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HomeMy WebLinkAboutBLD1990-00907 it UILDING 'ERMIT AprLIt ATION �1i '1eK ' P�/ i /`j -4 Jef erson Coun B lding Department0P .O . Box 12200Port Townsend. WA 98368 OCAT O► A ►, A A Ai ..A..�� 1/ SPECIFIC LOCATION SITE ADORE S /a 0 Fa i i Ale_ - - POSTAL DISTRICT /SUBDIVISION.-- - - - T✓✓✓ � LEGAL DESCRIPTION LOT .5 BLOCK DIVISION TAX NUMBER i PARCEL NUMBER C) ^ A- -4 -d / 1 / 4 SECTION k/ PLANNING AREA SECTION - / TOWNSHIP c2 NORTH RANGE WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE �� �� ❑ SINGLE FAMILY ANEW BUILDING MAIN FLOOR ❑ MOBILE HOME ❑ ADDITION 2ND FLOOR 9714•so • ❑ MODULAR HOME 0 ALTERATION BASEMENT DETACHED/ATTACHED 0 REPAIR CARPORT �J� GARAGE ❑ REPLACEMENT GARAGE `9O '�U, ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL p( MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL ,, NUMBER OF UNITS CZ MOBLE HOMES CID ❑ COMMERCIAL S 1 B c� @ Cr. $-3-5 F ��/ ❑ INDUSTRIAL 974 50 a7 $ i 6 t o YEAR r{{ ❑ HOTEL/MOTEL/DORMITORY MAKE UJ @ $ NUMBER OF UNITS c�j/ I . ❑ OTHER - SPECIFY ESTIMATED COST OF $9 �l - \ IMPROVEMENTS TOTAL- .FA ID _MAOK Y VALUE UBC OCCUPANCY GROUP $ $ / / 3 - "° SELECTED CHARACTERISTICS OF BUILDING 1 PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL p WOOD FRAME W ELECTRICITY 0 COLLECTIVE SOLAR ❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL zero C/PQ{'2tn e ' ❑ REINFORCED CONCRETE 0 OIL x OTHER - SPECIFY -irPpJeL P ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIESC2 TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS I PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 467 APPROVE RATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM, PUD TYPE OF WATER SUPPLY)S I .,tom, ^, -` / p PUBLIC ' ( NAME OF WATER SUPPLY L r)LxxJJ (,Ow" g APPROVED DATE PRIVATE ( NAME OF WATER SUPPLY 4 PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY ❑ N O e�(�.�1, APPROVED DATE BANK HEIGHT SETBACK .` PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NO NAME OF PUBLIC ROAD NAME OF PR I VAT.:. ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO IDENTIFICATION NAME MAILING ADDRESS /{rP TEL NO OWNER , are_ �aurc C,o M Paradise F`, • VOL et- III P p--4--. 1. nL.�w W a 319G LI37-ajo/ CONT We,/ _ • RCH HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS, - IGNATURE OF APPLj CA T - APPLI ATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH �2 ,C 7'`�C,r � _ J7/9Q ���p e APPROVED BY P RMIT W FEES © BASE FEE INSPECTION BLDG SURCHARGE PLAN CHECK ENERGY SURCHARGE $ TOTAL 911 NUMBER REFUND DATE DATE ISSUED BUILDING OFFICIAL • I . , UUI111 -DING ERMIT APPLICATION111 FAIRWAY VILLAGE 4- Site 17-B Flex Jefferson County Building Department*P .O . Box 1220'Port Townsend . WA 98368, LOCATION 500 feet south of Teal Lake Road ' L-o1 • _S „ /� P / aSPECIFIC LOCATION SITE ADDRESS Grin LA-/V P . POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT#5 BLOCK DIVISION TAX NUMBER PARCEL NUMBER 821-212-001 1 / 4 SECTION NW PLANNING AREA SECTION 21 TOWNSHIP 28N NORTH RANGE lE WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE i ❑ SINGLE FAMILY KNEW BUILDING MAIN FLOOR o�� ❑ MOBILE HOME ❑ ADDITION 2ND FLOOR --,?./1 _.__,_. ❑ MODULAR HOME ❑ ALTERATION �.r3RD `0 S` 9 ❑ DETACHED/ATTACHED ❑ REPAIR doo^0,r / 0 �O /� GARAGE ❑ REPLACEMENT GARAGE Cv, /�yr✓ ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL XMULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS4 MOBILE HOMES ql p n ❑ COMMERCIAL SIZE S��� . $ 3 54679Qp 7/0 ❑ INDUSTRIAL YEAR ,2,3l ,s2,1�/J/ @ $ 1 6 '#.3io/_ao� ❑ HOTEL/MOTEL/DORMITORY NUMBER OF UNITS '1 50. MAKE A sub so R3VJ0• E ❑ OTHER - SPECIFY ESTIMATED COST OF 0@ $ 6 IMPROVEMENTS TOT FAIR MARKET VALUE UBC OCCUPANCY GROUF f. $ $/ r 30�7.00 F/.�sl SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL X WOOD FRAME )0 ELECTRICITY ❑ COLLECTIVE SOLAR ❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY O MASONRY ( WALL BEARING ) DIMENSIONS SIC / o OTHER - NUMBER OF STOR I E 'S 3 TOTAL�'CLA D AR A(�J, (, 1!�(�'Gf S DEPARTMENTAL REVIEW • HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS 14 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ❑ I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM OM mow PUD TYPE OF WATER SUPPLY �] PUBLIC '( NAME OF WATER SUPPLY) L / 1.�-hL L (A t1±I k eE APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION YES NAME OF ADJACENT WATER BODY 0 NO APPROVED DATE /" BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES A NO IDENTIFICATION NAME I MAILING ADDRESS ZIP T E L NO owriER Rd . Suite *4 Pope Resources G0M Paradise Bay , Pt . Ludlow, WA _498365 437-21C1 T CONT same STATE LICENSE NO POPER*12389 , ARCH It1E OWNER • THIS 'UILDING AN THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. S 1 GNAT..: Ar'OF T APPL CATION DATEF7ECE 1 PT NUMBER CI-PECK NUMBER ORCASH / AIM /i / 7 33`7c2 1C/ • D BY PERMIT FEES . � �i BASE FEE INSPECTION I 2 ( 1';g — 1-1 BLDG SURCHARGE PLAN CHECK JEFfEFI$LJN COUNTY ENERGY SURCHARGE dam► 4,) 0 TOTAL PLANNING&SLOG DEPT ���c�-`��a $ i t �i" !✓ 9 1 1 NVt.t17E:R iirruNo DATE DATE I ^sUrD tiy PI LINIii;&NRCI t ) 7C7 .91(91 D - 7/6- oi2 1(4 Ill Ae4,--ew--11_ 5"/117 ph.".„6/ 1, p214-4-6- 0 74-0- 4-62- (: ) 1 .--‘ (h 0 /z - 2 , / (11 -1/ - A) / 7'6 Igt war0,6-c),-AJ rz -gt-z Ce,-24.aee4 90- 4 deybe• J2- / //t/A .21 -) 501 -1 46771/0t/