HomeMy WebLinkAboutBLD1989-00466 Ali
i _ . l3Ui'_ iNG 'ERMIT APPLICATION dr He
efferson County Building Department'P .O . Box 1220'Port Townsend, WA 98368LOCATI
SPECIFOIC LOCATION SITE ADDRESS l/0J1A /�1 /4 l��
POSTAL DISTRICT /SUBDIVISION I hPr iRaOR I/
LEGAL DESCRIPTION LOT#'3 BLOCK DIVISION TAX NUPIBER
PARCEL NUMBER YaZ1.1,7` 1 / 4 SECTION /-
PLANNING AREA SECTION /7 TOWNSHIP p?8 NORTH RANGE / G . WIM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTA
G
/E
ye
❑ SINGLE FAMILY � NEW BUILDING MAIZNDNFLOORR oC�� q
❑ MOLD I LE HOME 0 ADDITION
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE lgs7,2 Q - n,p
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
AMULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS l� MOBILE HOMES �J
❑ COMMERCIAL S 1 ZE 3no 6 3 al $3 5 1oS icg7 75
❑ INDUSTRIAL
YEAR � 'Y ox @ $ 16 7 39/3&
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $ 8
NUMBER OF UNITS ,,!!�� / 7/
❑ OTHER - SPECIFY ESTIMATED COST OF /l�o?"(g@ $B !/I 37( /6
IMPROVEMENTS TOTAL Al f3M9R ?T. VALUE
UBC OCCUPANCY GROUP $ $ / �j
1
1
-w1 SELECTED CHARACTERISTICS OF BUILDING
c;
�s PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
I. AT WOOD FRAME x ELECTRICITY 0 COLLECTIVE SOLAR
'> 0 MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
'`:, 0 STRUCTURAL STEEL 0 GAS 0 COAL ZPy.p C'Jedra/(e_Q_
Cr ❑ REINFORCED CONCRETE 0 OIL j' OTHER - SPECIFY __RAcotievex
❑ MASONRY ( WALL BEARING) DIMENSIONS
0 OTHER - NUMBER OF STORIES c=2-- TOTAL LAND AREA
c DEPARTMENTAL REVIEW • _
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS eS
N PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
c ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ I ND 1 V 1 DUAL WELL NUMBER OF EXISTING BATHROOM ,
v .
PUD TYPE OF WATER SUPPLY LuDLoc,� Woe_
ykl PUBL I C '( NAME OF WATER SUPPLY jl
4\", APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
tr) PLANNING DEFT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
X) NO
APPROVED DATE BANK HEIGHT SETBACK
‘6 PUBLIC �YORKS 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
`s• NAME �y _ �7MAILING ADDRESS p.,{� ZIP TEL �N/O
-owrlgR tPo F3eSourctS 1av dLs - tau. RL. y�/A -[" / Gy, /�7PPIc,/
Lin)Lo cg0/0y�
GOUT ^` iU DENSE a/t
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ARCH
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rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGN r OF `oie T APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPROt
BY P RMITIT FEES
, _, BASE FEE INSPECTION
NOV 1989 C0'�-.ea ' -LOG SURCHARGE
PLAN CHECK
JEFFERSON COUNTY, - ENERGY SURCHARGE ��Ka 2 `I (J�'�„�d 70T' .
PLANNING f4 BLDG DEPT II P
1 t NUMBER REKUND DATr_' DATM I,sptt�o