HomeMy WebLinkAboutBLD1988-00299 •ILDING PERMIT APPLICATION
Jefferson County Building Department•P .O . Box 1220'Port Townsend, WA 98368
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LOCATION
SPECIFIC LOCATION' SITE ADDRESS / / L jjvv/1Ir yV C_ - V-.;
POSTAL DISTRICT /SUBD I V I S[I�ON Q( O�c)5L
LEGAL DESCRIPTION LOT !. P BLOCK DIVISION -7 TAX NUMBER
PARCEL NUMBER / / ,�'j SO )0/, 1 / 4 SECTION
SECTION �
J TOWNSHIPS`() NORTH RANGE �1 WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ DULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT . GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL / c
❑ INDUSTRIAL S 1 ZE
YEAR / �`/7J` (-�J $3 5
�] @ $ 1 6
❑ HOTEL/MOTEL/DORMITORY ff MAKE I( Q ( C 0 $8
NUMBER OF UNITS \ ,,ee,
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
�❑ WOOD FRAME XELECTRICITY ❑ COLLECTIVE SOLAR
J4LANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
(-. ❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
„, ❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEP RTM NT I TYPE OF SEWAGE DISPOSAL I NUMBER OF PROPOSED BEDROOMS
fr �- l J 1. Si ❑ PUBLIC OR P NUMBER OF EXISTING BEDROOMSI 1
� N D I V I D UA SEPTIC - NUMBER OF PROPOSED BATHROOM
PPR-OVED DATE •
„, ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
f.,, PUD TYPE OF WATER SUPPLY � �
APUBLIC ( NAME OF WATER SUPPLY)`- f�f[A1 Z.Iii'W �.:/-dc�W.J
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
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NO
APPROVED DATE ANK HEIGHT SETBACK
PU�`�., I,C Y S DEPT ROAD RIGHT-OF -WAY WIDTH
/�l�l NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRE, S ZIP TEL NO
OWNER le LSsz3`V / ( .-
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CONT
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
S 1 GNAT OF NT A ,�L IIyC�AT 1 O D � RECEIPT NUMBER CHECK NUMBER Oft CASH
� � /2/ 1� 3 7( ! XN /. (�/
APti-�1 .�• _ t ® PERMIT FEES
AP � , L.� / �
LJ BASE FEE INSPECTION
Illi i ....�
011 4�� ✓. BLDG SURCHARGE PLAN CHECK
JEFFERSON 0 NTY r"
PLANNING&BG1 G QEpT ENERGY SURCHARGE $ 7), V r
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` `.j TOTAL
9 I 1 NUMBER REFUND DATE ' AT , 1SSIEDBUILDING OFFICIAL '�
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McCLANAHAN CONSTRUCTION SHEET NO Lor Abb- Dui' 4. OF
Sig290V1VA.17-; E$"
Rt. 2 Box 665 6 .
QUILCENE, WA 983 , CALCULATED BY 775"lr DATE '31'e7 Jo?pi4.-6,8
CHECKED BY DATE
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APPROVED -
Nov 1 6 1966
JEFFERSON COUNTY
NANNING&BLDG DEPT
//3 77777,) (CC re".,
CD LC_
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