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Home My WebLink AboutBLD1990-00909 RU> s) -D-- —�/ z, A 1 I U N ,� ILDING 4A P artment•P . O . Box 12_20'Port Townsend. WA 98368 Jefferson County Building Dep LOCATION ?--1-. Lan _o c&) - TD'lvle r door u,{11 a4e- - atie. Lf . , SPECIFIC LOCATION SITE ADDRESS �� S_-- e / 4 POSTAL DISTRICT /SUBDIVISION PY' 1'�}(1Y' LI 19e LEGAL DESCRIPTION LO O T BLOCK t DIVISION TAX NUMBER 7 PARCEL /NUMBER ��.f 1 7 - 1 / 4 SECTION PLANNING AREA SECTION /7 TOWNSHIP a taj NORTH RANGE / tom WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY KNEW BUILDING MAIN FLOOR crlt.31-1' n ❑ MOBILE HOME ❑ ADDITION 2ND FLOOR Cilif.CQ • ❑ MODULAR HOME ❑ ALTERATION BASEMENT N DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE R404 .50 ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL XMULTI - FAMILY 2 ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES ct \ • COMMERCIAL a3� , I a@ $3 5 CIS U<b/v , SIZE ❑ INDUSTRIAL YEAR J @ f 1 6 101k-050 ❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $ B N NUMBER OF UNITS `4 ❑ OTHER - SPECIFY 4 S-( c@ $g I ESTIMATED COST OF IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUP $ SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL IK WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR ❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL 7Pro CIekrahe� ❑ REINFORCED CONCRETE ❑ OIL )( OTHER - SPECIFY - nerlcrr P, ❑ MASONRY ( WALL BEARING ) DIMENSIONS❑ OTHER - NUMBER OF STORIES' , TOTAL LAND AREA OJ DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS N 14 PUBLIC OR PR I VATS NUMBER OF EXISTING BEDROOMS — ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROI'LIbED BATHROOM 4.7 C APPROVEAT E ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM, PUD TYPUBLICW( NAME or OATER SPWATER SUPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY V IA 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 ❑ NO °.! IDENTIFICATION &) NAME -� � . MAILING ADDRESS ZIP TEL NO -- OW ER - } _CONT phre, k eso LkYreS 4 A I C E,T121E n ,,..) r1 " * 1 _. , ARCH I tHE OSNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LASS, T' IG ATURE OF APB ICANT \ APPLIC •TION DATE RECEIPT NUMMER CHECK NUMBER Oft CASH G J\` 0 - O APPROVED BY PE MIT FEES 3J "�c BASE FEE INSPECTION BLDG SURCHARGE PLAN CHECK ENERGY SURCHARGE t TOTAL 9 1 1 NUMBER REFUND DATE DATE ISSUED BUILDING OFFICIAL — (3UAIIING 'ERMIT APPLICATION41/ PLAN IT Jefferson County Building Department'P .O . Box 122OePort Townsend . WA 98368 LOCATION �+ /�1�� `'`��'• � • SPECIFIC LOCATION SITE ADDRESS S u, i Kee/ ( 1-11 / " POSTAL DISTRICT /SUBDIVISior .h r RIB/` 1/ i LEGAL DESCRIPTION LO �1 BLOCK ryDIVISION TAX NUMBER /'� PARCEL NUMBER YCZ/7 ! ` 0p'-1/ 1 / 4 SECTION PLANNING AREA SECTION /7 TOWNSHIP p?n NORTH RANGE / E. WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE //-- ❑ SINGLE FAMILY )4 NEW BUILDING MAIN FLOOR 3G3 -1P; ❑ MODILE HOME ❑ ADDITION 2ND FLOOR ,Qe:1(Qf' e=4 ❑ MODULAR HOME ❑ ALTERATION BASEMENT .-e"� ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE /9o2 Q. - n./. ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL AMULTI - FAM I LY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS_41 MOBILE HOMES /1 �/ ❑ COMMERCIAL SIZE 3t2o3.4 @. $3 5 (Q51I a7 75 ❑ INDUSTRIAL YEAR o1__'_;_LYff��a1, @ $ 1 6 1/7 3 /3(/� ❑ HOTEL/MOTEL/DORMITORY MAKE I� @ $8 NUMBER OF UNITS ❑ OTHER - SPECIFY ESTIMATED COST OF Ay`2°2'7a $B //j 3-76./i IMPROVEMENTS aO AI A I(2�M?R, 7 VALUE UBC OCCUPANCY GROUP SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL * WOOD FRAME Ai ELECTRICITY 0 COLLECTIVE SOLAR ❑ MANUFACTURED [] WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL z 0 40vatm C_. ❑ REINFORCED CONCRETE ❑ OIL NtOTHER - SPECIFY _f Ac �l'X ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL 1 MB NUER OF PROPOSED BEDROOMS �' PUBLIC OR PRIVATE 1 NUMBER OF EXISTING BEDROOMS ❑ I ND I V I DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHUUUM APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM' PUD TYPE OF WATER SUPPLY wake_ X PUBLIC '( NAME OF WATER SUPPLY) LuDLoc.v wak APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY : PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY N 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 p-(7/yc /� �j� /7MAILING ADDRESS ZIP TEL NO O W N E R PO Fe' f iso y rS 4� - P(it Y/.�.d'l.11�. i Kt ')1.4:4411-/ f, l(O� ��7-a/c/ t L.14.T)L-a c v q CONT SA(V 1 �}.. iq G� TA ►`�I E�Qi3 C)D 1 i ARCH rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. SIGNA 0 ,O P 1 T APPL CATI DATE - R EIPT NUMBER CHECK NUMBER OR CASH PPOV A PERMIT FEES A P � BASE FEE INSPECTION UL VA s -. BLDG SURCHARGE PLAN CHECK JEFFERSON COUNTY /. ENERGY SURCHARGE t 700dC3 PLANNING&BLDG DEPT TOTAL II NUMBER REFUND DATE 1 DAT ISSUED BUILDIrFG OFFICIAL I 7/!/ [/ M 1989 JEFFE9SC1N COUNTY PLANNING&BLDG DEPT 1)77,-/O, LA) TcLfial RILk) 6 — 50,(A) c,(6 °la bp HzfrJ g64/0-12-( • (13-tt /Jo /A4 A