HomeMy WebLinkAboutBLD1990-00843 R cet) - rerin pQa ./ - 13 - /9- - I- /
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UUIL NG 'ERMIT APPLICATION W !N o- C
Jefferson County Building Department'P .O . Box 1220'Port Townsend. WA 98368'
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LOCATION vJ U 5/ �. � s� n.� vim iji-l�r I o 3
SPECIFIC LOCAA TION S I TE ADDRESS / SUBDIVIS ION y l// �i
�.� POSTAL DISTRICT / e
3 LEGAL DESCRIPTION LOY c _i3 Q BLOCK DIVISION TAX NUMBER
'�! PARCEL NUMBER 1 / 4 SECTION
// 7' NORTH RANGE / ( - WM
PLANNING AREA SECTION rl0 TOWNSHIP
BUILDING INFORMATION
C.7 BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE /7 &
* SINGLE FAMILY KNEW BUILDING MAIN FLOOR C O
ADDITION 2ND FLOOR � ) -�o
1 ❑ M O B I L E HOME ❑
C,- ❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR _CARPS R1DE L \ cQ.3
GARAGE ❑ REPLACEMENT GARAGE -S n
[] WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
D MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES �// ,,fY��
❑ COMMERCIAL S 1 XE /73& Y� @ $3 5 60 -7(7O
❑ INDUSTRIAL YEAR 53R"d5 @ f 1 6 C1 6,19Q
O HOTEL/MOTEL/DORMITORY MAKE ,Q,. / VI @ $8 / gi
NUMBER OF UNITS /
❑ OTHER - SPECIFY ESTIMATED COST OF g- VI @ $8 ' J ()(O!
IMPROVEMENTS TO F�AJ,17 MR ET VALUE
UBC OCCUPANCY GROUP ; $ cy((��
,,, SELECTED CHARACTERISTICS OF BUILDING
r PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
\.''� ixt WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL❑ REINFORCED CONCRETE ` �n
0 OIL MOTHER - SPECIFY`�IItQlaV�-
0 MASONRY ( WALL BEARING ) DIMENSIONS �Q � _
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA �Cn
,9
DEPARTMENTAL REVIEW ----a--
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDNOOMX�MS
// n PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS--
NUMBER'fI/ 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 0y
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM.
PUD TYPE OF WATER SUPPLY l / _ ` I , Ia�p
gPUBLIC ' ( NAME OF WATER SUPPLY) (-(( (� �J '\
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH .-30 / R
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE
ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
Z I P T E L NO
NAME MAILING ADDRESS140 ,
5w Eu 4)f R�ou.rcP� 690 NI Pc0a Sr . _ �.v. i.r;-c44 .3(0 `13-a.lor
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CONT Sa WI e-
poR._,i' C*E 7a�y9I
ARCH 1 I
rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIG TURF OF APPLICANT APPLICA ION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
//V90 (a�s`1�+ c 1 q 5 'r (,2(2/Q
•
APPROVED BY PERMIT FEES
5-3I, St) BASE FEE INSPECTION
-/ 50 BLDG SURCHARGE PLAN CHECK
ENERGY SURGARGE , clSURCHARGETOTAL
oil NUMBER RErUND DATE DATE ISSUED
• I DING orr ICIAL .
BUILDING 'ERMIT, APPLICATION /-%[,f-IN /6 -t5
flerson County Building apartment*P .O ., Box 1220•PoTownsend . WA 98368
I,... LOCATION EN- thew ,i t L-L-i + GE s (-re tp (�u �G .
SPECIFIC LOCATION
SITE ADDRESS �C� I
POSTAL DISTRICT /SUBDIVISION /--�i T/ iew 1/ le,
'3 BLOCK DIVISION TA NUMBER
LEGAL DESCRIPTION LOT
PARCEL NUMB R 1 / 4 SECTION�y
PLANNING AREA SECTION
TOWNSHIP (1 NORTH RANGE / /T . WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE/Q
SINGLE FAMILY X NEW BUILDING MAIN FLOOR �
0 MO1] ILE HOME ❑ ADDITION 2ND FLOOR —
❑ MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR C-AR-PO-RTDe, \ a 0Q
GARAGE ❑ REPLACEMENT GARAGE s 37
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES ���Cj���,f� / ��Q
❑ COMMERCIAL SIZE
/� s-'^''_� a@ $3 5 (c)
❑ INDUSTRIAL YEAR u, a $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE 00 a7 $8 / (POD
NUMBER OF UNITS0 -3-7y $8 „(�GJ/
OTHER SPECIFY ESTIMATED COST OF �'� /T'�'' chi / Y/
IMPROVEMENTS TOTA FAIR/ ,MAF1/$T VALUE
UBC OCCUPANCY GROUP $ $ U/ �! /f� • �)
2
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
gWOOD FRAME g ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED U WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL ❑ GAS 0 COAL
U OIL `{�( OTHER - SPECIFY
❑ REINFORCED CONCRETE /�
❑ MASONRY ( WALL BEARING ) DIMENSIONS Q
❑ OTHER - NUMBER OF STORIES � TOTAL LAND AREA(}/
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
N / PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 3-
r ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOMr2
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM T
_
PUD TYPE OF WATER SUPPLY /L/1
W PUBLIC '( NAME OF WATER SUPPLY) '01----0(A„) aleg
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
i
PUBLIC WORKS DEPT ROAD RIGHT -OF -WAY WIDTH 30
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME
MAILING ADDRESS ZIP TEL NO
a W hi E R �D ReS°"Ce3 (QD IV` PGZ. ra se, P c-1 Rv. SGci-0-1- /
CONT 6t-ve� _AR t
II 1Q 61 1
ARCH
THE OWNER F THE- BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
i / .,/
SIGN OF A 1.- A - APPLICATION DATE RECEIPT NUMBER CHECKIN ZE OR CASH
PPROV Y PE
-EES
BASE FEE INSPECTION
(1� BLDG SURCHARGE PLAN CHECK
0 i 1989
ENERGY SURCHARGE ci sc .S G� TOTAL
JEFFERSON COUNTY $ 1
hLANNING&ROG DEPT 0 1 1 NUMBER REFUND DATE DATEq1 SUED
BUILDING OFFICIAL [ 10(c 37
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