HomeMy WebLinkAboutBLD1990-00842 C-ka l) ' ie.o m 16-e' -k(2
4.0 l(, �1 (3UI G 'ERMIT APPLICATION �� 4; /7
Jefferson Coun�Building Department•P .O . Box 1220.Port—iownsend. WA 98368
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f LOCATION 11 fl V 1CW V I LI-- 4&6 /'—JJ S i 1� l� ��\\ I /, ym'
.._ SPECIFIC LOCATIOF SITE ADDRESS /0/ Li kd1Zv)Se D . 14- ""`0lrv�t)
POSTAL DISTRICT
//I STR I CT /SUBDIVISION a�f /// l/�.�CGt
LEGAL DESCRIPTION LOT ,2.& BLOCK DIVISION TAX NUMBER
PARCEL
PLANNING AREA SECTIONN/I�ER TOWNSHIPSECTION
c2(5 NORTH RANGE / C • WM
BUILDING INFORMATION
1---
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE/��
aSINGLE FAMILY )4 NEW BUILDING MAIN FLOOR
MOBILE HOME (❑ ADDITION 2ND FLOOR
0 MODULAR HOME ❑ ALTERATION BASEMENT fp
❑ DETACHED/ATTACHED ❑ REPAIR TD �(, "2---
Cr GARAGE ❑ REPLACEMENT GARAGE rj/(��
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
'' ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES / /� /
1v1 ❑ COMMERCIAL S I ZE /-� o@. $3 5 &C C60
❑ INDUSTRIAL YEAR 0@ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE c:' 2. VJ a� $8 ,5Y'
NUMBER OF UNITS �` /�'
❑ OTHER - SPECIFY ESTIMATED COST OF , 50-64 @ $8 �--` 41"`1�I(T
IMPROVEMENTS TOIFA �Mj1�j2KET VALUE
UBC OCCUPANCY GROUP $ $ (P L/f
N SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
JzS( WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL OTHER - SPECIFY fi'A,Q LC,CC��
❑ MASONRY ( WALL BEARING ) DIMENSIONS /
❑ OTHER - NUMBER OF STORIES ( TOTAL LAND AREAW n
L) DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
x/ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS —
�,/ �� ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM aZ
} APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF LY
N PUBLICwATER( NAMESOFPWATER SUPPLY) Lu )Loc.) (aak2
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 .: 0 /
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
..-
NAME
MAILING A DDRESS ZIP T E L NO
CIWNER {CS 0(A ie9S V / M P6Via Cti,C47_:`' yI . S' C-' �- j37O /o/
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGN TURF OF APPL CANT APPLIC TION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
'OW !//O /990 1LN1tc�ly66
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APPROVED; BY PERMIT FEES
-- y q ( , 0 0 BASE FEE INSPECTION
.'.f` 0 1 i S BLDG SURCHARGE / S, (0-C PLAN CHECK
.� ENERGY SURCHARGE I / ) TOTAL
J;,lk 16 0 $ �n
CotA v-TA
9 1 1 NUMBER REFUND DATE DATE ISSUED
BUILDI N FrrEIF4CT IL. _
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BOOING TRMIT APPLICATION , • LftN go- Ci
Jefferson County Building Department*P .O . Box 1220sPort Townsend. WA 98368
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LOCATION .
1
SPECIFIC LOCATION SITE ADDRESS i k1 d�y'OS 1✓ D�ve- ) L]�
POSTAL DISTRICT /SUBD I V I S I ON 4•0 T y I/ / v I E
LEGAL DESCRIPTION LOT
BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 1 / 4 SECTION
PLANNING AREA SECTION l (O TOWNSHIP ,7 U NORTH RANGE / (. - WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE /��
( SINGLE FAMILY KNEW BUILDING MAIN FLOOR
'❑` MOBILE HOME 0 ADDITION 2ND FLOOR `?�.
❑ MODULAR HOME 0 ALTERATION BASEMENT__
❑ DETACHED/ATTACHED 0 REPAIR E^ NTa3 L,
GARAGE 0 REPLACEMENT GARAGE ,5 n X" .
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES -y /� /, y�
❑ COMMERCIAL SIZE /C/3 ' 0 q1. $35 ��Jl�1i7/_Sf/�p/
❑ INDUSTRIAL
YEAR 53 14�{, a7 $ 1 6 C� I (LOLL
❑ HOTEL/MOTEL/DORMITORY MAKE a,2/ VI a7 $8 / g‘7Iffi
NUMBER OF UNITS
1 //�1/
❑ OTHER - SPECIFY i-/
ESTIMATED COST OF _5(X 0 a1 $8 z/ 6 0
I MPROVEMENTS T77OTAL, jrb MMO ET VALUE
UBC OCCUPANCY GROUP
r $ �, t�[[��
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
vit WOOD FRAME g ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS ((,��.- ��
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREAOW�C�
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
N 14- PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS'
0 1 ND 1 V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOI&2 LC .
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM —
ammilme
PUD TYPE OF WATER SUPPLY / , ,�/ `. , I ( 1/y
7"� PUBLIC `( NAME OF WATER SUPPLY) 1--(AVL OW vvc R
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
KN O
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH ,-(r
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP T E L NO
OWR R R u-rCPS b0 AA d-c.t�P .v.s f L i-C ALI I37- /
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CONT Sa VYl e--,
ARCH
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THE OWNER..;OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIG OFZi/FlANT4„,....„ APP IC ON DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPR Y D BY PERMIT FEES
i
P /J ,SO BASE FEE I NSPECT I ON
BLDG SURCHARGE PLAN CHECK
L a 198g ENERGY SURCHARGE TOTAL
JEEEERfii ( ,p /
P(�MNIIG 4,s pGNry (n ,( ) 9 1 1 NUMBER REFUND DATE DATE ISSUED
I SSUfEEDD
BUILDING OFFICIAL I 7/I7/� /
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