HomeMy WebLinkAboutBLD1989-00137 BUILDING ,•'ERMIT APPLICATIO
Jefferson County Bulling Department,SP .O . Box 1 •Port Townsend. WA 98368
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LOCATION
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SPECIFIC LOCATION SITE ADDRESS `� - an' -.1 nr y����.
POSTAL STRICT /SUBDIVISION f i ��/,L IL�I
LEGAL DESCRIPTION LOT BLOCK DIV S ON TAX NUMBER
PARCEL NUMBER 3 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE._ -
- �°�
73g-SINGLE FAMILY ❑ NEW BUILDING q MAIN FLOOR
❑ MOBILE HOME ADDITION K= z. .,,,_:• 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ICOMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES �/ -`
❑ COMMERCIAL SIZE , a $35 -ilC%(
❑ INDUSTRIAL YEAR
❑ HOTEL/MOTEL/DORMITORY 4 a $ 16
NUMBER OF UNITS MAKE a $g
❑ OTHER - SPECIFY ESTIMATED COST OF d a $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE•UBC OCCUPANCY GROUP #11 $ $
SELECTED CHARACTERISTICS OF BUILDING kjt1/12s1' -)(0---
�\��\PRI IPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
OOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - 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
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER__^a.UPPLY)
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 WO DEPT ROAD RIGHT-OF -WAY WIDTH
/,-/ NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADD ES S ZIP TEL NO
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CONT � �1 N. IWalr '11111111NA ,/rl .
ARCH
T nw R OF THIS SW DI G AND THE U DERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
GNATURE OF APP./..IC N ■
AP LICA N TE I NUMBER CK NUMB R OR CASH
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APP ROVE• B P RMIT F -S
A P P ®� O / + BASE FEE INSPECTION
J . 19110 5 _ i BLDG SURCHARGE PL CHECK
JEfiF,MN12[IY CCUtb'It ENERGY SURCHARGE $ ���r SC) TOTAL
PLMWMCOVL
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
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