HomeMy WebLinkAboutBLD1988-00443 LDING PERMIT APPLICATION ill
Jefferson County Building Department,P .O . Box 1220sPort Townsend. WA 98368
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LOCATIONC2) CY d H d(o _1(
SPECIFIC
C LOCATION SITE ADDRESS ,
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POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT 6 N BLOCK DIVISION TAX NUMBER//9
Pa/kAL ^/ Gi PARCEL NUMBERX 1 / 4 SECTION
(77 'p f -.-rt I/ SECTION x TOWNSHIP / NORTH RANG WM
BUILDING INFORMATION
ILDING TYPE /\T/YPE OF IMPROVEMENT SQUARE FOOTAGE
PSINGLE
FAMILY*BILE HOME j/ NEW BUILDING
❑~ADDITIONMAIN FLOOR
2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE rH�`M� /,
❑ COMMERCIAL SIZE L a@.
$35
❑ INDUSTRIAL
YEAR 17 q VI @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 07() oL d) @ $8
NUMBER OF UNITS
❑ 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 lPX/ ELECTRICITY ❑ COLLECTIVE SOLAR
�M.ANUFACTURED 0\WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) 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 f
XINDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE El INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM r
PUD TYPE OF WATER SUPPLY )
UBLIC ( NAME OF WATER SUPPLY til.) _
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
,
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
y� Y"�!
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 0 YES ❑ NO
R IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
C ' Ci(\G P). �-- U)6 3V ��'.?�� — 1 .9Y
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STATE LICENSE
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THE OWNER OF THIS BUILD G AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
a l `A� OF AP L I�M iPOPL 1'���N DATE IisI
NUMBER CHECK�BE�7CASH
A PPRO PERMIT FEES
7 ) II BASE FEE INSPECTION
360 BLDG SURCHARGE PLAN CHECK
OCT 1 4 188 ENERGY SURCHARGE �P
d ��
, v � TOTAL
JEFJN UNTY T
PLANNINGFERS 6COLDG O P s 1 1 NUMBER REk UND DATE DATP I ugx1 BUILDING OFFICIAL f Oil W/
I
�.. - 1 !!! v G 000 000
APPROVED
JEFFERSON COUNTY
PtAA #NR&8t06 OEPT
(1/36)11" ° a /111/27
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