HomeMy WebLinkAboutBLD1991-00913 411
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Jefferson County Planning and Building Department
Courthouse, 3rd Floor
PO Box 1220
Port Townsend, WA 98388
206-385-9141
PERMTT # Rr rt,,, 1 ��
= . DATE RECEIVED. -05/24/91
STTF. ADDRESS: 32851 HTCHWAY 101
-BRINNON. WA 98320
OWNER •PATRTCK RODG;ERS PHONE: 842-6549
MATT.TN( ADDR :P.O. BOX 11114
!WTNSLOW WA 98110
CONTRACTOR . . !NO CONTRACTOR PHONE !
MATLTNC ADDR:
CONTR. T,TC #: EXPIRATION DATE:
ARCHITECT/ . . ! PHONE-
DESTONER •
MAILTNO ADDR :
PARCEL NO. . . : 502023019 HEALTH:
LEGAL DESC. . :STR 02-25-02 WWM, TAX # 35 BY! DATE:
T,OT , BLOCK SHORELTNES
BY: DATE:
DESCRIPTION OF IMPROVEMENT! single family residence
BUILDING TYPE •RFS BEDROOMS--- BATHROOMS-- MAIN FL. . . ! 1852 sf
TYPO OF TMPROVEMENT:NEW EXIST. : 0 EXIST. : 0 2ND FL 0 sf
GARAGE./CARPORT • PROP. . • 2 PROP. . • 4 3RD FT. • 0 sf
WOODSTOVE • TOTAL. : 2 TOTAL. : 4 BASEMENT. . _ 1797 sf
UBC OCCUPANCY GROUP:R3 SEWAGE DTSP. . -SEPTIC CARPORT. . . - 0 sf
TYPE OF CONST WATER SUPPLY. :PRTVATE GARAGE • 0 sf
UNITS . : 0 STORTES : 2 HEAT TYPES. -EEE/ / DOCKS • 550 sf
DIMENSIONS ! MOBTT.E HOME COMMERCTAT,: 0 sf
FRAME TYPE:WOOD MAKE: YR : INDUSTRIAL: 0 sf
EST COST. $ : 115520 SI7F.: BANK HT. . . -0 ft
PROJ ORP. . - 1513 SH SETBACK:0 ft
Owner/agent FEES
Signature: type amount by date recant
PRMT $ 895 . 00 AK 05/24/91 55793
Date: PLCK $ 104 . 25 AK 05/24/91 55793
B.C . $ 4 . 50 AK 05/24/ 55793
Issued By:
Date: • (/ _
s•-•/°?A
$ 803 . 75 TOTAL
. 'BUILDING ;'ERMIT APPLICATION
•
Jefferson County Building Department'P .O . Box 1220SPort Townsend, WA 98368
•
LOCATION - T
SPECIFIC LOCATION .-SITE ADDRESS 7 CckVi ) (,1(t.11� 1 l I flia,', ? ..z 4.ri 7,��2i/
POSTAL DISTRICT 61Y1, T)\ /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER `.; %
PARCEL NUMBER l 1p;/+3 V I 1 / a SECTION
SECTION i' TOWNSHIP 2.. NORTH RANGE 2._. i..' WM
BUILDING INFORMATION .
B ILDING TYPE TYPE \OF IMPROVEMENT SQUARE FOOTAGE [[
SINGLE FAMILY .� NEW ,BUILDING MAIN FLOOR ( L
' / MOBILE HOME ADD! ION 2ND FLOOR
❑ ❑ 'r -7
0' MODULAR HOME ❑ ALTER\ATION BASEMENT I9 1
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
fGARAGE ❑ REPLACEMENT GARAGE
4/ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRI L
NUMBER OF UNITS DECKS? �� �
MOBILE HOMES
❑ COMMERCIAL SIZE I a°
I ❑ INDUSTRIAL
rf�
❑ HOTEL/MOTEL/DORMITORY YEAR / G` UJ � 20
NUMBER OF UNITS MAKE \ t�f`y{',t $ 1 0 T (�'
❑ OTHER - SPECIFY ESTIMATED COST OF . W q@ $ _,
I MpROV EMENTS TOTAL FA I n v n KFT '-'.. Ur
UBC OCCUPANCY GROUP $ $^ --1,.
SELECTED CHARACTERISTICS OF BUILDING
, ' 1 INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME 'ELECTRICITY 0 COLLECTIVE SOLAR
°,J ❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) DIMENSIONS
❑. OTHER - NUMBER OF STORIES TOTAL LAND AREA , `•
1`
... DEPARTMENTAL REVIEW -
` J . HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS `,
�--- ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM '1-
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
k PUD TYPE OF WATER SUPPLY
❑ PUBLIC_ ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE (NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME- OF ADJACENT -WATER BODY
1 ql r, .vim
D NO r t1
APPROVED DATE BANK HEIGHT 1 n SETBACK ..:) '
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
AME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES A NO i
IDENTIFICATION
!- NAME MAILING ADDRESS ZIP TEL NO
Z7WNER
; \ 1 '. TT, :) 2S(..__.7 08)
PAT%.v te_.0,4. OR P (..5 V .C.). ?, A' !Mg (_,A,...'+f L,>I[,_:,_, ! LA— - Cr8.[l Q/24 FL"?
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CONTV �','
STATE LICENSE N ,,,-
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I'HE OWNER OF THIS BUIL ING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SyGNATURE OF AP!LICAN7� APPLIC TI N DATE RECEIPT NUMBER CHECK NUMBER OR CASH
/ —tea;. r 7
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APPROVED BY PERMIT FEES
-1 _ BASE FEE INSPECTION
LI: BLDG SURCHARGE ((1 c 1- PLAN
CHECK
ENERGY SURCHARGE $ AKAIN p, Q '` 'TOTAL
C
tlil NUMBER 1 "EFUND DATE DATE ISSUED
BUILDING OFFICIAL 1
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