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ooq Devercpment Seruices
Residential Building Permit Application
F Applications by mail must include a check for initial
See Page 2 for details on plan submittal requirements.
plan review fee of $150 for valued over $15,000.
Zoning: K-6
Parcer n q,W- ?03 -ett1-
Project Address:
O hn^
#):n Tax(orILegal
ebck: '1Q
Lot(s z+
Proiect Description, 6,wJq,-f, nt [/glrOrr
must be provided for projects
valuation per RCW 19.27.095.
ect Valuation: $%r'.o,
Lender lnfo
Lender info
over $5,0P
Name
Add
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Phon
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Name:
Address:
City/SUZip
Phone:
Email New Addition ! Remodel/Repair
u)
NT tt
G
UU ls it finished? Yes
S
NO
areBuilding lnformation
Base
Manufactu
1tt floor
2nd floor
3d floor
Total Lot Goverage (Building Footprint):*
Square feet:_ %_
lmpervious Surface:*
Square feet:_ *Total existinq & proposed
Co
Add
Phone
Ema
State L
City
What year was the structure built?
lf work includes demolition, see Page 2.
the pqoperty?
)?6rN'
YAny known wetlands on
Any steep slopes (>15%
I hereby certify that
and that all
Print
Signature:
provided is correct, that I am either the owner or authorized to act on behalf of the owner
Laws and the Port Townsend Municipal Code.
f
Page 1
permit will be i
D/l
PERMTT # D t--Cdt '73 t
CITY OF PORT TOWNSEND
PERMIT ACTIVITY LOG
DATE RECEIVED o!
SCOPE OF WORK:
DATE ACTION INITIALS
ll t ENTERED INTO CHET Sta
I
CHECKED FOR COMPLETENESS
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Zoning;
Setbacks OK?
Lot Size:a U
i
Building Size:
Lot Coverage:
FAR OK?
Heieht OK?
Parkine OK?
Critical Area?
Demo?
Historic Rev?,-^7'I
Notice to Title?I
Lots of Record?\y
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