HomeMy WebLinkAboutBLD1996-00018 . .
JEFFERSON COUNTY PERMIT CENTER, 621 SHERIDAN ST, PORT TOWNSEND WA 98368
BUILDING PERMIT APPLICATION
PROJECT DESCRIPTION: Oir-/C) \C /1_,,,d K-IL-
7 s z 02e s1- )6 /c f lei / /eLtn,
BUILDING TYPE: PJECT TYPE: FRAME TYPE:
C�--`SINGLE FAMILY b NEW ❑ WOOD
❑ GARAGE ATTACHED/DETACHED ❑ ADDITION ❑ STEEL
❑ MODULAR ❑ ALTERATION/REMODEL ❑ CONCRETE
❑ COMMERCIAL ❑ REPAIR Cl MASONRY
❑ MULTI FAMILY/# OF UNITS ❑ DEMOLITION ❑ OTHER
❑ INDUSTRIAL
❑ OTHER
BEDROOMS: BATHROOMS: TYPE OF SEWAGE DISPOSAL:
EXISTING EXISTING �❑ EWER El COMMUNITY SYSTEM
PROPOSED— PROPOSED 1. '' INDIVIDUAL SYSTEM ❑ Conventional
TOTAL „3 TOTAL c�` PERMIT # SEP ❑ Alternative
WATER SUPPLY: TYPE OF HEAT:
CVPRIVATE WELL ❑ ELECTRICITY ❑ OIL
❑ PUBLIC Name of water system: ❑ WOODSTOVE 'P✓ROPANE
❑ HEAT PUMP ❑ OTHER:
SQUARE FOOTAGE:
MAIN FLOOR / 6.?6 of o
2ND FLOOR — FOR OFFICE USE ONLY
3RD FLOOR ,_--_ UBC OCCUPANCY GROUP
HTD BASEMENT
UNHTD BASEMENT
E I '- >S�N` aAs FEE CARPORT
GARAGE 2-_ - n PLAN CHECK , r
DECKS �_ ;_-- �S!/`� ✓�
• STATE SURCHARGE r♦,5p .,,��
COMMERCIAL TOTAL I : '
INDUSTRIAL
OTHER
TOTAL VALUATION RECEIPT # 1143.: . j „'" �
n U
or "{ 0- CASH / CK ) Y :c :I
ESTIMATED COST � t
DATE
IF WATERFRONT PROPERTY,
DISTANCE TO BANK OR HIGHS WATER LINE ft BANK HEIGHT ft
SIGNATURE . (!�-� 0,_ DATE ///)--/ry &
NAME (PLEASE PRINT) /t/k/ C(Q" 5/U I` S H:\Horne\Plncntr\Forme\Bldapp.Frm 6/95