HomeMy WebLinkAboutBLD1989-00134 '
•UILDING ' 'ERMIT APPLICATI•
Jefferson County Building Department'P .O . Box 1220sPort Townsend. WA 98368
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SPECIFIC LOCATION SITE ADDRESS m��iratit L� �/� /
POSTAL DISTRICT Alf /SUBD I V I Sl•N NAFAIWZMIN
LEGAL DESCRIPTION LOT . BLOCK 0 DIVISION TAX NUMBER
PARCEL NUMBER ` !r} 4t -- �� 5'3 1 / 4 SECTION
PLANNING AREA SECTION �� TOWNSHIP -(yJ NORTH RANGE ! WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOL' ILE HOME ❑ ADDITION 2ND FLOOR
❑ M DU.I,,,A$,,.�HOME ❑ ALTERATION BASEMENT
�ETACHED/ATTACHED ❑ REPAIR CARPORT
.-- gRAGE ❑ REPLACEMENT ( GARAGE AINSAMMIMI
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL
SIZE j @ $35
❑ INDUSTRIAL YEAR
❑ HOTEL/MOTEL/DORMITORY MAKE 0 q@ $g6 _
NUMBER OF UNITS
❑ OTHER SPECIFY ESTIMATED COST OF a7 $8
r IMPROVEMENTS TOVAL; VR MARKET VALUE
UBC OCCUPANCY GROUP, , $ $ (, �-f -7
1,,
SELECTED CHARACTERISTICS OF BUILDING
PR NCIPLE TYPE OF FRAME w PRINCIPLE TYPE OF HEATING FUEL
WpOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE -SOLAR
MANUFACTURED ❑ WOODSTOVE -
❑ PASS( SOLAR
❑ STRUCTURAL STEEL ❑ GAS 0_5 --C `
❑ REINFORCED CONCRETE ❑ OIL ACIOTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ,
❑ I ND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER'•"-SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ 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
1�MAIAA TILING ADDRESS ZIP TEL NO
-d 1 OWNER / '�IL�� c
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T-HE OWE -, OF S BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICAPLE LAWS•
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jak - ' '/�F PPL 1 ANT A� i C I N E RECEIPT NUMB CHECK Ti • :ER OR CASH
APPRO Er Y i PERMIT /FEES
J 1 90.00 BASE FEE 1NSPECT1ON
A PROVED (� SD BLDG SURCHARGE PLAN CHECK
® � � Q`1 "71 � L
MAR 2 9 1989 ENERGY SURCHARGE $ 93 s-? _ TOTAL
ATM COUNTY
911 NUMBER REFUND DATE DAT IS P.
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JEFFERSON COUNTY
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