HomeMy WebLinkAboutBLD1990-00171 AUILDING 'ERMIT APPLICATION
Jefferson County Builing Department.P .O . Box 12Port Townsend. WA 98368
..00AT)ON - L ""i6IL 'e( kfr e
SPECIFIC LOCATION SITE ADDRESS // JJ
POSTAL D I STR I C' %r<A V /SUBDIVISION �yli-C-/t'/rf3Z7 ts
LEGAL DESCRIPTION LOT z2., BLOCK DIVISION TAX N 1BERZO,2---"°
PARCEL NUMBER oZ / .4 SECTION 7
PLANNING AREA SECTION 7 TOWNSHIP 2SN NORTH RANGE i/.l;�S> WM
BUILDING INFORMATION
BUILDING TYPE 3TYPE OF IMPROVEMENT SQUARE FOOTAGE X SINGLE FAMILY X NEW BUILDING MAIN FLOOR d C,
❑ MOO] I LE HOME ❑ ADDITION 2ND FLOOI SOFT) /y 0
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT WSJ
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
M ILE HOMES /� �j
❑ COMMERCIAL SIZE wt (� @ $ 4 0
❑ INDUSTRIAL YEAR D 4 @ $20 ?"
00
❑ HOTEL/MOTEL/DORMITORY /,/
MAKE , Ig/l�0 @ $ 10 /4(e60
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTItSA D COST O 0 @ $ 10
A $
MP VEMENTS �\ TOTAL FA �R MARKET VALUE
UBC OCCUPANCY GROUPC%��� (J�'�
J
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
n WOOD FRAME Pi ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 1 0 GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
r
❑ MASONRY ( WALL BEARING ) DIMENSIONS /
o
❑ OTHER - , NUMBER OF STORIES TOTAL LAND AREA +(I'?
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS/
O P-UE3 L I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
[,- ► ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE py1-1\10 I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME, OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO __
tAr
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 ❑ NO
IDENTIFICATION
NAME /MAILING ADOR/E[���S ZIP TEL NO
OWNER ,_.� lLa� 41 W� /fir. r �� ~
:�g0/ill i "/ja` �< -� %jl�/*
CONT
S°1 ATE LICENSE ND
ARCH
A
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNAT R OF APPLICA APP ICA ION DATE REC 1 NUM R CHECK NUMBER OR CASH
'
APPROVED BY PER IT FEES
CIBASE FEE INSPECTION
; ) '4 BLDG SURCHARGE 44,623 PLAN CHECK
/
1. ENERGY SURCHARGE �^`
� i. ‘42
TOTAL• 911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL