HomeMy WebLinkAboutBLD1990-00164 — -
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Jefferson County Iding DepartmenteP .O . Box .00Port Townsend. WA 98368
That iLrtion of Gov. lot 1 & 2, sect. 1 twsp 28N, R1E, Jeff, Cty, Wn. •
LOCATION designated as Lot 36 bn suivev re or vi 6, Parcle 4 Pt. Ludlow
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SPECIFIC LOCATION SITE ADDRESS .
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POSTAL DISTRICTSUBDIVISION / A- - )0/ 1 /--
LEGAL DESCRIPTION LOT ‘'. BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 1 / 4 SUCTION
PLANNING AREA__,® SECTION i'd TOWNSHIP ;.L? NORTH RANGE / /7-7 WM
BUILDING INFORMATION vutetrae4,-(0 Pa_ie_ce_4 rt.5-7-7
BUILDING TYPE TYPE OF IMPROVEMENT SQUAPE FOOTAGE
Er. ,
XLSINGLE FAMILY ) NEW BUILDING MAIN FLOOR
• 0 MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE /4 c.) t.)
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
'''''' MOBILE HOMES
0 COMMERCIAL SIZE ao-oyi KCD4 -----
ge /6,6] @ $.4
0 INDUSTRIAL
YEAR 30D,./ 0 a) el6 d
0 HOTEL/MOTEL/DORMITORY
MAKE 7(;00 (A @ 4' ii On° —
NUMBER OF UNITS
............ /0 OTHER • SPECIFY 0 @ $8 ESTIMATED COST OF
IMPROVEMENTS
TOTAL. FAIR MARKET VALUE
UBC OCCUPANCY GROUP
$ $ /C.'`74,9--V D ----
/----
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
1WOOD FRAME .',;(4 ELECTRICITY 0 COLLECTIVE SOLAR
U MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER SPECIFY
0 MASONRY ( WALL BEARING )
0 OTHER - DIMENSIONS ..-2 4,0C,S.CI'Vevit
.....m......... NUMBER OF STORIES X--., TOTAL LAND AREA
(41A-s
DEPARTMENTAL REVIEW
,
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDRCXWIS 3
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
ya, I NO I V I D UAL ( SEPTIC ) N'!MBER a-- prtopos En BATHROOM APPROVED DATE • --'/Z-
, 0 INDIVIDUAL WELL NUMBER OF EX I ST I NG BATHROOM
.. 40110111■0
PUB TYPE OF WATER SUPPLY
• 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
...........
A.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 U YES U NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER r
ho r(-zt-ifk Ake) t34-
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0-al&S-r- (-1- ‘4_01-Y-70(al= 1
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migx,WNIER OF THIS BUILDING AN THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI ATURE OF\f P 1C NT
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APPROV BY APPLI ATION DATE RECEIPT NUMBER CRECK NUMBER OR CASH
O
P MIT FEES -
7 0 Q BASE FEE INSPECTION
/ -) . c_.
BLDG SURCHARGE / D 0 0,-3 PLAN CHECK
q E-0
ENERGY SURCHARGE ..$ /04/, SST TOTAL
/0 6 0 g 1 1 hiymazii HEF UNIO DATE !DATE 1 ssuco
1 BUILDING OFFICIAL
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