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HomeMy WebLinkAboutBLD1989-00497 "!JILDING 'ERMIT APPLICATION Jefferson County Bui lWg DepartmentO: •O • Box 122 'ort Townsend. WA 983A LOCATION \ ----/A.r) L-Ci T\. )eN19-k 1 C-,K ix....N.qetVAN... .l�yS4 7✓rz(`SPECIFIC LOCATIONE SITE ADDRESS �� .f) --0.".AAvgcy. Q np t-i it POSTAL DISTRICT /.SUBDIVISION Jj LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER // PARCEL.NUMBER B O//j70d6 1 / 4 SECTION PLANNING AREA SECTION / TOWNSHIP z-a NORTH RANGE 7 Ci WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR . MOBILE HOME pi ADDITION 2ND FLOOR ❑ MODULAR HOME W ALTERATION BASEMENT rj'�"� ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL 0 MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE C t7,�"�HOMES / ❑ COMMERCIAL SIZE Y('t h ft @ $3 5 ❑ INDUSTRIAL YEAR I96,9 0 • $ 1 6 ❑ HOTEL/MOTEL/DORMITORY MAKE .. „ .r NUMBER OF UNITS $8 ❑ OTHER - SPECIFY ESTIMATED COST OF 0 a@ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUJ� y3? $ In©d -� SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAME 6 ELECTRICITY ❑ COLLECTIVE SOLAR MANUFACTURED '® WOODSTOVE 0 PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS 0 COAL '�' OIL 0 OTHER - SPECIFY 0 REINFORCED CONCRETE ❑ 0 MASONRY ( WALL BEARING ) DIMENSIONS ® 0 OTHER NUMBER OF STORIES TOTAL LAND AREA f. w !. t4 Nj DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS i t $ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS z,,; 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM Ctit'i PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY ^„ APPROVED DATE (" PRIVATE ( NAME OF WATER SUPPLY (1.-yF`X.1C PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY x. ❑ NO 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 REQUIRED 0 YES ❑ NO IDENTIFICATION NAME MAILING ADDRESS ZIP TEL NO OWNER j� �/� '` L1!(21"g't - QCQC, Z:0A c ' • , NV/WV,l/\ _ 9i33°�5 '13&—yo7/ CONT • STATh LTtENS'E NO ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH c: . i �. �1 i l \\� -*, b®g. APP-i. - I. :Y _ PERMIT FEES A ' �� ,. BASE FEE INSPECTION 'g8'rl♦t BLDG SURCHARGE PLAN CHECK JEFFERSON COUNTY ENERGY SURCHARGE $ ! 8�� PI r.t."+Ur At PAN DEPT ( I TOTAL 81 1 NUMBER 1 REFUND DATE l nAT' I S E BUILDING OFFICIAL ! 4/7 I� joi BUILDING PERMIT APPLICATION Jefferson County BuildinlWartment• County Courthouse • Port Towns41 Wash.98368 • 385-9141 • N E I. LOCATION: geographic name S W SIDE OF /°� ROAD �� g FEET N E ���l/ i--atiCA�C .- S W FROM INTERSECTION OF ROAD AND � am_- 4ROfiD other specific location or landmark: Q, LEGAL DESCRIPTION: PCP, .,C Lot Block Subdivesion 1 ( VU(P T� PNumber /,Section Seen Township Range II.TYPE AND COST OF BUILDING - TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY 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? ❑WreckingVlobile Home ❑Moving (relocation) []Other—Specify ❑YES ONO ❑Foundation only 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: 12 "5 ❑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 proposed use. b. Plumbing c. Heating,air conditioning • d. Other (elevator,etc.) lX.