HomeMy WebLinkAboutBLD1988-00434 BUILDING PERMIT APPLICATI
Jefferson County Building DepartmentaP .O . Box 10•Port Townsend. WA 98368
LOCATION .j
SPECIFIC LOCATION SITE ADDRESS (/ 3 `47,U ' E)
POSTAL DISTRICT__�J i
/SUBDIVISION
I4*'-
LEGAL DESCRIPTION LOT S / BLOCK DIVISION TAX NUMBER
f/ PARCEL NUMBER 1 / 4 SECTION
9/ Y SECTION r7 TOWNSHIP .30 NORTH RANGE ND WM
' C.)
BUILDING INFORMATION
.NN> : BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE
"� " ❑ INGLE FAMILY NEW BUILDING MAIN FLOOR
MOBILE HOME ADDITION 2ND FLOOR
O, ❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILEy M�/”❑ COMMERCIAL SIIZE ! Y l Q/e @ $35
❑ INDUSTRIAL YEAR /Va 4 $ 160 HOTEL/MOTEL/DORMITORY NUMBER OF UNITS MAKE 0 41 $8
❑ OTHER - SPECIFY ESTIMATED COST OF A @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUT :!, $ $
�* SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
; `-- (XisilANUFACTURED 0 OODSTOVE ❑ PASSIVE SOLAR
, ❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING )
`N. DIMENSIONS
❑ OTHER - 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
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TY�PE OF WATER SUPPLY
I�I�PUBL I C ( NAME OF WATER SUPPLY)
APPROVED DATE (/❑ PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
El YES NAME OF ADJACENT WATER BODY
❑ NO
Ste-._,
! APPROVED DATE BANK HEIGHT' SETBACK
`µme 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
--•- -/N�A^ (hME p//II � /y-��- MAILING ADDRESS ZIP TEL>NO
OWNER JlX \ 'J7 I'V ' J --.2/�
` ;CONT
ARCH
THE, OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
1 TUR OF ,APPL 1 M Aral AT 1 O DAT • ' RECEIPT NUMBER I CHE NUMBER OR CASH
APPROVE BY PERMIT FEES
A P p , ASE FEE INSPECTION
LDG SURCHARGE PLAN CHECK
OCT I4 I
ENERGY SURCHARGE
C� j� TOTAL
JEFFEBGON COUNTY PLANNING&BLDG DEPT 9 1 1 NUMBER i REFUND DATE I DA I SUE
BUILDING OFFICIAL 61 (4 is, 1
APPROVED
OCT
JEFFERSON COUNTY
PLANNING&BWG GEI
/7 2 7/81:S l�4
e 'IT, /Z-e crtee. c
QlC.424