HomeMy WebLinkAboutBLD1990-00156 0 . 0 ,. . 4.- c Nb 1#,
BUILDING 'ERMIT' APPhCATION i
Jefferson County Building Department'P .O . Box 1220'Port Townsend. WA 98368 ' 70 0
LOCATION Pdz z'o /Y
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SPECIFIC LOCATION SITE ADDRESS u/eu^,-Qwe�� FPl7 ',t-e- /
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT % BLOCK DIVISION �� TAX NUMBER
PARCEL N M,ER --�—��_1 / 4 SECTION
PLANNING AREA SECTIONt e , �'7 TOWNSHIP 7 g NORTH RANGE / 6-. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
XSINGLE FAMILY X NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION
Z N D FLOOR —_---r •
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT ---
GARAGE 0 REPLACEMENT GARAGE - '74U
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS R I MOBLE HOMES
❑ COMMERCIAL SIB /. .d� @. / '
❑ INDUSTRIAL YEAR @ ; g J c'�'
O HOTEL/MOTEL/DORMITORY MAKE 8r, @ fr 7g 0
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF $8
IMPROVEMENTS TOTAr Fen unnurT VALUE
UBC OCCUPANCY GROUP $ $ !
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
X WOOD FRAME J�Q ELECTRICITY ❑ COLLECTIVE SOLAR
•
❑ MANUFACTURED /❑ WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREA/d 50
DEPARTMENTAL REVIEW • .�g-
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS,'3
PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ()
0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM C
PUD TYPE OF WATER SUPPLY �� 'J(��/ _ 6,04z
71e
pPUBLIC ` NAME OF WATER SUPPLY ]C
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . 'WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
ANC)
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH ____ /
NAME OF PUBLIC ROAD (i�/�-�I?e�
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO *_____—
IDENTIFICATION
NAME J // MAILING ADDRESS ZIP TEL NO
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owNER u� S (o � iga�t . e e / 4 -
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CONT 6a Y/fr,
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ARCH
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FHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGN TURF OF APPLI, AN A PLICATION DATE ( RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PERMIT FEES
��
`j I. CO -,+SE FEE ____, INSPECTION
LIi 7 D BLDG SURCHARGE ! ?t b S .-LAN CHECK
j
ENERGY SURCHARGE r J c� TOTAL
0 ,UU 911 NUMBER REFUND DATE DATE ISSUED
Atltl h1NG OFFICIAL