HomeMy WebLinkAboutBLD1988-00291 E.LDING "ERMI'f APPLICATION 410
Jefferson County Building DepartmentgP .O . Box 1220•Port Townsend. WA 98368,
LOCATION
SPECIFIC LOCATION SITE ADDRESS J�-e , )\ e'e---y"IN- _
-DG --��^^
POSTAL j�DISTRICT /SUBDIVISION' (-� 1 '
LEGAL DESCRIPTION LOT '( - I BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 0 1 / 4 SECTION
SECTION TOWNSHIP NORTH RANGE / I WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT /
,GARAGE ❑ REPLACEMENT GARAGE
WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL" '
(] MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE ______16 q@ 85
❑ INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $8
NUMBER OF UNITS
O OTHER SPECIFY ESTIMATED COST OF CU $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GRO 27 $ $
SELECTED CHARACTERISTICS OF BUILDING
Nj
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0 WOOD_FRAME 0 ELECTRICI -e COCCECTIVE SOLAR
❑ MANUFACTURED ❑ OBSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL ❑ GAS 0 COAL
O REINFORCED C ETE 0 OIL 0 OTHER - SPECIFY
" ❑ MASONRY ALL BEARING ) DIMENSIONS
F ❑ OT - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT ' TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS -'-
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
O I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
_rmw
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELLNE-JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
T�-f_QO
APPROVED DATE BANK HEIGHT SETBACK
•
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
0
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
OWNER {D ) t . � l2
�± r 1 C- i F(Jay
- (par a, 1Jic I-!
., CONT
CO TT ATE LICENSE NO 1
C
ARCH
THE OWNER O H1 BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNAT E OF AP L ANT APP CAT,IOM.A - RECEIPT NUMBER CHECK NUMBER OR CASH
A r e yf ` PERMIT FEES
r- ,5 r 0 V BASE FEE INSPECTION
DE 1988 ci(1) s�
�. :iz_____ , BLDG SURCHARGE PLAN CHECK
JE Yi II&BLDG
V ENERGY SURCHARGE $(. U Sr)
TOTAL
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
_11/4.e C447. 13 PA V4_ if 1% 7-4.-et41
/2/036 lei, 1/: (
‘,.. ) e 457,,
/ 2 (4.$ ,e 4 /A4540:-.0•c_72„),41/° "v/e2sb
,,/,f0 stage_ CCo 11-744 e 401 cA— cis J"e_
,e/* r/) /a&sit- e e- ct-et_ -4414/Jr- 3 6 4
yi,le 71-5 /-1/47,
ty"
3V er
r"e•e-e a I/342?--C.--
7 /7/4)
I e
r
/7/24
il -
7Vh e_cs z-• /474:1) Z;;;1 a
(
4,c/drAivu
fl;err /11/36 ,/;e
r
715- (71(16 0.- --71.)v6 4/.1
(.7/tize c__7-egv zr" /2, 4-re
APPROVED
DEC 5 IVO ‘.› TIE
JEFFERSON COUNTY
PORNIN6&131.06 DEPT