HomeMy WebLinkAboutBLD1989-00454 •ILDING 'ERMIT, APPLICATION411
Jefferson County Building Department*P .O . Box 1220/Port Townsend. WA 98368
LOCATION ••
SPECIFIC LOCATION SITE ADDRESS / (9Qz1 � /lAA—,(
POSTAL DISTRICT - /SUBDIVISION T015., , Q,LnLEGAL DESCRIPTION LOT BLOCK DIVISION X NUMBER
PARCEL NUMBER ?DC `V 1 / 4 SECTION
PLANNING AREA SECTION aC TOWNSHIP NORTH RANGE /e,) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOLIILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
qARAGE 0 REPLACEMENT GARAGE
3' WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS '
MOBILE HOMES
❑ COMMERCIAL
SIZE -----,.[f @ $3 5 ^,,,___
❑ INDUSTRIAL
0 HOTEL/MOTEL/DORMITORY YEAR @ $ 16
NUMBER OF UNITS MAKE 0 $8
0 OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
- J IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
P NCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
07
WOOD FRAME �❑ ELECTRICITY ❑ COLLECTIVE SOLAR
', 0 MANUFACTURED E WOODSTOVE 0 PASSIVE SOLAR
c' 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW ` —.
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDR, 1S-
❑ PUBL I C OR PRIVATE NUMBER OF EXISTI_NC,-B bROOMS
❑ I ND I V I DUAL ( SEPTIC ) NUMBER OF PIjQP6SED BATHROOM
APPROVED DATE ❑ I ND I V I DUAL WELL NUMB Efj EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF W SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME WATER SUPPLY
PLANNING DEPT , WITHIN SHO INE JURISDICTION
O YES a ME OF ADJACENT WATER BODY
,,�[f NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC W99R"KS DEPT ROAD RIGHT-OF -WAY WIDTH
/ NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
4.
jj��NAME �,y�,,�,�n // /J�J�M`/f�AgI LING ADDR SS �JJ/�Z I P TEL NO
OWNER 111 n ���i NJi/l�d� /3 / t J�Y/(//,�/ ( L(J,?3
CONT r
STATE LI CETiSE NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
V SIG ATURE QF, ICANT 7
APPLICAT ON TE RECEIPT NUMpER CHECK NUMBER OR CASH
t (�7 1 7 I77a__
2
PPROVED BY P RMIT FEES
BASE FEE INSPECTION
A P P * • i':
1 1 •. 356 BLDG SURCHARGE G��PLAN CHECK
`� IWi: ' 2 1989 ENERGY SURCHARGE
c>28TOTAL
JEFFEANPIN SOk SRC O 9 1 1 NUMBER REFUND DATE DAT I SSU
At_ALD'nIla& O OEf'? ,�,02 P1
BUILDING OFFICIAL