HomeMy WebLinkAboutBLD1990-00845 --K--(6)01 -A-----0 e_. *- levrs,N6Dt-
DING . 'ERMIT AP,PLICP,TION • Lf N /6- C 1 ,
Jefferson County Building Department'P . O . Box 1220'Port Townsend. WA 98368 3q
LOCATION -BA\ View VtL-l- fl-&E ,5/TE
�Pp. /..--u*I-xJSPECIFIC LOCATION' SITE ADDRE S , 1 ' /POSTA LL DISTRICT /SUBDIVI.SION 45 4Gtt i i�� e
LEGAL DESCRIPTION L011 3 9 BLOCK DIVISION TAX/ NUMBER
•
' PARCEL NUMBER 1 / 4 SECTION
PLANNING AREA SECTION / (O TOWNSHIP �48' NORTH RANGE / t - W1'1
0 BUILDING INFORMATION
BUILDING' TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE J�
( SINGLE FAMILY KNEW BUILDING MAIN FLOOR❑ MOBILE HOME ❑ ADDITION 2ND FLOOR . Q
( 0 MODULAR HOME ❑ ALTERATION BASEMENT,,,
(^v 0 DETACHED/ATTACHED 0 REPAIR -NR-PORT %k 023
I .
a GARAGE ❑ REPLACEMENT GARAGE .5 n
0 WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
_t 0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES - /_ ()
❑ COMMERCIAL SIZE �7J� �� �:' f38 ."L _"-�
❑ INDUSTRIAL 1 1
YEAR 8
❑ HOTEL/MOTEL/DORMITORY MAKE a d� a��� S8
NUMBER OF UNITS Q� ,/5
❑ OTHER - SPECIFY ESTIMATED COST OF 50" w @ $9 >?0 ` 1
IMPROVEMENTS TO FA II D •• T VALUE
UBC OCCUPANCY GROUP $ ;' //ice l QJ
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME Y°$ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL M OTHER - SPECIFY-Phyla-6--
ID MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES , TOTAL LAND AREAWC
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
/4—
PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS-- -
N0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM2. ,
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM,
1 PUD TYPE OF WATER SUPPLY / , I;�/ r. l 1 �p p
�'r�/y g PUBLIC `( NAME OF WATER SUPPLY) Cat 1JLOW L Jc1€ \
'Zr�[ APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
, PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
p NO
APPROVED DATE '` BANK HEIGHT SETBACK
C�r PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH .-0 1
(3- NAME OF PUBLIC ROAD
�— NAME OF PRIVATE ROAD
4APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
• NAME A MAILING ADDRESS ZIP TEL NO
0". "
rr. E n ^R) _ Fou.rcPS (DO] Th a d P . RU.S I i*Az/ 1-4N-;40/
CONT Sa VYl e.- `
4. A' E LICENSE rD
ply{ k I{- s t
. . ,
ARCH
ENE OWNER OF THIS BUILDING`AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI ATURE OF AP LICAN APPLI AT ION DATE
RECEIPT NUMBER CHECK NUMBER OR CASH
,, •: ' 5---)--.040 •
APPROVED BY P RMIT FEES
4d .)—ImASE FEE INSPECTION
s
. 4-1-4-60 BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE t .(), 0(:) TOTAL
911 1 TR./FARM RFrUND DATE DATE ISSUED
DUILDIUG orr ICI AL
=a' "LDING 'ERMIT APPLICATION 'off/-,/ / ,'
* Jefferson County Builc �g Department•P .O . Box 1220SDrt Townsend . WA 98368
_ 'Bit Vt (A) VI �1A-G - SiTe lo
LOCATION
SPECIFIC LOCAT 1O SITE ADDRESS VI ta) D
RDSf RR�tV P—I)/ ), •'
POSTAL DISTRICT /SUBDIVISION [_ ,,(r //! / ! • a-
LEGAL DESCRIPTION LOT ' , BLOCK DIVISION TAX NUMBER
PARCEL NUMBER/ Ems-//h - 1 / 4 SECTION
PLANNING AREA SECTION /ll7 TOWNSHIP l? NORTH RANGE / WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE/��
O SINGLE FAMILY (� NEW BUILDING MAIN FLOOR
MOBILE HOME (❑\ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT --'—
❑ DETACHED/ATTACHED ❑ REPAIR C R R-T004 - -----
GARAGE 0 REPLACEMENT GARAGE j!Y?&
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL SIZE /7th0 g) $35 (QCr(VQn
❑ INDUSTRIAL YEAR ��{{,,
❑ HOTEL/MOTEL/DORMITORY W W $ 16
MAKE oR R1 @ $8 S(
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 5 01
nA a $8 gay41
•
IMPROVEMENTS TOT�rL((�� ��jj FAA/M KET VALUE
UBC OCCUPANCY GROUP�c j' $ g 1
r -
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
gWOOD FRAME U ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL �
❑ REINFORCED CONCRETE 0 OIL p OTHER - SPECIFY // 1.12 '
O MASONRY ( WALL BEARING ) DIMENSIONS /
❑ OTHER - NUMBER OF STORIES ( TOTAL LAND AREA/ ()
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
Nl PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS '—
!l ❑ 1 N D 1 V 1 D UA L ( SEPT I C ) NUMBER OF PROPOS ED BATHROOM cr2_.�
APPROVED DATE
❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY // ',/' \ ff Qo � �p
PUBLIC ' ( NAME OF WATER SUPPLY) �--�ti)r 0w Wa J�g
,
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
wre. nw......m
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 ❑ YES 0 NO
IDENTIFICATION
NAME y'/�(� 4 /^/� }�/^�MAILING
eA�'II L I NG ADDRESS\r/, fir(-J ZIP �,-//TEL NO
OWNER , S o 1 l Y S lfl(l M p�/I[.[l ti,lf'i j}�.I 1 l31/O/
', l t -4-. u L-o c,�.) Eat
D
CONT ��SA.e.j
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
5 1 GNA ' ,OF PL„4C/}MT� AP� �ATE RECEIPT NUMBER �CHECK NUMBER OR CASH
/G// ATIO 7
PROV D Y PERMIT /F fEES
A p /F D q7/1 V .-.) BASE FEE I NSPECT ION
Lit, S BLDG SURCHARGE PLAN CHECK
SEP 7 1989
[J ENERGY SURCHARGE $ c� SD TOTAL
JEFFERSON COMFY -�-
PLANNING BLDG DEPT 9 1 1 NUMBER REFUND DATE (D 6 1 UE
BUILDING OFFICIAL ) .7 f) ``
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