HomeMy WebLinkAboutBLD1989-00449 BUILDING if;ERMIT APPLICATIal
Jefferson County Building Departmentr-P .O . Box 17700Port Townsend, WA 98368
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SPECIFIC LOCATION SITE ADDR7SS :T •MIRIMI
-- 6.041
POSTAL DISTRICT NI /SUBDIVISION
LEGAL DESCRIPTION LOT BLOC DIVISION TAX NUMBER
,, PARCEL NUMBAR (),fl>, V 1 / 4 SECTION
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PLANNING AEA SECTION 7(7 -- TOWNSHIP j NORTH RANGE ( WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O _ HOME 0 ALTERATION BASEMENT
ETACHED/ATT • CHED 0 REPAIR CARPORT
0 REPLACEMENT GARAGE i -5LI (-/
O WOODSTOVE I IRO/ 0 WRECKING/DEMOLITION I COMMERCIAL
O MULTI - FAMILY TJ REEOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS —
MOBILE HOMES
O COMMERCIAL 0 @ $35
SIZE
O INDUSTRIAL YEAR 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
MAKE I WO &( $8
NUMBER OF UNITS
O OTHER - SPECIFY ........_JA @ $e
ESTIMATED COST OF
IMPROVEMENTS TOTAL.2 .A.I.fiARKET VALUE
UBC OCCUPANCY GROUP $ $ 10
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SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL .-----
PR NCIPLE TYPE OF FRAME ----
WOOD FRAME
0 MANUFACTURED 0 ELECTRICITY 0 COLLECTIVE SO-L-Aft
0 WOODSTOVE -----
0 PASS I VE---SOLAR
•-''';., „.„,----
O STRUCTURAL STEEL 0 GAS O_COAL
0 REINFORCED CONCRETE 0 OIL __,--- 0 OTHER - SPECIFY
k , 0 MASONRY ( WALL BEARING ) _ ----'
DIMENSIONS
C:7---- 0 OTHER - 4.---N6M73ER OF, STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW kr, • _.---------
......„ HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED 00MS
O PUBLIC CR PRIVATE NUMBER OF EXI BEDROOMS
O INDIVIDUAL ( SEPTIC ) rJMn9POPOSED BATHROOM
APPROVED DATE 0 .„--
INDIVIDUAL WELL IVME3t17 OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY,,...,
O PUBLIC ( NAME 0 - TER SUPPLY)
APPROVED DATE 0 PRIVATE ( N , E OF WATER s,yrrLy),_
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PLANNING DEPT . WITHINELINE JURISDICTION
O NAME OF ADJACENT WATER BODY
„.„-•-•
"'"•-,.:„ „,
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„,•-' 0 NO
\-.) APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
An NAME OF PUBLIC ROAD
N'c'" . • .
NAME OF PRIVATE ROAD
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APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME i MAILING ADDRESS ZIP TEL NO
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CONT
- SITE L I CSI:7-11-'3'
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ARCH '
1
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
'GNAT E OF APP ICA PPLI ATIO 7IR77
T. NUMBER ' CHECK WINDER OR CASH
APPRO D 0 \ PERMIT FEES
\ ...La ASE FEE INSPECTION
A p: \,\ ___11 \ :_
. \ LOG SURCHARGE PLAN CHECK
_
0 , .13,,_,-",. ` ______
2 Ng \ •... .•ro. ENERGY SURCHARGE $ /
2)0 \,,
TOTAL
JEFFEFtsoN \
PLANANAG 4 COUNTI, 9 1 1 NUMBER REFUND DATE 7174Inc/
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BUILDIFICIAL ki 6616 (
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