HomeMy WebLinkAboutBLD1988-00325 SILDING PERMIT APPLICATIONS
Jefferson County Building Departmen•L•P .O . Box 1220'Port Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION! SITE ADDRESS 7 0 cs (o drit
C
POSTAL D I STR I CT�t - /SUBDIVISION �'Q/� �L2.� {'/�
LEGAL DESCRIPTION LOT io q_(f BLOCK DIVISION / TAX NUMBER
PARCEL NUMB R 9 'WOO/C) ?\ 1 / 4 SECTION
SECTION � TOWNSHIP C NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL
$35
❑ INDUSTRIAL SIZE a@
❑ , HOTEL/MOTEL/DORMITORY YEAR $ 16
NUMBER OF UNITS MAKE $8
- SPECIFY
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,-4 � OTHER no� djl ESTIMATED COST OF Iu @ $8
1 re 04 C _"� IMPROVEMENTS ' TOTAL F IR MARKET VALUE
4 UBC OCCUPANCY GROUP $ $ /00
SELECTED CHARACTERISTICS OF BUILDING
WIP NCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
OOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
"' ❑ MASONRY ( WALL. BEARING )
o DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
i
DEPARTMENTAL REVIEW
r ej HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING B IS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPO BATHROOM
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF STING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER PLY) .
APPROVED DATE 0 PRIVATE ( NAME OF ER SUPPLY
PLANNING DEPT . WITHIN SHORELI JURISDICTION
❑ YES NA OF ADJACENT WATER BODY
O
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WO 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 NGC�ADDRESS ZIP/� TEL NO
OWNER
F— 4 i) Cp 7C �. ( 9g.z5
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C O N T (- 6 / l 1 Cezy ( /Y\_x gts
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ARCH / _ -
THE. OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIC A RE OF APPLICANT APPL CAT! N TE RECEIPT NUMBERCK NUMBER OR CASH
60 (��� 1 3/fcP1 CHECK
APPRO D PERMIT FEES
A P P 0 E r ��,(ES BASE FEE INSPECTION
IV` li5-7:)BLDG SURCHARGE PLAN CHECK
CT121988 _
ENERGY SURCHARGE R$ iX \
JEFFERSON COUNTY P v TOTAL
PLANNING&BLDG DEPT 9 I I NUMBER I REFUND DATE IllelsV( 1 S UED
BUILDING OFFICIAL t
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