HomeMy WebLinkAboutBLD1988-00410 WILDING PERMIT APPLICATION
Jefferson County Building Department.P . O . Box 122u Port Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS,
.A..i t Li 4' c_ —
POSTAL DISTRICT /SUBDIV ION t ..>4 ,; ' 4
LEGAL DESCRIPTION LOT ( BLOCK DIVISION TAX NUMBER
PARCEL NUM ER�`11O 3C'- �, ;; '-"77 1 / ,4 SECTION
SECTION TOWNSHIP ( sg&)7ORTH RANGE ie WM
BUILDING INFORMATION
XSINGLE
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE�7^� Z
FAMILY kNEWBUILDING MAIN FLOOR /5Z73❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE .74 _ ,1,b
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
`D ❑ MULTI -FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
0 COMMERCIAL 2� _
❑ INDUSTRIAL SIZE l� 'q� $35 7/ o� �jD�
❑ HOTEL/MOTEL/DORMITORY YEARS 0t q� $ 16
NUMBER OF UNITS MAKE i L7���� ' "" W @ $8 .:Z •
❑ OTHER - SPECIFY C� /_� '
��../' ESTIMATED COST OF p� $8 lP
V IMPROVEMENTS
�7c._ UBC OCCUPANCY GROUP �� $ $TOTA FAJR MARKET VALUE
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
/)' WOOD FRAME 7ELECTRICITY ❑ COLLECTIVE SOLAR
-►<. 0 MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
`0 ❑ STRUCTURAL STEEL 0 GAS ❑ COAL
Cam" / ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING )
r ❑ OTHER DIMENSIONS
NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TY E OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 4g
PA.-SC G:7u 61t. NI PUBL I C OR PR I VATS
.,QIRd a NUMBER OF EXISTING BEDROOMS
APPROVED DATE ❑ 'INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM„
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PurlZT-1/) -'- ' O T PE OF WATER SUPPLY
l \ � PUBLIC ( NAME OF WATER SUPPLY Pcc- 6-,LQMiiA,!
ROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION r
❑`YES NAME OF ADJACENT WATER BODY
)CNO
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 0 NO
IDENTIFICATION
NAME B �-{/�p 1 MAILING .ADDRESS n j�.� ZIP C T E L NO .
OWNER O 4 n i 1,`h1�� ua I m.��1 1� t . AA ) 4. f-� `7 o 6 O aJ
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C O N T Ir4 4t t_ `LAA. . _ 9g3t0� !✓ 714 J`kr�i1�S ( L 7C10/4 s f L ctMY
ARCH '
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SI N TURF F APPL _ APP ICA ION ATE RECEIPT NUMBER CHECK NUMBER OR CASH
APP VED BY PERMIT FEES .._
A P P R "r S ,00 BASE FEE INSPECTION
3•SD.. BLDG SURCHARGE PLAN CHECK
SEP 2 2 1988 `` l�U ENERGY SURCHARGE qg S---o TOTAL
JEFFERSON COUNTY 10 REFUND DATE J77I7UED)PLOFFICIAL 9 11 NUMBER t
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APPROVED
SEP 2 2 S9 ----F ) /f.J A 4:7 ,) s,t d ___
JEFFERSON COUNTY
KAMM&812G DEBT
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