HomeMy WebLinkAboutBLD1988-00310 BSDING PERMIT APPLICATION •
Jefferson County Building Department•P .O . Box 1220•Port Townsend. WA 98368
LOCATION '
SPECIFIC LOCATION1 SITE ADDRESS ,3 ) C`()I 'k21 aiv ) I )a
POSTAL DISTRICT /SUBDIVISION --4 7
LEGAL DESCRIPTION LOT iJ) BLOCK DIVISION TAX NUMBER
PARCEL NU R L f / 4 SECTION
SECTION-- TOWNSHIP O NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAG ,
FAMILY ❑ NEW BUILDING MAIN FLOOR /`7 C1�D
[X.....!INGLE
OBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT q C2(DGr
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE •rJ 7(,
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES r�.J(�� 1
❑ INDUSTRIAL SIZE Llr �. $35 > ol�:�
❑ HOTEL/MOTEL/DORMITORY YEAR q� $ 16 __
MAKEr q� $8 C f(�I NUMBER OF UNITS �,� /
❑ OTHER - SPECIFY s/ � @ $8 (r7 Cr/ '-)
ESTIMATED COST OF
IMPROVEMENTS TO &IR ' MARKET VALUE
UBC OCCUPANCY GROUP AG
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
... ( WOOD FRAME �r ELECTRICITY ❑ COLLECTIVE SOLAR
MANUFACTURED N WOODSTOVE ❑ PASSIVE SOLAR
y
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
t ❑ OTHER - NUMBER OF STORIES ,- TOTAL LAND AREA
DEPARTMENTAL, REVIEW
c HE LT D PA MENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSEDOM BEDROS
C / U B L I C OR PR I V A T E NUMBER OF EX 1 ST I NG BEDROOMS INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
.. APPROV D DATE (/
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
�/26 �� TYPE OF WATER SUPPLYO
"� A
UBLIG ( NAME OF WATER SUPPLY)�C� P� ��('�APPROVED D�ITE ❑ PRIVATE ( NAME OF WATER SUPPLY\
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 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 ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING j� G..,ADORE S ZIP(� TEL NO
_
OWNER V _ �� ,c �Iv L) IL. (a W/ .S
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CO N T (,J�IY Y g C-R �4610fJZ
904_62<„`-bn
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
IrkliT:Jr„..:FS ,L1 ,NT APPL CATION T RECEIPT NUM R CHECK NU ER R CASH
A-PROVED BY PERMIT ='F'ES
APPV E
_g��, (���ASE FEE INSPECTION
EP 2 9 '; LDG SURCHARGE _PLAN CHECK
JEFFERSON COUNTY NERDY SURCHARGE -/' � .s� TOTAL
PLANNING&BLDG OPT9 I i NUMBER REFUND DATE Jk SUED
BUILDING OFFICIAL JC[/J)t (//
1 / o
JEFFERSON GUUn i
PLANNING u BLDG DEFT
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