HomeMy WebLinkAboutBLD1995-00598r 7
JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368
BUILDING PERMIT APPLICATION
PROJECT DESCRIPTION:
U DING TYPE: PROJECT TYPE: FRAME TYPE:
SINGLE FAMILY NEW WOOD
El GARAGE ATTACHED/DETACHED . El ADDITION El STEEL
❑ MODULAR ❑ ALTERATION/REMODEL 1%CCONCRETE
El COMMERCIAL El REPAIR ❑ MASONRY
El MULTI FAMILY/# OF UNITS ❑ DEMOLITION ❑ OTHER
El INDUSTRIAL
❑ OTHER
BEDROOMS: BATHROOMS: TYPE OF SEWAGE DISPOSAL:
EXISTING EXISTING El SEWER ❑ COMMUNITY SYSTEM
PROPOSED PROPOSED INDIVIDUAL SYSTEM El Conventional
TOTAL TOTAL ,7;l 2 1 PERMIT # SEPg j.(j�Z _a ( Alternative
W TER SUPPLY: TYPE OF HEAT:
PRIVATE WELL El ELECTRICITY ❑ OIL
❑ PUBLIC Name of water system: ❑ WOODSTOVE ' PROPANE
❑ HEAT PUMP ❑ OTHER:
SQUARE FOOTAGE: ,//
MAIN FLOOR Z/ ? lc
2ND FLOOR , Co ` 3 }j 0 3 3. s FOR OFFICE USE ONLY
3RD FLOOR � UBC OCCUPANCY GROUP
HTD BASEMENT 0 `7 I/0
UNHTD BASEMENT ---
CARPORT �� BASE FEE
GARAGE t PLAN CHECK'.
DECKS ?) ��
STATE SURCHARGE 4.50
COMMERCIAL
TOTAL i td x
INDUSTRIAL
OTHER t `
TOTAL VALUATION RECEIPT # `
or DATE f`�
ESTIM TED COS Coll
(.... t;21-D . c)
CASH HECK:# J/d {
IF WATERFRONT PROPERTY,
DISTANCE TO.BANK OR HIGH WATER LINE ft BANK HEIGHT fJ
SIGNATU '`1i ...-_. DATE l(}--t—c
NAME (PLEASE PRINT) C...211,0 rl 6‘ CiO,',(11r1E1-. \ fi
h:\HOMEPLNCNTR\FORMS\bldepp. m 6/95