- • TOTAL COST OF IMPROVEMENT $ III.SELECTED CHARACTERISTICS OF BUILDING - PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS ❑Masonry (wall bearing) ❑Public or Private •Number of Stories •Total square feet of floor area, ❑Wood Frame +Individual septic tanl ,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 t((�G NUMBER OF OFF-STREET MadElIndividual (well,cistern) PARKING SPACES Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE El Gas Outdoors ❑Oil RESIDENTIAL BUILDINGS ONLY Electricity Number of bedrooms ❑ oal TYPE OF MECHANICAL Number of Full f Other— pe ify bathrooms tOOC -- Partial IV. IDENTIFICATION- /5C) (--.aitAA„k 4( • 12_‘Q Name Mailing Address—Number,street,city and State / ZIP code Tel.No. 1. an`('e_ k) _ . u (fin /�'? — Owner l V � / � �J . 7t'�� / 2. Contractor State License No. i 3. Architect The owner of this building and the undersigned agree to conform to all applicable laws. Signature of applicant Address Application date .,_—)4,1,7\-4.2. /9 .// ui,q - e/ 1 PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT APPROVED BY JE RSON COUNTY �I LTH DEPARTMENT APP VED BY: Ih -y PERMIT FEE ISSUE DATE RECEIPT NUMBER /('.VV ? k. el 3,sz) (-_ 21a s--- ________ BUILDING OFFICIAL /Sip The Printery—Port Townsend II .., . , . . e ....... , ..,, . . . . . ...„ . . . . .. . . BUILDING 1'Llit•M11 At t'LILA i IUN . - Jeflr•son Cnun►y 8.,ridrng Department • County Courthouse • Port Townsend. I:jsh 9.368 • 335 1310 N E FEET I. LOCATION. prup•annrc ni•+•e S W SIDE OF ROAD N E L^W ROAD S W FROM INTERSECT ION OF ( • ROAD AND ^ r cent,specific rocar,on or ranomars l j Z�� fV 1 7 E K F b a1 I 1�1 c..1 1 LEGAL DESCRIPTION: Bock Suborvr+eon Lot \5 )o -rlII r� '2 �iv ©\ I lownshrp ant Ian Number Y.Section Sect on II.TYPE AND COST OF BUILDING TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY JD o Single Family 0 New County Resident New building • '0 Addition D Multi-Family Is this structure to serve the residential number al units or comtakcal needs of those employed Alteration Hotel,Motel, Dormitory at either theZT..,Naw•s Trident or Repair,replacement number of units Indian Island Fatrlii`res7 D Wrecking ®Mobile Home 0 Moving(reloca`ron) D Other —Specify 0 YES ONO 0 Foundation only USE OWNERSHIP 0 Full-time Residence 0 Private (individual,corporation, _ D Second Home. Recreation Cabin,etc. nonprofit institution,etc.) D Second Home: Future conversion to ❑PubLc (Federal,State or loot goJt.) UBC OCCUPANCY GROUP: permanent residence . COST (Omit cennl Nonresidential— Describe in detail proposed use of buildings,e.g.,food processing plant,machine shop,laundry building at hospital,elementary • Cost of improvement S parking caraoe for To be installed but not included school,secondary school,college,parochial school,pa in the above cost department store,rental office building.office building at industrial plant. If use of existing building is being changed,enter proposed use. a. Electnol b. Plumbing. I c. Heating,air conditioning d. Other (elevator,etc.) • TOTAL COST OF IMPROVEMENT S III.SELECTED CHARACTERISTICS OF BUILDING - hlo�run S3tt,(Q c1 SQ'P _ / DIMENSIONS PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL •Number of Stories ,D Masonry (.+all bearing) D Public or Private •Total square feet of floor area, Q'Wood Frame ttgJr)Qividual (septic tank,etc.) all floors,based on exterior ( 4�_, .., ., dimensions 1 IC,,.',(vi 0 Strucrural steel TYPE OF WATER SUPPLY •Total land area,sq.ft. D Reinforced concrete D Public or private • company . 