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Commercial Building Permit Application
F Applications accepted by mail must include a check for initial plan review fee of $150) See the "Commercial Building Permit Application Checklist" for details on
plan submittal requirements.
250 Madison Street, Suite 3
Port Townsend WA 98368
Phone: 360-379-5095
Fax: 360-344-4619
www.cityofpt.us
Lender lnformation;
Lender information must be provided for projects
over $5,000 in valuation per RCW 19.27.095.
Name
Project Valuation: $
Construction Type
Occupancy Rating He ^ \*\,- C.o-v*e-l
Building lnformation (square feet):
l"tfloor .-y Restrooms: .-&-
2nd ftoor 4r e, I I O
3'dnoor CJ@A
Basement:.1'J 557
Deck(s):-ry
Storage .-ry
ls it finished?No
New! Addition! Remodel/Repair
Change of Use I {
I hereby certify that the information provided is correct, that I am either the owner or
and that all accordance with State Laws and
Print Na
Project Address & Zoning District:
9l*o1;-8c.81
L+? 4etlnl
Legal Description (or Tax #):
Addition: € ) Se, ,.r L'<ri-S
Block:_r V
, / -7*L,,n.* 3Lot(s)
Office Use Onlv
Associated Permits:
Proj
Ue-
P
Address
Prope
Email
ntative
e-
sl
-s
0
.o
Phone
Email
ContacURe
City/SUZip:
Address
Name
State License #:_Exp:_
..,k* tGontractor:
8._-,
Ema it.
P
City/SUZip
City Business License #
Total Lot Coverage (Building Footprint)
Square feet:
lmpervious
Square feet:
S
Municipal Code
on a trffi
Port
OFctry
Signature:
with will be
Date:
t
City of Port Townsend
Deve lopme nt Se rvices Depa rtment
250 Madison Street, Suite 3, Port Townsend, WA 98368
(360)379-s095
lnvoice
Date:22-OCr-08
lnvoice # 551
JEFFERSON CO PLJBL HOSP DIST #2
834 SHERIDAN ST
PORT TOWNSEND WA 98368-2443
Application No BLD08-119
PTOJECI: BIRTH CENTER CMNGES
ApplicationType ComrercialMiscellaneous
Flarcel # 94837141
Subdivision: EISEMES ADDIIION
Site Address: 834 SHERIDAN AVENUE
Description
Building Permit Fee
Plan Review Fee
Slate Building Code Council Fee
Technology Fee f or Building Permit
Record Retenlion Fee for Building Fermit
Fire Code and Fire Prevention Construclion
Review and lnspection Fee
BlocULot
$734.75
$477.59
$4.50
$14.70
$10.00
$110.21
Fee Amunt l+rid/Credit
$0,00
$1 50-00
$0.00
$0.00
$0.00
$o.oo
Total Fee Arnount:
Total Paid/Crediis:
Balance Due
$734.75
$327.59
$4-50
$14.70
$ 10.00
9110.21
I
$ 1351 .75
Balance Due
Payment due within 30 days
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a
$1201.7s
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5^t
l%ge 1
CITY OF PORT TOWNSEND
PERMIT ACTIVITY LOG
DATE RECEIVEDPERMIT #
SCOP
DATE ACTION INITIALS
ENTERED INTO CHET
CA - to Plann - No evidence
CHECKED FOR COMPLETENESS
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