HomeMy WebLinkAboutBLD1989-00293 f3 _DING x 'ERMIT APPLICATION 411
Jefferson County Building Department,P .O . Box 1220'Port Townsend , WA 98368
LOCATION 7. �
SPECIFIC LOCATION SITE ADDRESS 44 , / j
POSTAL DISTRICTS-7 /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMB R ( i%C ,IG.. / / 1 / 4 SECTION
PLANNING AREA SECTION /" TOWNSHIP 5i ' NORTH RANGE /f ° WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY IEW BUILDING MAIN FLOOR
❑ MO : ILE HOME ❑ ADDITION 2ND FLOOR
❑ M DULAR HOME
CH ❑ ALTERATION BASEMENT
DETA /ATTACHED ❑ REPAIR ,c.AR.P-_QRT /
GARAGE ❑ REPLACEMENT GARAGE ,, /(�-C (('
❑ WOODSTOVE ❑ WRECKING/DEMOLITIO RCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS - /
MOBILE HOMES
❑ COMMERCIAL SIZE
-----0 @ $3 5
❑ INDUSTRIAL YEAR @ $ 16
❑ HOTEL/MOTEL/DORMITORY
1-16
NUMBER OF UNITS MAKE �5: `_'"1 _ $8 'T
❑ OTHER - SPECIFY ESTIMAT COST OF 0 @ $8
I$MPRO MENTS TOgl Fj/j,-F<R MARKET VALUE
UBC OCCUPANCY GROU / $ C�..'% L�(y�.
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL G.
PRINCIPLE TYPE OF FRAME =
[]WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SO_LAR-"` ~-
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASS l y-E--"SQLAR
❑ STRUCTURAL STEEL ❑ GAS GC)AL
❑ REINFORCED CONCRETE ❑ a��--� 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA '?(
DEPARTMENTAL REV 1-1?W
HEALTH DE MENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS --
❑ P2IVOUAL
L. 1 C OR PRIVATE NUMBER OF EXISTING MS
0 rL+'4").-- I I V 1 D UAL ( SEPTIC ) NUMBER OF BATHROOM
BATHROO
APP VED DATE WELL NU OF EXISTING BATHROOM
PUB 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
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 ❑ YES 0 NO
IDENTIFICATION
NAME MAILING A DRESS r ZIP TEL NO
OWNER
/./7 )(71 ftr4C-c 71r: laZY 60:17 b / ' gel Lc , 5-c_.3
1--)19 n --,;-r c-1.-7-) ---//CW-- ..&1-5-5,16
CONT
S`I A'1 L1 LrMSE NU
.-
ARCH
f
THE O, -R •F,..TK ",S'i-,„pU -LDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE AYMS;-
ySIGN T 'R -A• P'_ JA7T77TE
RNR CHEC ( NUMBF_R O C'R; ED BY PERM FE
(/ )L
C It BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
440 2��-L� IJ&EENERGY SUICI IFIRGE $ TOTAL
JEFFERSOP OUNTV
P1,9I41!NI' IY BP OEPZ _ S 1 1 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL %I/ /69
AROVED
)12 7 IV
COUNTY
LANNiNT;fa ROG GEPT
40,t6vi id6„
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