LUN-CA.4.) k-kh-fleS, . ----
-
APPROVED DATE U PRIVATE ( NAME OF WATER SUPPLY - ,Ti i
'....,g,
I...-'t.., • -..,•,,ry.•G , .
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
K NO
APPROVED DATE DANK HE SETBACK
--- ---
PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH
NAME OF PUBLIC ROAD . 1
. 1
NAME OF PRIVATE ROAD I
APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES W NO
--------
- ( \
IDENTIFICATION I
. ---!
— " NAME MAILING ADDRESS — 1 ZIP
3-ii-TIETt— ---
Pope Resources 60M Pa - . Bay Rd . Suite 44:4 —
Pt . Ludlow, WA 98365 437-21(11
....._. i
'CONT same
d-- '
. t r.",..._
POPER*12389
— - I
AncH
4 s _
rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
. IGNA , OF A 1,, I T APPLI ATION DATE
_ RECEIPT NUMBER ICHECK NUMBER OR CASH
-
pno E 7„,,, PERMIT FEES
AP %MST) BASE FEE INSPECTION
I3 LOG SURCHARGE PLAN CHECK
NOV 1 1989
— ENERGY SURCHARGE. $t3(4,tCO
TOTAL
JEFFERSON COUNTY PLANNING&BLDG DEPT _
i • 2 . 7
i
4 I
FROM: PLANNING AND BUILDING DEPARTMENT
ADDRESS REQUEST
1 X NEW ADDRESS ADDRESS CHANGE 11,AGOIED-
2 . NAME : POPE RESOURCES
3 • MAILING ADDRESS: 6OM Paradise Bay Road Suite #4
Pt . Ludlow,
•
4 • TELEPHONE 437-2101
5 . LOCATION: Please attach map.
LEGAL DESCRIPTION- Sect . 21
(Fairway Village)
Site 17-B
SECTION 21 TOWNSHIP 28N RANGE lE
LOT02 BLOCK �__ PLAT
6. ROAD E:
BETWEEN ST. &
����jj 11�l���n� ST•
500 I EET�FRCrIvi r 0C 72 ' f0 d�
7 . NEIGHBORS :
NAME:
ADDRESS : N S E W
NAME: NSEW
ADDRESS:
NAME:
N S E P1
S . FEE PAID CASH
CHECK NO.
•
NEW ADDRESS
4
STREET:
CITY:
REAL MILE POST
1
date entered AlatQ sent
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