HomeMy WebLinkAboutBLD1990-00161 411LDING , TRMIT APPLICATION
Jefferson County Building Department9P .O . Box 1220sPort Townsend ' WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS /L(;2-D S4-1CAZ. J5F-41F-
POSTAL DISTRICT ' ')/SUBDIVIS ION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 3:1,1 15 ( OC7 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP 02,r= NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
Cr'SINGLE FAMILY z"- 0 hi7EK,-) BUILDING MAIN FLOOR --kor-Llg
Li MOVIILE HOME / 2ND FLOOR
0 MODULAR HOME AyfERAT I ON BASEMENT
E DETACHED/ATTACHED 0-1EPA I R CARPORT
GARAGE . 0 REPLACEMENT GARAGE
WOODSTOVE Ej WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY . 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL SIZE 77A $40 )/08o
O INDUSTRIAL
YEAR 2 $20
O HOTEL/MOTEL/DORMITORY
M KE $ 10
NUMBER OF UNITS
O OTHER - SPECIFY csr 0 @ $ 10
MATED COST OF
IMPR VEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU 3. $
SELECTED CHARACTERISTICS OF EUILDI /4'11S6 64"-11'4?' 11-t4"
ajqj
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL AlL)
WOOD FRAME [1----ELECTRICITY D COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR ./Vt(d ) Mg/
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL D OTHER - SPECIFY
O MASONRY (WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS )
O PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS (
[4--1 ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
12 -1-NDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
O NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
rn yr) min
Corn-
mrlm LIcriTr'c no
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER ctiecK NUMBER OR CASH
;)3 P2-I c10 Ic72__qo
APPROVED BY PERMIT FEES
4:2(11 / (r) BASE FEE INSPECTION
BLDG SURCHARGE -43 , V; PLAN CHECK
C41
ENERGY SURCHARGE $ 332 ra TOTAL
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
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1135 LAWRENCE STREET
PORT TOWNSEND, WASHINGTON
98368
PHONE (206)385-5614
Drawn by
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Date
Mn261-1
Scale \�L)TEiJ