HomeMy WebLinkAboutBLD1988-00068 B4110DING '`''ERMIT APPLICATION
Jefferson County Building Department•P .O . _3ox 1220iPort Townsend. WA 98368
LOCATION
LI)SPECIFIC LOCATION SITE ADDRESS ( 11---otiPOSTAL DISTRICT /SUBDIVISIONa t! -1i c b4
LEGAL DESCRIPTION LOT ; ( BLOCK DIVI ION TAX NUMBER
PARCEL NUMBER ,NC/0 1 / 4 SECTION
SECTION -: - TOWNSHIP L NORTH RANGE 1. 0, WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
5N(!OODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ .ULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
0 COMMERCIAL SIZE �." t�hS1 a $35
❑ INDUSTRIAL YEAR W,-{{, a� $ 16
. ❑ HOTEL/MOTEL/DORMITORY MAKE W @ $8
NUMBER OF UNITS
0 OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
V UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD_FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
N. ❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING )
DIMENSIONS
❑ OTHER - NUMBER OF STORIES 7TOTAL LAND AREA
DEPARTMENTAL REVIEW
-.NJ HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSA ' NUMBER OF PROPOSED BEDROOMS
0 PUB 1 C OR PR I VATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( S E I,r 1'C ) NUMBER OF PROPOSED BATHROOM
:.a APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC,.-( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
/D 70 YES NAME OF ADJACENT WATER BODY
4-0 ❑ NO
D
APPROVED EV 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 ❑ NO
IDENTIFICATION
NAME ''y I MAILING ADDRESS C ZIP2 TELhy..��NO
OWNER iller
5( X f mil , ,� ✓9' - '-1 (/` I
> „-ram -. i
CONT 411
S r A'I E L I LTN S'1: NO I
ARCH
A
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
4NATUkE OF PPLIC NTf APPL C TI TE RECEIPT NUMBER CHECK BER OR CASH
'y
APPROVED Y PERMIT FEESl/`;
R 0 V E $C BASE FEE I NSPECT I ON
N V 0 4 1968 3i BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE '" g,C-.2
TOTAL
JEFFERSON COUNTY
PLANNING 4 BOG DEPT
8 1 1 NUMBER ' REFUND DATE DATE ,I,fSS{ED.
BUILDING OFFICIAL 11 �I ) ��,`U
M.