HomeMy WebLinkAboutBLD1988-00448 •ILDING PERMIT APPLICATION•
Jefferson County Building Department•P :O . Box 1220sPort Townsend, WA 98368
LOCATION _
SPECIFIC LOCATION P
SITE ADDRESS �J ( {�` ' 7 r 9(
POSTAL DISTRICT 1 �/SU 1V SION O/ /Y1
LEGAL DESCRIPTION LOT 3C( BLOCK DIVISION TAX NUMBER
PARCEL 7U7ERC/77772.7175-bke 1 / 4 SECTION
SECTION TOWNSHIP NORTH RANGE L � WM
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE (p�J1Q
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS ---
MOBILE HOMES❑ COMMERCIAL SIZE ----0 a@ $35
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY YEAR $ 16
NUMBER OF UNITS MAKE 7 @ $5 �(,j --
PII-Pi
S tFESTIMATED COST OF 1t� @ $8c'C1 IMPROVEMENTS
UBC OCCUPANCY GROU $ $TOTAL,. / MARKET VALUE
,S ri
SELECTED CHARACTERISTICS OF BUILDING
'\,. PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
(:., WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR ----
❑
• ANUFACTURE D ❑ WOODSTOVE PASSIVE SO i
r ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL HER - SPECIFY
i
❑ MASONRY ( WALL BEARING ) DIMENSIO
❑ OTHER - NUM OF STORIES TOTAL LAND AREA
y ,. DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
O PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED-BATHROOM
`.... APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
,
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
"
APPROVED DATE ❑ PRIVATE ( NAME OF T WAERSUPPLY
PLANNING DEPT . WITHIN SHORELINE' JURISDICTION
❑ YES NAME-OF ADJACENT WATER BODY
❑ N���
APPROVED DATE /- BANK HEIGHT SETBACK
PUBLIC WOR . DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
('1 [BENT I F I CATION ~�
A/' NAME MAILING ADDRESS ZIP TEL NO
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�����...THE OWN OF T 1S BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
may'G U�OF P �L 1 CPy,NT ��1 ATC',1�/O/7 DATE RECEIPT�UMBER CHECK NUMBER OR CASH
APPR D BY PERMIT FEES
A P - BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
T ? ENERGY SURCHARGE $[Ca IJ_ TOTAL
PLJEFFERSON COUNTY REFUND DATE DAT I ss ED
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EUILDINGO�R�''FLCIAL
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tEFFEBSGN COUNTY
PLANNING&BLDG DEPT
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