HomeMy WebLinkAboutBLD1988-00417 B•DING PERMIT APPLICATION •
Jefferson County Building Departm(nt•P .O . Box 1220•Port Townsend. WA 98368
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LOCATION J\
SPECIFIC LOCATION' SITE ADDRESS c / ( J C ; U) )1A.(1 ,61.5 i-i /}'.�
POSTAL DISTRICT /SUBDIVISION JG�(
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER /R(Ea7J �(I
PARCEL NUMBER_ .�J L.f/� 1 / 4 SECT I ON /f /
SECT I OII33` WNSH 1 P�` '3O NORTH RANG WM
BUILDING INFORMATION 7 (2i?e /(i/ Cits:(', . 595%.,..11,'itrO� „C.l�� /C
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE &e)1,30ti
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ TI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL
$35
❑ INDUSTRIAL SIZE 0 p�
❑ HOTEL/MOTEL/DORMITORY YEAR d] @ $ 16
NUMBER OF UNITS MAKE $8
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
• - ❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE -------- j'"' ASS I VE SOLAR
-
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❑ STRUCTURAL STEEL -- GA ❑ COAL
❑ REINFORCED CONCJET /� 0 OIL ❑ OTHER - SPECIFY
❑ MASONRY„_.(.-WALL BEARING ) DIMENSIONS
❑ OTHER -
NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
` h HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
,. ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDRp)MS
,r, ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED—EIATHROOM
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EX1 ST I NG BATHROOM
7--
PUD TYPE OF WATER SUPPLY _
❑ PUBLIC ( NAME OF WATER--SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME 9V-4ATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES J)I-AME 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
PPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME
MAILING ADDRESS ZZIIPTEL NO
OWNER `i() i MaAAf11i"L 0,5 CfK7 CONT
STATE LICITISt NO 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SI NA URE OF PP 1 A T "1._
XAPPLIC IO •A E RECEIPT NUMBER CHECK MBER OR CASH
7
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ASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE
PANNING&IIOG DEfT d ��
//�P� v TOTAL
911 NUMBER REFUND DATE ME
ISS
BUILDING OFFICIAL �
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