HomeMy WebLinkAboutBLD1989-00468 BUADING „ 'ERMIT, APPLICATION
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Jefferson County Building DepartmentoP .O . Box 1220rPort Townsend. WA 98368
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SPECIFIC LOCATION SITE ADDRESS 7 7 0 V.,,P Kr irm .1)r--------
POSTAL DISTRICT 1-) '
7- /SUBDIVISION
LEGAL DESCRIPTION LOT ....- BLOCK DivISIAN ...___-; TAX NUMBER
E/PARCEL NUMBER ali() .SCO 0'4-1 1 / 4 SECTION
PLANNING AREA SECTION 15 TOWNSHIP 3 CD NORTH RANGE / WM
BUILDING INFORMATION
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Bu,yLDING TYPE TYPE OF ImPROVEMENT SQUARE FOOTAGE
leSINGLE FAMILY 0 N W BUILDING MAIN FLOOR
0 monILE HOME ADDITION461/444,22477 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
D DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
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0 COMMERCIAL MOBILE HOMES
$3 5
O INDUSTRIAL
,g1 D HOTEL/MOTEL/DORMITORY
YEAR 4 @ $ 16
ZT NUmBER OF UNITS MAKE 0 @ $8
O OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IIP IMPROVEMENTS TOTAL FAIR MARKET VALUE
uBC OCCUPANCY GROUP t '
-10------,- .p $
; 1
Cr SELECTED CHARACTERISTICS OF BUILDING
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PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0/WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED W WOODSTOVE 0 PASSIVE SOLAR
1 0 STRUCTURAL STEEL
0 GAS
O REINFORCED CONCRETE
0 OIL 0 COAL
U OTHER - SPECIFY
. ..'cj 0 MASONRY ( WALL BEARING ) DImENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
D PU IC OR PRIVATE NUMBER OF EXISTING BEDROOMSINDIVIDUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED 0Alk
0 INDIVIDUAL WELL NUMBER OF EMSTINGBATHROOM
PUD TYPE OF WATER SUPPLY
Et/PUBLIC ( NAME OF WATER SUPPLY) - - )
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLYLU
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
APPROVED DATE BANK HEIGHT - SETBACK
A
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
N
NAME OF PUBLIC ROAD
A NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
- .
NAME MAILING ADDRESS ZIP TEL NO
OWNER q..<, ;_.,S
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ARCH -15)
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IOWN R OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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APPy CAT I OArr I RE E I I'T NIgER I CHECeZI MB-1E34 CASH
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APP 0 Y \ P E 45T cfEE S
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A P P '
BASE FEE INSPECTION
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,,,1 s 0
BLDG' SURCHARGE PLAN CHECK 1
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SEP 6 1989
ENERGY SURCHARGE $ q ,
TOTAL
JEFFERSON COUNTY
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PI.A ?Nr&FLOG Dun' 9 1 1 NUMBER REFUND DATE rt T ) I SSIJAPT) ,
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