HomeMy WebLinkAboutBLD1988-00327 . . .
' ...
WILDING PERMIT APPLICATIO.
Jefferson County Building DepartmetibP ..0 . Box 1220•Port Townsend, WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS_
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOC DIVISION TAX NUMBER.,2 "
of PARCEL NUMBE 1 / 4 SECTION
,..>
,, // SECTION TOWNSHIP d\._ i NORTH RANGE / WM
,74
BUILDING INFORMATION
...
-,,, ------
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
V..
ss.) 0 SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
D MOBILE HOME 0 ADDITION 2ND FLOOR
s.A
-,.._ 0 MODULAR HOME D ALTERATION BASEMENT
D DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
77400DSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
LZD MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
---- MOBILE HOMES
0 COMMERCIAL
SIZE 0 2 $35
0 INDUSTRIAL
YEAR 0 @ $ 16
D HOTEL/MOTEL/DORMITORY
MAKE 0 @ $8
NUMBER OF UNITS
D OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP
$ $
SELECTED CHARACTERISTICS OF BUILDING
to ----
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL,,,,,,
D WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE D PASSIVE OLAR
t.'
0 STRUCTURAL STEEL D GAS 0 COAL -
Li REINFORCED CONCRETE 0 OIL 0 0 ER - SPECIFY
0 MASONRY ( WALL, BEARING ) DIMENSIONS
P OTHER - NUMBER OF STp ES TOTAL LAND AREA
DEPARTMENTAL REVIEW .
HEALTH DEPARTMENT TYPE OF SEWAG " DISPOSAL NUMBER OF PROPOSED BEDROOMS
C-(- '
'.: 0 PUBLIC 0 PRIVATE NUMBER OF EXISTING BEDROOMS
El I ND I V I AL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
0 IND ( IDUAL WELL NUMBER OF EXISTING BATHROOM____PUD TYP7 OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY) '
APPROVED DATE P PRIVATE ( NAME OF WATER SUPPLY)
---
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
0 NO
APPROV DATE BANK HEIGHT SETBACK --
PUBL C WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD ---
NAME OF PRIVATE ROAD
_ / APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
----
IDENTIFICATION
NAME MAILING ADDRESS .
ZIP TEL NO
--•-•,.. r
OWNER -_s - i
k..)
--.....-...... .--
CONT
-----TI*71=-171—. 0 Nsa NO
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ARCH
' 1
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
SI ,.1:ATURE9.VF APPLIOf.NT
2><
‘./)'1/6' ---- AIP/PLZAT,25n,,7 IRFIPTiNUMBER ICHECK N7ER OR CASH
Wr7 I 27 T 6." __.=
APPROVED BY PERMIT Fees
--... ,
A P P R 0 V ‘ __ CASE FEE INSPECTION
EG
3. :-.)-1 LDG SURCHARGE PLAN CHECK
, ENERGY SURCHARGE TOTAL
RiAqo, 4 1400 DEPT 911 NUMBER REFUND DATE DAT IS44JED
BUILDING OFFICIAL /C) /VgC6
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ebT'.1;11, C, 1.4A--44.1 I'L„„46 *-727
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