HomeMy WebLinkAboutBLD1989-00135 BUILDS `'ERMIT APPLICATION 0
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Jefferson County Building Department+P .O . Box 1220.Port Townsend . WA 98368
OCAT 0 ^111 Q' M "�.l
SPECIFIC LOCATION SITE ADDRESS - SUB• VISION
'u1- ,�";.- .:I .may( k_ POSTAL DISTRICT /
` BLOCK DIVISION�_TAX NUMBER
LEGAL DESCRIPTION LOT •� /��� C�Q� „29a 00�/ i / 4 SECTION
PARCEL NUMB Y
SECT I ONy T Y NSH I P , S L LNORTH RANGE I.
WM
PLANNING AREA '
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
/ �;� NEW BUILDING MAIN FLOOR aay
( ( SINGLE FAMILY �� 2ND FLOOR
// MO❑ 1LE HOME ❑ DDITION
❑ MODULAR HOME ❑ ALTERATION BASEMENTp� s
❑ DETACHED/ATTACHED ❑ REPAIR ViJ �t S�-
❑ REPLACEMENT GA AGE E�
GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ RELOCATION/MOVING INDUSTRIAL
❑ MULTI - FAMILY t�
NUMBER OF UNITS MOBILE HOMES a -'$35
p COMMERCIAL YEAR pc]]� �1,
❑ INDUSTRIAL YEAR �' a`„ " $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE �p 7 CtVI @ $e
NUMBER OF UNITS /C� ,�, $8❑ OTHER - SPECIFY ESTIMATED COST OF :. J--Y�
IMPROVEMENTS T%,-T,A& FAAFMARKET VALUE
UBC OCCUPANCY GROU: $ ''�� 771t // 1
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL X'
INCIPLE TYPE OF FRAME ' ELECTRICITY ❑ COLLECTIVE SOLAR
WAND FRAME
�' • OODSTOVE ❑ PASSIVE SOLAR
❑ MANUFACTURED ❑ COAL
❑ STRUCTURAL STEEL ❑ GI❑ GAS ❑ OTHER - SPECIFY
❑ REINFORCED CONCRETE ,
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA 111
DEPARTMENTAL REVIEW
H ALTH , EPARTMENT TYPE OF SEWAGE DISPOSAL SABER OF PR PO ED BEDROOMS
❑ PUBLIC OR PRIVATE I� , O I NUMBER OF PROPOSED BATH�L` ry NDIVIDUAL ( SEPTIC (
A PROVED DATE IPA NDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
1., - ten TYPE OF WATER SUPPLY
of{ q�J1}- ❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY _ _
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
yr,N Ill► NO
APPROVED DATE
=ANK HEIGHT SETBACK
PUB IC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
�/ - NAME OF PUBLIC ROAD
i\- �}B� NAME OF PRIVATE ROAD
APPROVED DATE
ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION ZIP TEL NO
MAILING ADDRESS -
OWNER 'T-���
CONT �
_'-• RCH
-
HE OWNER OF THIS BUILOING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
.AT RECEIPT NUMBER CHECI(N� CASH
IF .' , ��r " 7® S
A"P'OVED BY PERMIT FEE
7
BASE FEE INSPECTION
A p P � �BLDG SURCHARGE PLAN CHECK
1 ENERGY SURCHARGE $ 7 ( ()- S ) TOTAL
g.ffi Se&WAIL_ ,, 9 1 1 NUMBER REFUND I DATE DA , ISSU oe
pt'Mite g BLDG
BUILDING OFFICIAL
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