HomeMy WebLinkAboutBLD1989-00476I .
B.DINGERMIT APPLICATION
Jefferson County Building DepartmentP .0 , Box 1220ePort Townsend, WA 98368
LOCATION ' 0 t
SPECIFIC LOCATION SITE ADDRESS . , Li)•-i In 1
POSTAL DISTRICT ( /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER gtd -O-2.*.ccr 1 / 4 SECTION
PLANNING AREA SECTION 23 TOWNSHIP (-77 NORTH RANGE aLLI ) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROvEMENT SQUARE FOOTAGE
0 SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME ADDITION ZNB FLOOR
O MODULAR HOM.g Lj ALTERATION BASEMENT _______
)4DETACHETTACHED) 0 REPAIR CARPORT
--.E„ GARAGE 0 REPLACEMENT GARAGE ____
O WOODSTOVE 0 WRECKING/DEMOLITION I COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS l ' •
MOBILE HOMES
0 COMMERCIAL
yi a $35
SIZE. .
0 INDUSTRIAL
YEAR 0 @ $ 16
0 HOTEL/MOTEL/DORMITORY
L O/MOF UNITS
TEL/D ORM 1 Tony
NUMBER MAKE -63(,6 0 @ $8
O OTHER - SPECIFY .
' ESTIMATED COST OF --___O a $8
IMPROVEMENTS ,TOTALFALR MARKET VALUE
UBC OCCUPANCY GROU
7 . _ $_...., 7 5 (0
X-/
..,
E-..... SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
yr---)N OOD FRAME
0 MANUFACTURED ,
O STRUCTURAL STEEL
E(]] :LO.TS7OITY
0 GAS
___-_.----1PCOAL
0 COLLECT_LVE_SOLAR
A,SSTVE SOLAR
i 0 REINFORCED CONCRETE 0----OTT, 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING )45s.) 4 DIMENSIONS
0( OTHER - NUMBER OF STORIES TOTAL LAND AREA
cr DEPARTM NTAL REVIEW
=Z...
HEALTH DEPARTMENT, TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
-.0 ii`i 1:=L- 0 P U B L I C OR rR 1 V AT E NUMBER OF EX I ST!NG BEDROOMIS
XI ND I V I D UAL ( S E P T I C ) NUMBER OF PROPOSED BATHROOM
..,..i. ED DATE
INDIVIDUAL WELL NUM13EE OF EXISTING BATHROOM
QPUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLYa
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS 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
----
NAME MAILING ADDRESS ZIP TEL NO
.,-..,.,..... ,-
C)IP=.0.3kla i.e .,,,.. ........ c(30 3
L ) )
-
NT ef(D rein Iscg,w4.4„tp,--14:
A-IT-: .c1 nrt EVF}20,Y)i-ii-1,3(Y7 I , _
RCH Does-ter
1 I
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
--"--- -- --.....--.....-
El GU
TUNE r APPL CANT _ APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
i 1 OB '..))() P)1 Y',-2,3116D iO8LI
APPROV. • ,%y PERMIT FEES
A V
9•1.00 ,. PASE FEE INSPECTION
9
LI I 5.-0 BLDG SURCHARGE PLAN CHECK
AUG 3 1 1989 ENERGY SURCHARGE $ 1 (... --.)
..0 TOTAL
JEFFERSON COUNTY
PLANNIN6&BLDG OEPT 9 1 1 NUMBER REFUND DATE E lio D
BUILDING OFFICIAL ._ / e4D
"ro H-0 8 30 69