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HomeMy WebLinkAboutBLD1988-00302 UILDING PERMIT APPLTCATIO Jefferson County BuilUrng Departmenat*P .C. Box 122 Port Townsend, WA 98368 r LOCATION • SPECIFIC LOCATION! SITE ADDRESS �, ( Cc 0:_e La POSTAL DISTRICT S� /SU(�D N I S I ON 2e0(.d1.1` LEGAL DESCRIPTION LOT 4 (00 BLOCKG /� �DIVISION -- TAX NUMBER PARCEL NUMBER 93SOw/( e 1 / 4 SECTION SECTION TOWNSHIP NORTH RANGE WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY _ NEW BUILDING MAIN FLOOR ❑ MOBILE HOME ❑ ADDITION 2ND FLOOR ❑ M FR- OME 0 ALTERATION BASEMENT ETACHED ATTACHED ❑ REPAIR CARPORT `� // GARAGE 0 REPLACEMENT GARAGE ,2W-Vr g1.91 O WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES ❑ COMMERCIAL ❑ INDUSTRIAL SIZE q� $35 ❑ HOTEL/MOTEL/DORMITORY YEAR @ $ 16 NUMBER OF UNITS MAKE ?.l7 n� 4 @ $8 97.f, Ni 0 OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE SO UBC OCCUPANCY GROpp / $ $ '"` SELECTED CHARACTERISTICS OF BUILDING NJ Nj PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLA MANUFACTURED 0 WOODSTOVE 0 PASSIVE R te ❑ STRUCTURAL STEEL ❑ GAS ❑ CO 0 REINFORCED CONCRETE 0 OIL iI�FOTHER - SPECIFY O MASONRY ( WALL BEARING ) DIMEN S s� 0 OTHER - NU ER OF STORIES TOTAL LAND AREA ", 1' DEPARTMENTAL REVIEW m HE�ILTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS �/ A } (/ 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS / ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM -mmommur ' C PUD TYPE OF WATER SUPPLY 0 PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY) PLANNING DEPT . WITHIN SHORELINE JURISDICTION 1 PS- _____❑ YES NAME OF ADJACENT WATER BODY 1 , 11 N ❑ NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH 04)r NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO IDENTIFICATION NAME MAILING ADDRESS ZIP TEL NO OWNER 9)0_i 7P.A .. ©0 .Pet:` 1 �Q � �^) CONT (�(t S��I�'E L 1 c +i o bod r- ES (n �J l 7-' 0I-ls �LY �e�.i �oG 1 STD ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; S ATURE F ApQ --FIG j �PP���C p 10N DATE �RECEIPT����NUMBER CHE�DO NUMBER OR CASH A- " N• _- • BY PERMIT FEES A P '`; Q • D�� 7 2 BASE FEE INSPECTION , ► fl_' ✓+ BLDG SURCHARGE PLAN CHECK OC ;1 �' " ENERGY SURCHARGE �$ 3�`-'C J ERSON COUNTY 12) TOTAL ANMNG&BLOG ORT ..... 9 1 1 NUMBER DATE DATI ED BUILDING OFFICIALfREUND11t __,- 7 , e \ T QN I a L I Krn O O 1 Z OQ I C . 14 I s 1 } • iv ' ' ISN Q� \ \v% \ T 1 _ I , 4 II fi , 1 o` er ? / ' - t c 't o ca a • I IC\ . : . , .is_ :�..'.x^C:(ia?_ 1sr::. LI" R I —tom -....,;z1., -4-Y..-1. ..„,, .-tz,. , .. 1 ..,.. -0) , „.. ......, 4 4.--,,, 1 , i ......„ / ._,,, , ......„... . : ......: IL• .,:,... . , . ,.,„ , . . .,,,,.. ,.,. Ij . . . , . . . . :....„ , , , , . _ . . ,, . 1 . . .. , li : 1 • . _.... , ,„ , : „...,:, ...... , „..... , ,Ct c� t '173 { . 6 / •Ld,, /SSOC_