HomeMy WebLinkAboutBLD1988-00386 BUSING ERMIT APPLICATION 0
Jefferson County 'building Department'P .O . Box 1220.Port Townsend. WA 98368
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LOCATION JJ i
SPECIFIC LOCATION SITE ADDRESS // CD/� �"G
POSTAL DISTRICT I /SUBDIVISION ( 1�.1 .S / 1 0
LEGAL DESCRIPTION LO fA"r , BLOCI DIVISION TAX NUMBE'
_ ARCEL NUMBE JI.
0 1 / 4 SECTION
SECTION/ /(i TOWNSH1 i�NORTH RANG WM
BUILDING INFORMATION r
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ge/)( k fKIC
❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR
❑ MOBILE HOME `� ADDITION 2ND FLOOR
❑__ ODULA_RT�QME ❑ ALTERATION BASEMENT
DETACHED TTACHED ❑ REPAIR CARPORT
G RAGE - %� ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE & $35
❑ INDUSTRIALYEAR rh
❑ HOTEL/MOTEL/DORMITORY MAKE ,W V�t� $ 18 A �'
NUMBER OF UNITS Q@ $8 ':0,, :y:�l
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS UBG OCCUPANCY GROUPC& 1 ;(14*FiTIV5
SELECTED CHARACTERISTICS OF BUILDING
aJJJ PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
���V.. '�� WOOD.FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
'�/❑ ANUFACTURED ❑ WOODSTOVE ( PASSIVE SR"
0 STRUCTURAL STEEL 0 GAS ❑ COAL,,_-
t9 ❑ REINFORCED CONCRETE ❑ OIL 1l--�HER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - r�'tlfe / 1 ��l�a,f NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
r.( APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
`-'� PUD TYPE OF WATER SUPPLY � "
❑ PUBLIC ( NAME OF WATE-R SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NCME' 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 0 YES ❑ NO
,- IDENTIFICATION
—^�{ NAME MAILING
MAILING ADDRESS y ZIP [ TEL NO
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X CONT
STATE L I CrNSE NO 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
S I GNATUR OF APPLICANT IIPPL T I f�N D TE 17,7„5.,(777 I CHECK NUM47 CASH
APP ED BY PR ?T F>-r
A p R _ \ / l T. aASE FEE I NSPECT I ON
WP 3, 5L BLDG SURCHARGE __„�, - PLAN CHECK
DEC 1 2 1988 ENERGY SURCHARGE
, 5(J--- TOTAL
JEFFERSON COUNTY REFUND DATE PATE i SS
PLANNING&BtOG DEPT f 0 9 I 1 NUMBER
BUILDING OFFICIAL /c-// .ED `;
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DEC 1 z 1988 �..-�
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JEFFERSON MO M
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