HomeMy WebLinkAboutBLD1990-00157I *1.) O 7 2
BUILD. 'ERMIT . APPLICATION
Jefferson County Building Department'P .O . Box 1220sPort Townsend. WA 98368' �90
LOCATION PO�f to-to
Lu n , /}� ��,,
SPECIFIWI
C LOCATION' SITE ADDRESS ��#71 8?o 1)-- b��a c7r Le-
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT 753 BLOCK DIVISION T TAX NUMBER
• PARCEL
777 ,
1 / A SECTION
PLANNING AREA SECTIONTOWNSH1P �(�'NORTH RANGE / 6. WI'I
BUILDING INFORMATION ,
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAG . ,
SINGLE FAMILY X NEW BUILDING MAIN FLOOR I �C//
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
•
❑ MODULAR HOME 0 ALTERATION
BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT ____--
GARAGE ❑ REPLACEMENT GARAGE _ /
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE /• V590 @' ^i
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY MAKE ig9�' aA( I73C7C
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 bl $8
IMPROVEMENTS TOjA.L. FAJ Rn,MARKET VALUE
UBC OCCUPANCY GROUP $ $ /
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
x WOOD FRAME )ELECTRICITY 0 COLLECTIVE SOLAR
•
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS '' �/
❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREA/ 9/O t
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ,
XPUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 0
❑ I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM v2
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISJTIINGl BATHROOM ja.,
PUD TYPE OF WATER SUPPLY L
❑ PUBLIC '( NAME OF WATER SUPPLY
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLYImmmwmommimmzmmw 3,.,,,.„.....,.
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
A NO
APPROVED DATE BANK HEIGHT SETB,ACK
PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH
NAME OF PUBLIC ROAD Me ✓ C' 112d .. --61-7,-c--/
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
NAME
MAILING
AILIING ADDRESS ZIP TEL NO
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ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIG TURF OF APP i CA T APPLIC TION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PERMIT FEES
41> CAD
BASE FEE I NSPECT ION
'
Ll ,Ca) BLDG SURCHARGE 7
S ( - PLAN CHECK
ENERGY SURCHARGE 4'` - q ( 3 TOTAL
ICJ . � 911 NUMBER REFUND DATE DATE ISSUED
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