HomeMy WebLinkAboutBLD1990-00159 •
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BUILDING 'ERMIT APPLICATION C� .
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Jefferson County Building DepartmentIP :O. Box 1220'Port Townsend. WA 98368 .�(Q iq
rLOCATION /;7 l6-D
SPECIFIC LOCATION SITE ADDRESS -reA4/1117d9'C daVil-e-
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POSTAL DISTRICT /SUBDIVISI N
LEGAL DESCRIPTION LOT �(J BLOCK DIVISION L:3 TAX NUMBER
PARCEL N MBER p 1 / 4 SECTION
PLANNING AREA SECTION D OWNSHIP CO// NORTH RANGE Rl C WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR Sa o
❑ MODULAR HOME 0 ALTERATION BASEMENT /f O
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE / ,1
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES -/k-' \
❑ COMMERCIAL SIZE
/� �. ;3 5 '
❑ INDUSTRIAL /c7
❑ HOTEL/MOTEL/DORMITORY YEAR 9�0�{, q1 ; 1 8 I-e-r-7-r '_
NUMBER OF UNITS MAKE l/O (� @ $8 1c.f/ L C)
❑ OTHER - SPECIFY ESTIMATED COST OF 4/49 0 a S 8 -_`�� f -
IMPROVEMENTS TOTA S_ FA ►ta. m""..""" VALUE
UBC OCCUPANCY GROUP
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME x ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS f
0 OTHER - NUMBER OF STOR I E�!� TOTAL LAND ARE/tRa Zo�--
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS_
XPUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ()
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHItOUM o3
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY // �, ,� ', �/// ����/pO
XPUBLIC '( NAME OF WATER SUPPLY) �Dl�w 600- Z
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
p\ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
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NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAMEgezerr-ov.ai /�J .M/MAILINGA/DDD/RESS yZIP TEL NO
f E RPO ((/r // / Pv `„il a_ �y%���Cy �
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)ANER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LABS.
\TURF OF APPLICA APPPL ION DATE t RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PER IT F S
I C BASE FEE INSPECTION
4 BLDG SURCHARGE '!Cy , �/(�7 PLAN CHECK
nn ENERGY SURCHARGE
� TOTAL
AV, ( ) 91I NUMBER REFVND DATE DATE ISSUED
BUI _ MG orrlcIAL