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HomeMy WebLinkAboutBLD1988-00126 BUIlNG PERMIT APPLICATION ` 0 Jefferson County Building Departmnttf . O .TBox 1220•Port Townsend, WA 98368 LOCATION SPECIFIC LOCATION' SITE ADDRESS P� 0l d,�-/\Q f?..„.9 . POSTALD S TRICT '( _ � � /SUBDIVISION E( I�L�PC.� Ut a -- LEGAL DESCRIPTION LOT (9 4 BLOCKS, DIVISION TAX NUMBER PARCEL NU ER Wp0 ) (p(40�} 1 / 4 SECTION SECTION TOWNSHIP CXh r kJ NORTH RANGE J( _ WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE rS I NGLE FAMILY 1 NEW BUILDING MAIN FLOOR /e C J^ 0' �❑ MOBILE HOME ❑ ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR tE OGIC" 0(.( GARAGE ❑ REPLACEMENT GARAGE 53 7 2* ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ❑ MULTI -FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS ❑ COMMERCIAL MOBILE HOMES ,_,cc, C/ j\ ❑ INDUSTRIAL SIZE / ��UJ q� 3 5 � �� V ❑ HOTEL/MOTEL/DORMITORY YEAR $ 16 NUMBER OF UNITS MAKE .r)�? (� $8 15/� 9.c . ❑ OTHER - SPECIFY ESTIMATED COST OF a©0 0 @ $8 /e0 0 IMPROVEMENTS TOTAL F R MARKET VALUE %GG UBC OCCUPANCY GROUP,/ $ $ i SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRI CIPL TY(PPE OF HEATING FUEL WOOD FRAME l�'"� ELE TRIOI i7Y ❑ COLLECTIVE SOLAR ❑ MANUFACTURED V❑\ WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS 0 COAL Q.-1 ❑ REINFORCED CONCRETE ❑ OIL '.OTHER - CI, ❑ MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUDc- TYPE OF WATER SUPPLY \, L// PUBLIC ( NAME OF WATER SUPPLY) Y APPROVED DATE ///❑ PRIVATE ( NAME OF WATER SUPPLY) _ PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY 0 ( E\- ❑ NO 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 0 NO IDENTIFICATION NAEAME I /r�/� MAILING AA�I �L�I NG ADDRESS ylp (�ZIP [T1EL7 NO OWNER I 1 P � ( 1 �t/l.(.�.//ILL(' �. fa. lit. ! 11,S 7 ! vr��,� P. L , ,Qro1 CONT CV ARCH I THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS: r S yGNATWQFy/OF A,pPL I C/jNT.- APPL/q/ C1 DATE N BER CHECK NUM ER OR CASH 9 ' RECEIPT353q, I /(1 APA'2 .- $ ® PERMIT FEES _so76o FEB I - ,,:: 7.00... FEE INSPECTION S? Ail. 3. BLDG SURCHARGE PLAN CHECK A E ,.c. wry �i / A1.1t41Nr;B,flli3G DEpTli� (S'/ () ENERGY SURCHARGE l�� Sr)Y ti J ✓ /` TOTAL /04 911 NUMBER REFUND DATE DATE ISS ED BUILDING OFFICIAL O II5 89 SGly - - . lam 77-Z 1t1,_/_ _/_L`.______ .- ___ ____ 1`-7' _r,.► e,-- '- ? f r� 't'✓7--2/./ • H n . zz' - i i (______(1'' v . — -- _ OGELk i I v e io' .. _ .�D 3, ey- _ i • , i z'8" . �. r i i I i i i5qs 0 1 , ' i 1i i . I i I I I i i i :k 3 isz- /O. o • G1 4 , O,i I _ as i i i I i i c• i i I i I Ta'{ jam,.. = i I( 1 i ! i. lilt N. ti _ n 537 i i j j I I `r 1 1 It Z3' ! I I ! i I I i ' I I { I I I l ! i I i i I i i I ! i. j, , . : , , . ..z,, a, „ i . ; OD t I j .r.. A/', . , • I ( I [ I i /3 64? trued,p,`y,/,"40A-le by 'WIT 15Z=c. y/.4 cal AA C�r,_,__ C) /ftez..1 °1/4/1-r-r-- 4 c r e ei., ;G rL 71:1L1I) 7- Z �I � e�� l '4c�cis Vs(, jib 2/4" Vee, ®CS eJ "/e 7 -44c eT �it)c-J 7 art co //, ',7 4, c C.J/C3Z:...c_6 6D. S.) L V/81 /7 7:7:44. G ?x�l 1 1At i6c r -ED