0 Other—Specify NUMBER OF OFF-STREET 0 Individual (we ll,cistern) PARKING SPACES-- _ Enclosed PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE Outdoors 0Gas RESIDENTIAL BUILDINGS ONLY ❑Oil Number of bedrooms Cl"Electricity TYPE OF MECHANICAL Full Coal - - - Number of • D Other— Specify bathrooms Pan ial IV. IDENTIFICATION- ZIP tilde Tel.No. Name Mailing Address— Number.street,city and State 3z aim+. �• 7 :. zb °w."' (aeve v?Jitter- 6te/s (1 r)dnAiisn e RE-CEIVE1, 2. State License No. I JEFFERSON COUNTY Contractor 3. 6�F'R2, j19Fr Architen .t The owner of this building and the undersigned agree to conform to all applicable laws. PLANNING DEPARTMENT $.grsarore of applront Address ty Q!rcation d 1 date • ' _. > � �'- 4/Z)/1 , t • PLANNING AREA (D FIRE DISTRICT nQ SCHOOL DISTRICTL WATER DISTRICT APPROVED BY 5D �, �'U D --4 �U - J,A[w C Neer N STT'• DE e'T 1 c ISSUE DATE PERMIT NUMBER w Av PERMIT FEE i . ,. -.„.. , I APgR D C linR 4 O VG 1y4-.....-56-63(,) i : G !4, p J� nn�n^ ` 33 o` w`i`^^ n - r �� ��� /) Ave,., eue, fi-e_e a c-,r Ares e..rl'er7. 2.) ig.-71.•-/ `;•// c.,-e - 7/o--,•-y a 0.-1) „„,,z`,.so ,-1 2- g" x/ 04,e.- e:iie.%,'f•e/..,./ Qxfe..-eOCt/ 4.4 1 7 ' d p a Z a o 4..�s��,c ...�v' ac 7l ei.,. S.c0e1 N 3) u/%'tee ,X;,.... ,.....c_/E� a.se #:;.X..-e-,.r. / Aded GL.,i-y �/0 fl Kit ', . .,".-geN � C�� el 40P0,x.360 !o a $ao �•�,:✓F e% a..-e`.s A.;cc. .� ,c j 4 �i re A o c..! Qi..L I-a e.0 e.✓2 7e O y Off.4Q .I' �r LS�'e a0<de Df�P r- ,..r lrG.C7it-/-C-r- "24. 470-r/d0 e 4.onY ,____) .iG/. , 7ne 6//e.... 4-,„ i / Q /60a 7c/ Al ,k , , N 2'fc/••O/ "wie k...... I, 7,_....„..,,., xf�. GO.,-..,G� 2.. , 10' 1-----i T— ,Ali or x I `Xfe 3 s_� lif -,e , I /G,t,• -/a-7;1 I- -- - - - - - _ _ _, tip/ /o - .i / .J'ce/e, A/ > V ; ,M,h, -VW" ---xt fkP. • -5? 51 r 3 v. ,Cpropesect) , 4f , .:. . ,_ . e f- A tr Rs 3 ....-- --- 4410 4e , X ,. fsi#rev- Solet C. 0 3 _ . .......e0'1 . 4 A---". .- OSII SP 0 , isZ: .. 4 .Dz —I ' • . i- rt. IP, n 6 ii-4 v }...,ie.?. ,' -4" lc-: ' .4(., • . . , . ::..6 — • . — ._ ,. .) ._ . 4 .::, . i.• d ...1., • ( --- — ri -41 t N • • it. - • k Pc '‘ '-6 ..- cr. E -,., ft-E -, ii• i cr' i. to 401 lil:10. -;" 4 o _ . a!".: s b. (ON e•. r _ ...... , " 44 . Ks ...0 . ... U. 1 1 th I , 1' I 'I 0 't 420 .41, ' 4 I I i I 41' -WO I .4Y—•• ft+ RECEIVED t_10, 1 o t... c, \ A ,, ---i-. .-..... , HEALTH il \ ul f,•;_. t \'------------,____L- __.) _ . -- .n W{ ~; Jr ' --- • 8f./ 11 O 9 96 f9� _ _ __ ._"` ! . ,. 1 to Fk I o c L ' '1' o - ' _ o8Fb/ J -,� v, y i.. �u 4l/Ok' O I , 1 09.eL/ uo Vt c4 .. -Z V CtA hu x t. (7., ,,,‘ mte. , .(146C. i 1,1 r , 1.1 i�+ i L1 N _ -! m 4) 4 b ti ------2-7- ----->. 1\0_. *• n, Q ) 00obZ' a, a o3 ` a �. _ _ r► ^l' i 00 f Ze ,�/IioN - -- \___,:2-,---1)--, . . O iLa • �n i„ , . ..„. 1 0 Dij ��� _ c C9 'I • O v Rl ` �< • W 09 f 0 ) 0` o� p � L9 009 4a /4kr 1 r: 1 /F06' /i'"06" Al y Al ZZ;bS-e0 4' 2i', 4 ,, - ti � f�'� N �p Q `\ =f . ,t l,. < < t qIII 2 `AALTH E 1 ,( I 4717/J? Ccik.fre_t„/ Sc. 4,7 ,, en.41.4.4.. 6.,C , 4)a ottc ‹Wpc7-120,_ ...„....„_.--, 1 C--)tc.444 A P • • 4 D 410 JUN . LES u& \\Q.,.. J1. VA. \.\-- C.) ._..............„ 1 / 67(1/?0 le 14,47:Z4,1, z i l' chal ,?e c-tea4..ta 1-R R--:0-de415 &•_- 7/2-i 7 o — Mc