HomeMy WebLinkAboutBLD1989-00455 BUllOINGERMIT APPLICATION
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Jefferson County. Building Departmeret,P .O . Box 1220tPort Townsend, WA 98368
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____IocATION
SPECIFIC LOCATION SITE ADDRESSRI ,--tir-72-0 , ., i\
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POSTAL DISTCT __ p/SUBDIVISION 1 .,0 a t /
LEGAL DESCRIPTIO LOT (7 / BLOCK DIVISION TAX NUMBER
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PARCEL 77112(42 ,12 1 / 4 SECTION
PLANNING AREA SECT I ON _c __TOWNSHIP _NORTH RANGE (4,1) WM
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V() BUILDING INFORMATION
(..-.. B 1 LD I NG TYPE TY E OF IMPROVEMCNT SQUARE FOOTAGTm (
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SINGLE FAMILY NEW BUILDING MAIN FLOOR c----,4All Q.
MOBILE HOME A IT ION 2ND FLOOR _____
O MODULAR HOME 0 ALTERATION BASEMENT ---
0 DETACHFD/ATTACHED 0 REPAIR CARPORT
GARAGE D REPLACEMENT i GARAGE _. .
c,. 1 D WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 PELOCATION/flOvING INDUSTRIAL
NUMBER OF UNITS
---- MOBILE HOMES
0 COMMERCIAL -;' 8(f?"4 a $35 77/
SIZE 06K)
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O INDUSTRIAL
0 HOTEL/MOTEL/DORMITORY _
__ . ' 0 @ $8 ---- ---TA NUMBER OF UNITS
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0 OTHER - SPECIFY _CA @ $8
EST1MATr , COST OF ______ ,......
— — — lMPR EMENTS TO-1 ,A4, -FAA I+, MARKET VALUE
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SELECTED CHARACTERISTICS OF BUILDING
, P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
' ,) N WOOD FRAME
+ _ECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE D PASSIVE SOLAR
D STRUCTURAL STEEL U GAS [3 COAL
D REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY,,, A-Q.
1 0 MASONRY ( WALL BEARING )
V7-- 0 DIMENSIONS
OTHER -
NUMBER OF STORIES TOTAL LAND AREA— —._
C.- DEPARTMENTAL REVIEW ' I
EALT DEPA, T 1%. TYPE OF SEWAGE D I S p OS AA,_ 1.7:,,'r rUZ OF PROPOSED BEDROOMS :)----_,
D PUDDI VI DUA Li CORL
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P fI li z A:f 0‘ NUMBER O
NUMBER
OFF Pc) ED Ai PROPOSED ST I I ,., BBEDTIR
N. IN 1 )
APPROVED DATE
D i ND I V 1 DUAL wr,:t.L. NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
0, PUBLIC ( NAME OF WATER SUPPLY),
APPROVED DATE , PRIVATE ( NAME OF WATER SUPPLY1
PLAN 'LING DEPT . WITHIN SHORELINE JURISDICTION
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0 YES NAME OF ADJACENT WATER BODY
0 NO _ • , '
APPROVED DATE BANK HEIGHT SETBACK
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PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
0. ( NAME OF PUBLIC ROAD rra
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO
OWNER
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ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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,"URE PP !CANT
APPLICATION DATE RECE177UMBER CHECK la R CASH
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55-1,00 BASE FEE I NSPECT 1 014
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_ 7) Dt.,DS SURCI-LIEGE PLAN CHECK
,MERSON COUNTY
PLANNING Ft BLDG DEPT . EM G ERy SURCHARGE ,sS
S1) TOTAL
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BUILDINGOFFICIAL ; 1 f n ”
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RECEIVED
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JEFF. COUN.
iEALT1-1 DEP_
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