HomeMy WebLinkAboutBLD1990-00844-KO)011 5-1-c) C_
. I APPLICATION •L _ ! &- C� I /
� UU��D�G ERMiT � � IV �y i s)..6p7 ,
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Jefferson County Building Department0) .0'. RBox 1220.Port Townsend. WA 98368� ,58
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LOCATION WI
I I V I V t L-t fl-G - S fl E ifit :
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SPEC I F I C LOCAT ION' S I TE ADDRESS 1,C/ - 1 //, ��/
POSTAL DISTRICT /SUBDIVISION GeN XXai
3
LEGAL DESCRIPTION LOT' BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 1 / 4 SECTION
i PLANNING AREA SECTION__Ll0 TOWNSHIP c7 ' NORTH RANGE / 74 • WM
BUILDING INFORMATION _
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE /��
a * SINGLE FAMILY V' NEW BUILDING MAIN FLOOR p
❑ MODILE HOME 0 ADDITION 2ND FLOOR .9-.�Q
❑ MODULAR HOME 0 ALTERATION BASEMENT �3
0 DETACHED/ATTACHED 0 REPAIR
GARAGE 0 REPLACEMENT GARAGE .S n
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES '�/ ,{, �y �(�
❑ COMMERCIAL a7. $3 9 COL `t (1` l lG
SIZE C p ' -
❑ INDUSTRIAL YEAR J3(1 ��// p� 1 6 �_ j
❑ HOTEL/MOTEL/DORMITORY MAKE 0,2 I V, @ $5 „ f/ / f p�7)
NUMBER OF UNITS @ $e
❑ OTHER - SPECIFY a.��C� �0�)
•
ESTIMATED GOST OF g" 0
IMPROVEMENTS TO L F^ " MARIK!"s' VALUE
UBC OCCUPANCY GROUP $ f- �
SELECTED CHARACTERISTICS OF BUILDING ✓✓✓���✓✓✓'''"'jj
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
f ` WOOD FRAME❑ MANUFACTURED
ELECTRICITY ❑ COLLECTIVE SOLAR
0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE 0 O I L OTHER - SPEC 1 FY--P'.fPla0--
❑ MASONRY ( WALL BEARING ) DIMENSIONS �p
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREAOD C
DEPARTMENTAL REVIEW •
I HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS S
_ - NM-
// p( PUB L I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
f y ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATH1tvVIWo2.'/,�.,
-._,_t`; APPROVED DATE ❑ INDIVIDUAL WELL NUMBERNUBER OF EXISTING BATHROOM___
PUD TYPE OF WATER SUPPLY ,, ,, ,- l WO
gPUBLIC ' ( NAME OF WATER SUPPLY) C �W LAJa `I\
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
jNO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH .-,f)
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP _ TEL NO
OWrIER R2 Rou.rcPS Coo M Cti, P . _ R.(U.S/ia-r Z 107-;40/
-. Lu DLo c,) u .3105
CONT=^ Sa vne-
TA E LICENSE r D
D( �IZ iE./s VI f
ARCH
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rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIG TURF OF APP CA TIli
►/f�APPLIC TiON T/E/�J - RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PE MIT F S
!� BASE FEE INSPECTION
t �„!-"BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE (/ j
/I, --Uk ) TOTAL
A 1 1 r lira r REFUND DATE_ DATE I SSUED
BUILDIrIG orrlctnt
13U ' DING 'ERMIT APPLICATION 7>L f7i/ l'b-S
Jrff "`son County Bui1din� DepartmentSP .O . Box 1220.•,t Townsend. WA 98368
0.-t a [� ^ 1 / ,
I.00AT 1 ON 13 t"C v l e w V L 1---`/4-GC - S ITC 6
SPECIFIC LOCATION SITE ADDRESS
qf
POSTAL DISTRICT /SUBDIVISION / tA.) , 7,
LEGAL DESCRIPTION LOT 8CJ BLOCK DIVISION TA NUMBER
PARCEL NUMB R 1 / 4 SECTION PLANNING AREA SECTIONTOWNSHIP NORTH RANGE / /-
WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGEs2
MAI
HOMELE LY XNEW❑ ADDITION IONBUILDING 2NDNFLOORR ��
0 MOBILEB
❑ MODULAR HOME ❑ ALTERATION BASEMENT
� --
❑ DETACHED/ATTACHED 0 REPAIR � R'T,VC.C_K .? QD
GARAGE ❑ REPLACEMENT GARAGE J 3 7
O WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES 2/ 5_20 @ $3s 6 : goZQ
❑ COMMERCIAL h "j/
SIZE
❑ INDUSTRIAL YEAR 0 p1 $ 16
❑ HOTEL/MOTEL/DORMITORY
NUMBER OF UNITS MAKE - boo�0 @ $8 / CO
❑ OTHER SPECIFY ESTIMATED COST OF `. . - a7 $8 �`�/%"
IMPROVEMENTS TOTA4.. FA i R ,MAR EET VALUE
UBC OCCUPANCY GROUP3 / / -7! P O
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
g WOOD FRAME )4 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS ❑ COAL r� ,�
❑ REINFORCED CONCRETE 0 OIL OTHER - SPECIFY ? �/
❑ MASONRY ( WALL BEARING ) DIMENSIONS (1
❑ OTHER - NUMBER OF STORIES f/ TOTAL LAND ARE/VC?(0)
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS o�
Nal--- g PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM-2 3/t
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM —
PUD TYPE OF WATER SUPPLY //W ,AG`
W PUBLIC •( NAME OF WATER SUPPLY) C/ i�L-OCA) -kj '
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPL J
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 .B Q
NAME OF PUBLIC ROAD •
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
�Y--��NAME � ~ / /��I` /-'��nMAILING ADDRESS / �,y ZIP TEL '"N/O
O W N E R �0/'-` R e (1 ( ( o l V 1 l I/l ,iSP i l�`-� RL• SV`�l 1� �37,2 c/
CONT e-/'
S • t 1EENSE NO
ARCH
r
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF p'PLIC NTn APPL AT10 DATE RECEIPT NU ER CHECK NUMBER OR CASH
r' / -e
PPROVED B1� P RMI FEH�S
A PBASE FEE INSPECTION
91evaiwil• / BLDG SURCHARGE PLAN CHECK
4
(J1 ENERGY SURCHARGE / TOTAL
UMW'&Binh fpto-y 9 1 1 NUMBER REFUND DATE E 1 y
` BUILDING OFFICIAL I
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