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HomeMy WebLinkAboutBLD1988-00348 .UILDING PERMIT APPLICATIOFS Jefferson County Building DepartmenteP .O . Box 1220•Port Townsend. WA 98368 1 LOCATION 1)A.1 -c c�1 2S"1 lA -1 ld1 W. C1_r. k-e.? P / L,eL...k$ � SPECIFIC LOCATION SITE ADDRESS i' ( -1. lc 1 S tdl ) POSTAL DISTRICT CSC /SUBDIVISION Zed QLo c 4I04.1 LEGAL DESCRIPTION LOT BLOCK / rDIV�I+c!ON TAX NUMBER c`'Sld 11 PARCEL NUMBER X (10t.+�. • / 4 SECTION ,�-- SECT I ONE 2-4 TOWNSHIPx Z� NORTH RANGE x /- Wr,M BUILDING INFORMATION ,-, --1 BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE 1 ❑ SINGLE FAMILY ) NEW BUILDING MAIN FLOOR 2°x3° — 4°° ❑ MOBILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME 0 ALTERATION BASEMENT ` ( 7IJETACHED A 0 REPAIR CARPORT GARAGE Cr..-.0 ...- -') ❑ REPLACEMENT GARAGE ❑ WOODSTOVE 0 WRECKING/DEMOLITION ! COMMERCIAL • MULTI - FAMILY J RELOCATION/MOV NQ ( INDUSTRIAL „„w .. NUMBER OF UNITS 7777,... MOBILE HOMES ❑ COMMERCIAL SIZE @ $35 ❑ INDUSTRIAL YEAR lu a7 $ 16 N` . 0 HOTEL/MOTEL/DORMITORY MAKE oa0 c>) $8 /cS°6° NUMBER OF UNITS L 0 OTHER - SPECIFY ESTIM ED COST OF 0 @ $8 VA" IMP VEMENTS TOTAL FAJ R MARKET VALUE UBC OCCUPANCY GROUP 4/ $ $ a du Mkt SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL 54 WOOD FRAME 0 ELECTRICITY ❑ COLLECT I_,VE--'SOLAR ❑ MANUFACTURED ❑ WOODSTOVE LL.P-ASSIVE SOLAR ❑ STRUCTURAL STEEL 0 GAS -�-- 0 COAL ❑ REINFORCED CONCRETE ❑._O-"E 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW • HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUM D BEDROOMS ❑ PUBLIC OR PR I VAT NUMOM OF EXIST!! BFDRCOMS.,,z A A.- o It 0,6- ❑ I ND 1 V 1 D SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE I V I DUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY WA:— o4: ,,,,,t, 0 PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY) AMSTIMM INFIII PLANNING DEPT . WITHIN SHORELINE JURISDICTION YES NAME OF ADJACENT WATER BODY ,A1/,-.— c>\C- u,...._ L. �z L c L_ * ❑ NO ± ,. ,.... APPROVED DATE BANK HEIGHT ic ZI 1.3if SETBACK X 43� PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH /- O� NAME OF PUBLIC ROAD l NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO IDENTIFICATION NAME MAILING ADDRESS ZIP TEL NO OWNER /!' xLL��G1 Meu (kV) K 2Z3cc55 L ' . � �. . 4 J..- . e5 viv- W w T. s Z o I SGZo 7 -3'S,43 CONT X 5e10. x ._ ( s rATe L IrcE:N ;E"'iZ°I�.1' ' ` M c OL g (-YAM Jet.►,.. cse(� 4 Ail itv) w., pit,Dos Oe ic.f.N• pc) . A,o i Z4-& 7 ANS p(11.4 cilK ri C. 3 6 7 zc(. 4 S2-S&,c THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. <S G\7C- RF APPLICANT " � A Py. O l- DATE I RECE7 rKMB R CHECK fN �E�OR CASH • p P�pEz%A__________,. PERMIT FEES A II�� o.� Z BASE FEE INSPECTION N. 2.\ )5 3 3 S` BLDG SURCHARGE PLAN CHECK Jf F€ER,5OF4 COUNTY ENERGY SURCHARGE 7 S S'4 MLANNINO?A SLOG OPT ENERGY _ TOTAL 911 NUMBER REFUND DATE I DA E I S D BUILDING OFFICIAL 1 I ) • ill ..-'� , ,....© ,,,, , ib - p,. 7 t 4" \ ,..- _____<.--";--.. ‘\ yAl \ 'V'. ):' ' 0 -\4'k : , ly / ' ,, , , ir, ., \ , ‘ _. \seyt-(:), \ , ,,,‘ ,?1.Q ,c'43‘ 1.06,6 \ \,.". q . _\ r9 \ ,,- - ` \ lc) \ti. �� < : -'\ Lt L LE hc.4\? ,.v- \ i slps ,•►V \`-r-' \ / q • P 0 .1., 1 4 B �, ,�� '�`'1,4 Rk I,.. tx G2 \ „r., ` ► c Co4L- DISc2a�c4 Df,j .YIKk. S° y �s-f 1 y4f '�U'� �Gk(JG it l?lam