HomeMy WebLinkAboutBLD1988-00307 BUI•NG '`')ERMIT APPLICATIONII
fferson County Building Department•P .O . Box 122040Port Townsend. WA 983680
LOCATION �� .,
SPECIFIC LOCATION SITE ADDRESS (-1
POSTAL DISTRICT /SUBDIVISION r7/!rt d-ate. U Q'
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER A+,2700 0 o71 / a SECTION
SECTION -7 TOWNSHIP 5 NORTH RANGE i e WM
BUILDING INFORMATION
�
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE _
� p ((��SINGLE FAMILY NEW BUILDING MAIN FLOOR
4 ❑ MODILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT /n r U
4,
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE y00
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE (./ @, $35 5-1-3 .D
.+. ❑ INDUSTRIAL YEAR $ 1 6
.. ❑ HOTEL/MOTEL/DORMITORY MAKE l ��✓$8 D�/
NUMBER OF UNITS �\
❑ OTHER - SPECIFY ESTIMATED COST OF q @ $8 3a0�._J IMPROVEMENTS TTO A, FjA�F)MARKET VALUE
UBC OCCUPANCY GROUPT _ $ . ��jj((
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
'WOOD_FRAME ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
1. ❑ MASONRY ( WALL BEARING ) DIMENSIONS
( 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
k
DEPARTMENTAL REVIEW
H A TH D PAR -MENT TYPE OF SEWAGE DISPOSAL MBER OF PROPOSED BEDROOMS -'*�
t 0 PUBL I C OR PR I_ I il4,r; MBER OF EXISTING BEDROOMS
`� i ��� I ND I V I DUA ( SEPTIC l NUMBER OF PROPOSED BATHROOM L.2—
!J APPROVED DATE ❑ INDIVIDUAL WEL NUMBER OF EXISTING BATHROO
k PUD TYPE OF WATER SUPPLY r) <
c ' j PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
() ) 'YES NAME OF ADJACENT WATER BODY
A.
C-A NO
l APPROVED DATE ' 3ANK HEIGHT SETBACK
� PUBLIC WORKS DEP1 ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
—
IDENTIFICATION
— �y NAME �/7 MAILING ADDRESS ZIP� TEL NO
OWNER ( Y ( �lJ CM- ..J���
CONT C-C. sy`Q_
5 I AT L L I CENUk. NO
ARCH
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L
T OWNEROF • 1` BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
\; J t' O+ .�i'L I C NT APP I CAT I N TE RECEIPT NUMBER CHECK NUMBER OR CASH
APPRO E• f = PER- U �MIIT FEES��
A P Pf., 01 1 / 3 / BASE FEE INSPECTION
i C 1 3 1988 3,S BLDG SURCHARGE PLAN CHECK
/ D
( 6 ENERGY SURCHARGE $ C/gl`S� TOTAL
JEFFERSON COUNTY `
PLANNING Si BLDG DEPT REFUND DATE1 _ Ef�� �,.9 1 1 NUMBER DAT 1 SSED
BUILDING OFFICIAL 1
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APPROVED
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JEFFERSON COUNTY
PLANNING&SLOG DEFT
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