HomeMy WebLinkAboutBLD1988-00050I ll
EOLDING4,1'ERMIT APPLICATION 0
Jefferson County Building Department0P .O . Box 1220.Port Townsend. WA 98368r /
LOCATION �
SPECIFIC LOCATION SITE ADDRESS (//D(2 (n `�7 ro �� ( )P� �-r� P / `POSTAL DISTRICT_ I /SUB [VISION `J / ,
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER I()
kn, TCe--I PARCEL NUMBER 1 / a SECTION
OQ f (:(>2. 015
SECTION Cf)() TOWNSHIP ;•'�L NORTH RANGE (.(I WM
•
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE }�
NE/SINGLE FAMILY 'NEW BUILDING MAIN FLOOR � �13 ; ) 0
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE 5,31
❑ WOODSTOVE 0 WRECKING/DEMOLITION • COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES -y q 7�
❑ COMMERCIAL L,:; fl q`� $3 5 l) 1(oC,
SIZE
O INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 5 .31 A a@ $8 '-i Li R
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTQL FAIR
I2RQ RKET VALUE
UBC OCCUPANCY GROUP $ $ Cn
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
',WOOD.FRAME ELECTRICITY 0 COLLECTIVE SOLAR
'b MANUFACTURED /❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS pp
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA ,'57
DEPARTMENTAL REVIEW _
HEAt
TH ,DE'ARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS L1
� 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
1 ND 1 V I DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM_o�
PUD TYPE OF WATER SUPPLY •
UBLIC ( NAME OF WATER SUPPLY
APPROVED DATE '❑ 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 REQUIREDYES 0 NO
IDENTIFICATION
NAME , (( \ MAILING ADDRESS ZIP TEL NO ,
OWNER l �� �.LJ � � 1 _ -� �
CONT 671. STATE L 1 ChNSE NO
ARCH ,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIGNATU K I PLICANT APPLI ATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
/k. _ -• _D BY ', PERMIT FEES
r P '�i � V 4'I '1 t�. n() BASE FEE
-� FP)
INSPECTION
DEC �1g88 ?) e 7 J BLDG SURCHARGE PLAN CHECK
JF.rrERSON COUNTY I , J < ENERGY SURCHARGE �d I Gl ` , I(' TOTAL
PUNMNG&BIOG OPf'T $
911 NUMBER REFUND DATE DATE 1 )- IS ED
BUILDING OFFICIAL �
o 0 /O / 4
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