HomeMy WebLinkAboutBLD1989-00538 I3UI NG '`'ERMIT APPLICATION cF72-i efferson County Building Department.P .O. Box 1220•Port Townsend. WA 98368
�, L lc p Lo e,c,? I LOCATJO� il -i vt' \, — J_ '1,- ( 1/:T '
SPECIFIC LOCATION SITE ADDRESS 1 ---6� -�''�J![ T
POSTAL DISTRICT` /SUBDIVISION L3 7 / /7 7
40/ '•
LEGAL DESCRIPTION PLOT BLOC
_ f' „� DIVISION TAX NUMBER
'3/ �'Do O/S" PARCEL NUMBER 1 / a SECTION
PLANNING AREA SECTION >' µc TOWNSHIP 77 NORTH RANGE F / 4- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT
SQUARE FOOTAGE
" SINGLE FAMILY [} NEW BUILDING MAIN FLOOR
0 MOr! 1 LE HOME
❑ ADDITION
l\l,.-,�R 0 MODULAR HOME 2ND FLOOR
❑ ALTERATION BASEMEN
0 DETACHED/ATTACHED ❑ REPAIR CARJ�ORT' S() GARAGE ❑ REPLACEMENT�� !! 0 WOODSTOVE GARAGE ���i
❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL ---^ MOBILE HOMES / /�
❑ INDUSTRIAL SIZE
�71 Ct� $35 ►PV 0�(JC
❑ HOTEL/MOTEL/DORMITORY YEAR 0) q� $ 16
NUMBER OF UNITS----
MAKE ��VI @ $86
❑ OTHER SPECIFY + 90g„/
ESTIMATED COST OF $8 X
IMPROVEMENTS
....) UBC OCCUPANCY GR457-4_11; TOTL, F9 RKET VALUE
SELECTED CHARACTERISTICS OF BUILDING F `
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0" WOOD FRAME 0" ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL ,�"n,,
0 MASONRY ( WALL BEARING )
0 OTHER - SPEC 1 FY !/tx JI�t/
0 OTHER DIMENSIONS
NUMBER OF STORIES i TOTAL LAND AREA (2t/
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
N A- [Q PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
APPROVED! DATE ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 'e
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY) 1-441)l,..Q(.J (,(J(z, .-€g
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT , WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT
SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH 30 ' —
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
►O P' 'es a- rces horn I7 c&s e, bat/.. 5-*4 P-/-.0 u qs -4 q37 Ll
CONT , ftesococ6 c.VI'►e
Pope. /a 3 • C!/
ARCH
rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
1 GNATS/RE OF PP IC N
APPLICAUOF)...DATE RECEIPT NUMBER CHECK NUMBER OR CASH
, 7*:e' %/ , 7. ' i r - / -i
PPROVED 'Pi PE(1 I T FEES
OD
P BASE FEE INSPECTION
A
� '�§ ....0. SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ �� �
JEFFE>iaU CgUN7Y TOTAL
PIA `
AL
� a 91 1 NUMBER REFUND DATE D T!�r. 1 SS
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BUILDING OFFICI �� L�1)
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FROM: PLANNING AND BU I lip NG DEPARTMENT
•
ADDRESS REQUEST ,
FLAGGED:
1 . ° X NEW ADDRESS ADDRESS CHANGE
2 . NAME: POPE RESOURCES
60M Paradise Bay Rd. Suite 4 Pt. Ludlow, WA 98365
3 . MAILING ADDRESS:
437-2101
4 . TELEPHONE:
5 . LOCATION: Please attach map.
LEGAL DESCRIPTION:
SECTION 16 TOWNSHIP T284 RANGE R1E
LOT 17 BLOCK PLAT
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6. ROAD NAME: a-t 1✓l{� Q�-�
BETWEEN ST.
MILES/FEET FROM •ST.
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?. NEIGHBORS:
NAME: NSEW
ADDRESS:
NAME: NSEW -
ADDRESS :
NAME: NSEW
SEW
ADDRESS: „'
8 . FEE PAID CASH CHECK NO.
NEW ADDRESS
STREET:
CITY:
date entered ___
4.P "
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