HomeMy WebLinkAboutBLD1990-00627 [3UILDING . 'ERMIT APPLICATION •
Jefferson County Buiing DepartmenteP .O . Box 12 4Port Townsend. WA 98368
LOCATION 1 . ±A) 0 , ; ( L)° C t c,.1 ! ( C.e t r a. 93 '"6
SPECIFIC LOCATION' SITE ADDRESS 9/ 13 I-` r Q t., i/c. ev, P
POSTAL DISTRICT- ? /SUBDIVISION
LEG L DSCR PTION LOT BLOCK DIVISION�7 TAX NUMBER
>4-�rQ G , Q _ PARCEL NUMBER Q / '3' 3'4 /i l T / 4 SECTION
PLANNING AREA SECTION" ,'J TOWNSHIPS �-_NORTH RANGE / WM
0-E, /
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT , SQUARE FOOTAGE
❑ SINGLE FAMILY 0NEW $Ut`L`t3-I•"NH- L• ',.:: MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS D.QG.f,. 16 o _ `
❑ COMMERCIAL MOBILE HOMES
❑ INDUSTRIAL SIZE q@ $40
❑ HOTEL/MOTEL/DORMITORY YEAR $20
NUMBER OF UNITS MAKE $t0
p' OTHER - SPECIFY ESTIMATED COST OF 0 @ $t0
D e. ,-' IMPROVEMENTS
UBC OCCUPANCY GROUP $ OTAI//1, R MARKET VALUE
11
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL XI' .:
W WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
O PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
INDIVIDUAL ( S E P T I C ) UMBER OF PROFCOF PROPOSED BA T I-MOivj O
APPROVED DATE ❑ INDIVIDUAL WELL ' NUMBER OF EXISTING BATHROOMgosmi.-
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 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
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME f!- 1A �^�Qp C' g '1 MAILING/�II_. ADDRESSD/ �,J 1 ,/ gCZZIIP r.TEL `N'O (Akr*
GQ-r}W OWNER (n e."+ �fN'r�S1sk I 1 f id-� // ,e , I L-. ?c(.H e p, . I i5,6 3 G,)x._Oi F,� oG3'J700
c o-«rLy •of r?� Cep.�.o 4•- 1,36 I f '' / f- / l(,-�• =r kl.s'. Z�7=O /� us`(-36'
r
CONT
1 1 A I'E L I CENb"r NO '
I
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF ApP1'LI }1N APPLICATION DATE RECEIPT NUMBER CHECK UMBER OR CASH
r� � � I 1
APPROVED BY PERMIT FEES
.J '� if q•1 ASE FEE INSPECTION
li %NW SeJ BLDG SURCHARGE Jr C PLAN CHECK
ENERGY SURCHARGE & 4_ TOTAL
P .�'__
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL _
s
111 III
T7F: K.F.._3CO7N C:C)tTT T V e=itJT T,T)T. T,TC .A e'er%>T., 17 C..A,TT C )I
Jefferson County P7.a.n.ni.ng and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-385-91.41,
PERMIT #. . . . :BLD90-0627 DATE RECEIVED. : 09j12j90
SITE ADDRESS:91 WOLF RD
:QUILCENE, WA 98376
OWNER •WEBSTF.RjSAMPSON PHONE: 828-0631 tOrthsek
MAILING ADDR.: 741.1 1 2 7'1'H AVE NE
------
G.L , 4 5M313 e, Su sa_�
:KTRKT,AND WA 98033 - p28 _OR 16
CONTRACTOR. . :OWNER PT-TONE !
MAILING ADDR:
CONTR.. LTC #: EXPIRATION DATE: / /
ARCHITECT/ . . : PHONE
DESIGNER •
MAILING ADDR:
PARCEL NO. . . : 601334012 HEALTH:
LEGAL DESC. . :STR 33-26-01 WWM, TAX # BY: DATE:
LOT , BLOCK , SHORELINES :
BY: DATE:
DESCRIPTION OF IMPROVEMENT: deck
BUILDING TYPE •RES BEDROOMS--- BATHROOMS-- MAIN FT.. . . : 0 sf
TYPE OF IMPROVEMENT:ADD EXIST. : 0 EXIST. : 0 2ND FL 0 sf
GARAGE/CARPORT - PROP. . : 0 PROP. . : 0 3RD FL 0 sf
WOODSTOVE - TOTAL. : 0 TOTAL. : 0 BASEMENT. . : 0 sf
UBC OCCUPANCY GROUP:R3 SEWAGE. DTSP. . : CARPORT. . . : 0 sf
TYPE OF CONST • WATER SUPPLY. : GARAGE • 0 sf
UNITS. : 0 STORTES :0 HEAT TYPES . : DECKS • 160 sf
DIMENSIONS: MOBILE HOME COMMERCIAL: 0 sf
FRAME TYPE:WOOD MAKE: YR: INDUSTRIAL: 0 sf
EST COST. $ : 1600 SIZE: BANK HT. . . :0 ft
PRO.T GRP. . : 821 SH SETBACK: O ft
Owner/agent FEES
Signature: L t/a type amount by date recpt
PRMT $ 37 .00 AK 09/12/90 50394
Date:
/2- 41111101411111111 PLCK $ 5 . 55 AK 09j12/90 50394
/� � I . ► B.C. $ 4 . 50 AK 09ji2j90 50394
Issued Rv: A , ` „I,
' c � •
Date: �-��-�-e•- �y�'k ril d
Jefferson County Planning $ 47 .05 TOTAL.
& Building Department
(c)t J T J 'Y F3 L T T T..i T T'T C3 T7 . .TR T'4 T 'T'
Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98368
206-385-9141
PERMIT # •RLD90-0627 DATE TSSTJFD. :09/26/9O
SITE ADDRESS : 91 WOLF RD
:QUT_LCENF, WA 98376
. OWNER •WEBSTER/SAMPSON PHONE: 828-0631
MATT.TNG ADDR : 7411 127TH AVE NE
:KTRKLAND WA 98033
CONTRACTOR. . :OWNER PHONE :
MATTING A DDR :
CONTR . LTC #: EXPTRATTON DATE: / /
PARCEL NO. . . : 6013340.12
LEGAL DESC. . :STR 33-26-01 WWM, TAX #
LOT , BLOCK
DESCRIPTION OF IMPROVEMENT: deck
( ) Footing/Setbacks (Shoreline Setback) /Mobile Home Blocking:
Foundation :
( ) Underground. Plumbing/11nder,ground Insulation:
( ) Framing/Plumbing/Chimney:
) Tnsu.iation :
( ) Sheetrock:
( ) Sewage Disposal System Final :
( ) Final /Occupancy Approva..l :
z
GALL 385-9141 24 HOURS TN ADVANCE TO SCHEDULE INSPECTIONS.
Office Hours 9 a.m. to 5 p.m.
Tnspector. ' s Hours 9 - 10 a.m.
24 Hour Recorder for Inspections.