HomeMy WebLinkAboutBLD1988-00359 WILDING PERMIT APPLI CATIO,
Jefferson County Builaing DepartmentcP .O . Box 122U+Port Townsend, WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS � , N etc C� r.�►�
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POSTAL DISTRICT ) I L C
/SUBDIVISION AR.ft!iS fl.S
LEGAL DESCRIPTION LOT 1-I) BLOCK DIVISION TAX NUMBER
PARCEL NUMBER. UC71 1 / 4 SECTION
SECTION 30 TOWNSHIP 3,Nt NORTH RANGE / WM
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE
'11( SINGLE FAMILY NEW BUILDING MAIN FLOOR �oq6(ii
❑ MOBILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR G-JeVW,"--O 4 flecks 5810
GARAGE ❑ REPLACEMENT GARAGE -716 tli
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS - -�
❑ COMMERCIAL MOBILE HOMES
❑ INDUSTRIAL
SIZE
��G 0 `� $3 5 73, 3 by
❑ HOTEL/MOTEL/DORMITORY YEAR 0 CI� $ 16
NUMBER OF UNITS MAKE SB/ 0{ @ $8 �6g8
❑ OTHER - SPECIFY ESTIMATED COST OF 2 6. i @ $8 0 GNI
$MPROVEMENTS/��J� $TOTAL�FI�137CARKET VALUE
UBC OCCUPANCY GROUPy Y
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F`r / SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
c '$WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL }�
❑ REINFORCED CONCRETE ❑ OIL OTHER - SPECIFY )-)ENT 1�1 ,e
`X9 ❑ MASONRY ( WALL BEARING ) DIMENSIONS si I'LAt•
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA-J 7
DEPARTMENTAL REV 1 EW S;R �eS\gr,,. .S ly 1ES^) ,— _\+T 1.rkSi0-, \ii5-1-
HE LJN
TH DEPAR M NT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 3
R ! 88 ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
d ! 1 I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM «'
CO\ APPR6VED DATE T❑` INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY) \. (..3c-Ts��
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY) _
?LANNING DEPT . WITHIN SHORELINE JURISDICTION
913% 88 C15 ZOU 6 YES NAM OF ADJACENT WATER BODY
I/G� u�
C> f4'u/1 `_���/ �sw Y
.!T/f°�� NO t �y
APPROVED DATE 1 Jp 777 BANK HEIGHT S0 1 SETBAC 2 .\-. /"�
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH At•E . e CA A. L._
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE� LAWS:
SIGN OF A IC T A \�LW \n N DATE I RECE 1 P-NUMBER I CHECK r/1 5 CASH
APPR E BY PERMIT FEES <_^,/l� /`/)�
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® 72'po
BASE FEE INSPECTION
3 S o BLDG SURCHARGE PLAN CHECK
i988 d�
JEF I Splp 1- ._ ENERGY SURCHARGE $ /n O D S� TOTAL
PI EFF MINTY ..�.. C%
1If 8,MttG MPT
911 NUMBER REFUND DATE DATE ISSU D
BUILDING OFFICIAL, `/ ��� �a
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