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HomeMy WebLinkAboutBLD1988-00406 !JILDING PERMIT APPLICATION efferson County Building Departrrtient*t"..0 . Box 1220+Port Townsend. WA 98368 •LOCATION ^ / SPECIFIC LOCATION SITE ADDRESS l ) . al (7, 0c _ POSTAL DISTRICT /SUBDIVISION .1.,/`OWi %(�CI�� l� LEGAL DESCRIPTION LOTI--q BLOCK DIVISION TAX NUMBER PARCEL NUMBER 1 / 4 SECTION SECTION _ � TOWNSHIP O NORTH RANGE r (A ) WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR OBILE HOME ❑ DITION 2ND FLOOR ❑ ODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES ❑ COMMERCIAL $35 ❑ INDUSTRIAL SIZE _ q'� 0 HOTEL/MOTEL/DORMITORY YEAR f�X [� $ 16 NUMBER OF UNITS MAKE /'i�_r $8 ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUP 5 $ $ SELECTED CHARACTERISTICSIS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL O WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR Ve MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR • STRUCTURAL STEEL 0 GAS ❑ COAL O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HE ' LTH D PAR`TME T TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS -J� // / / ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 7fI ND I V I DUAL ( SEPT I C) NUMBER OF PROPOSED BATHROOM 0 APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY ~ PUBLIC ( NAME OF WATER SUPPLY APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY XNO 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 ADDRESS Z I P TEL NO '.,.. OWNER Cto ed --n -1176456—H-94110 El /rn7 /NV/"�/p CU . &)/i CONT r r_.._.—.___ s't'A m—i I C 7�Y'S E N ) 'ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED A.REE TO CONFORM TO ALL APPLICABLE LAWS; 1 G A/ U��OF • -// p .�_ APPL CA�1 ',�•:E I RE�1��� R CHECK /c7 R OR CASH ( w y /lam - A' • - PERMI • il FEE INSPECTION i._ SURCHARGE PLAN CHECK ' 8 19,: ENERGY SURCHARGE sqq C ---?) TOTAL JEFFERSON COUNTY / DAT s�uE.:PLANNING diL/BLDG DEPT O a �-/ 8 1 1 NUMBER REFUND DATE DING OFFICIAL fl } ; i 4- �, 1 t i - _ -+ --__ i 1 . 1 , ' 1 f ! i i ._L—.-.__.. -- i 1 1 } � ; j t j i 1 1 i , - 1 1 j r >. t i i ' i j rt I �. I t i I 1 I I I i i ! 1 1 i ; • t ! i a I - _, 1 [�i` , _._ i i ► i- . «t .� 1 i 1 r , ' i i ' 1 , 1 , ' a 4, , i tp . i 1 i ; i ,, i - y,,, ice`) - p c I® WIIINNnlliMHII , : : ,0 : el if a, _._+. . __,,, . , .. • , • % , , , , , , , . , _. ___4. i , , --;--._ � _ 1, , , h ,, mmilmonimmEmum • 11111111111111111i®■ I I ■®1.11 1 111E. 1111'iI !Ik : ••••=mmemommumme r 1111IIIialIM MENIMEMINIMIMMER # f i i i 1 i n . = t ; aaaa a ■ w 1 ! } Ric, _1 IMMIEREMINIIM111111111111111111111111L1111.11 1 j�FF' I'o APPROVE © r� NOV 8 19 fir- U L JEFFERSON COUNTY PLANNING&BLDG DEPT Ct 'Vi/j"- (1/ 1(\ tr' (4) Ckza_it. (-s S <<<< C.) A(S V i cpph — Gam/ Cccc ©L er is 5 ,gz_- c4- w�;