HomeMy WebLinkAboutBLD1988-00433 BUIOING ''ERMIT APPLICATIONIII
Jefferson County Building Department®P .O . Box 1220.Port Townsend. WA 983684
LOCATION r
SPECIFIC LOCATION SITE ADDRESS (O T). 3 11)t a O ` c-- lr
POSTAL DISTRICT /S IVISION
LEGAL DESCRIPTION LOT 4 BLOCK DIVISION TAX NUMBER
PARCEL NU B R5,4' J �._..� 1 / 4 SECTION //!!A
SECT I O(\� TOWNSHIP ✓NORTH RANGE t ) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR
'`J"MOBILE HOME '❑ ADDITION 2ND FLOOR
'❑ MODULAR 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 S1ZE ILt( X . (r) a $35
❑ INDUSTRIAL
YEAR I CI P) ( VI a1 $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE 0 Pi-(.t)Cryt, [A @ $8
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 a7 $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME �`
PRINCIPLE/ TYPE OF HEATING FUEL
❑ WOOD_FRAME Q9 ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
-.. ❑ MASONRY ( WALL BEARING ) DIMENSIONS
"4 ❑ OTHER NUMBER OF STORIES TOTAL LAND AREA
�J DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
LI I ND 1 V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM I
APPROVED DATE ❑ \ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM ,
PUD TYPE OF WATER SUPPLY
'U' PUBLIC ( NAME OF WATER SUPPLY) ( !-y
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
1 ❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
t NAME OF PUBLIC ROAD
`d. NAME OF PRIVATE ROAD
l APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
NAMEQQ [�/� I� \/ /'MAILING ADDRESS �n{yn�Z IP
TEL NO
�. OWNER ,I lel-A vin P( I d n ,1 )) , I( 1 )'lc( -ngAcf
.,./') �J t 4-r ruj,
'. CONT
STATE LICIL.NSh. NO 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
IG ATURE pF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
F1 /Ltf l ( [ /e.8 1 1-7Iq(1 Ccc� k.
APPROVED BY PERMIT FEES
AP ROVED -JS,(`Y.-) BASE FEE INSPECTION
1 , 8 '8 A . SO BLDG SURCHARGE PLAN CHECK
JE.ff SON COUNT ENERGY SURCHARGE $ ` ` \ /- TOTAL
c,.
PIro', IN G &SLAG OFPT
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
APPROVED
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JEEfERSON COUNTY
PLIANNIND&81.0G DEPT
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