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HomeMy WebLinkAboutBLD10-123JAC CALE 4 STSFEGS (NN JO SEH ABQT FER ~-ACTIVATING TRE 22tD ANT HDR (0 -6(2 F /Z22. \WWE= BCR B’K (NV ZOO AKL TKO ON FINENUNG FULLBD 36 VE AbO (oO ege Z KEelty LAPNT TIMINK Ze HA TIA FREED A= (7 KK, C4N CEKE FAGK WW AND JALIC 7H Yea You — FAANK SS GREP LAS EN) C=6 7370-4560 mit? (GP Ceo pith PO et RECEIv ED CITY OF PORT Townerun rp ID- S15 BLP [b- }23 CITY OF PORT TOWNSEND BLDG PERMIT ACTIVITY LOG PERMIT # FLD 1O—\25 DATE RECEIVED Ay - So — Zo/o SCOPE OF WORK: Burldi aX) ee DL , TavddahdouheS. 7 DATE ACTION INITIALS @_ l~ —10 | ENTERED INTO CHET pa WO CHECKED FOR COMPLETENESS Plan Review # Bedroom(s) = # Bath(s) = Heat Type: SEPTIC? Zoning: Setbacks OK? Lot Size: Building Size: Lot Coverage: Modulation? FAR OK? Height OK? Parking OK? Critical Area? (Check Impervious Surface limits 19.05.050D4(a) Shorelines Jurisdiction? Demo? Historic Rev/ Design Rev? Notice to Title? Lots of Record? P:\DSD\Forms\General Use Forms\Activity Log Bldg Permit.doc July 12, 2010 DEveivep Development Services APR 6 2010 U) Ok. CITY OF PORT TOWNSEND DSD 250 Madison Street, Suite 3 Port Townsend WA 98368 Phone: 360-379-5095 Fax: 360-344-4619 www.cityofpt.us Residential Building Permit Application Project Address: Zoning: Parcel# i Fa) Z2lZBFOr LAL DODYERY P SAEKAEA! | Adsition: ECSEM BES ings LS Block: (3H BULEINGS VITA PACKING FOR Project Description: COK/S7TRUCT” TO\WNAHOUSES “ny & Legal Description (or Tax#) | Office Use Only \7 > Permit # BLD10-2-*S>- Letts}: Ju LHF (a oo eae = Yz oF (9TA SbP i6-o1% Lore 19~ OU. (@ CAt2S . Applications by mail must include a check for initial plan review fee of $150 for projects valued over $15,000. See Page 2 for details on plan submittal requirements. Property Owner/Applicant: Name: YZ, csi) Address: 2.527 MGA kL AID Lo3r° City/SvZip: PT JOISEVD TF 36S Phone: Email: .———@ Contact/Representative: Name: _C% (A Phone: 246 -S92-FIGL Contractor: O Same as Owner Name:_A/O7 SAZECTED Address: City/St/Zip: Phone: Email: State License #: Exp: City Business License #: Emait: A4QGET © THE LASER RCH Tens. Com Building Information (square feet): 1" flor /PZOXZ Garage 2" floor L92Z0A2 Carport: S S2Ox2. Za 3" floor ——— Other: Basement Finished: WA Unfinished: Decks / Porches Covered: / 70x Z Uncovered ~ Heat Type: BISEBHE/D Electric oN Heat Pump Other. Total: #BedroomsO4Z #Bathrooms IX Size of lot Z/OS@ _ Square feet Total Lot Coverage (Building Footprint):* Square feet: ZooON 2 % 2474 Impervious Surface:* (ME wes CAE 7 Square feet: /003 *Tot & proposed Lender Information: Lender information must be provided for projects over $5,000 in valuation per RCW 19.27.095. sii. ee Project Valuation: $ 22 ) G00 What year was the structure built? MA If work includes demolition, see Page 2. Any known wetlands on the property? YW) Any steep slopes (>15%)? Y | hereby certify that the information provided is correct, that | am either the owner or authorized to act on behalf of the owner and that all activities associated with tp Print Name: Signature: Oo - Page 1 of 2 - 1/4/2010 yS permit will be in accordance with State Laws and the Port Townsend Municipal Code. Date AS ‘(ZO oF - -OVER- Receipt Number: BLD10-123 948313401 PLAN REVIEW DEPOSIT 150 $150.00 $150.00 $0.00 Total: $150.00 CHECK 4193 ) $ 150.00 Total: $150.00 genpmtrreceipts Page 1 of 1 BI Z SI K L NI LO N Po 22M 19 MEN Leesa LS NYNSBHS TP 2 on y SIXOTIVN es Se O A W E I a Cr IS O S -F LBzaLS SHOANSH | NO U W L I 9 I A ic a l | AE S FA L L Y N Ni v e l | (L B 3 S Z A L S HL b | da L w W o w A