HomeMy WebLinkAboutBLD1989-00098 111 BUIL �G ,:'ERMIT APPL CATTON
Jefferson County Building Department''P . O . Box 1220/Port Townsend ' WA 98368
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LOCATJ ON "-` "I
SPECIFIC LOCATION SITE ADDRESS94 a. cs
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POSTALC DISTRICT /SUBDIVISION
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LEGAL DESCRIPTION LOT4.. BLOCC( DIVISI TAX NUMBER
PARCEL NUMBER / ! L 1 / 4 SECTION
PLANNING AREA SECTION : _ . OWNSHIP NORTH RANGE �; . WM
BUILDING INFORMATION
yy � BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
@! ❑ SINGLE FAMILY ❑ NEW BUILDING MA
IN FLOOR
"' ❑ MOD1 LE HOME ❑ ADDITION 2NR FLOOR
\ ❑ MODULAR HOME ❑ ALTERATION BASEMENT
"b+ ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
53 y' GARAGE ❑ REPLACEMENT GARAGE'
`s ❑ WOODSTOVE ❑ WRECKING/DEMOLITION 1COMMERC AL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTR
NUMBER OF UNITS \\\\,
❑ COMMERCIAL MOBILE HOMES SIZE $3•
_ a7.
❑ INDUSTRIAL YEAR _J
$ 16
❑ HOTEL/MOTEL/DORMITORY MAKE
NUMBER OF UNITS $8
• OTHE - SPECIFY ESTIMATED OST OF $8
4144
let�� IMPROV ENTS TOTAL FAIR MARKET ' ALOE
UBC O CUPANCY GROUP $ _ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ 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 EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBtR OF PROPOSED BATHROOM
APPROVED DATE "..k.,, INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPP
❑ PUB ( NAME-'"' F WATER SUPPLY)
—T APPROVED DATE ❑ PR I VAT AME OF WATER SUPPLY �^
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PLANNING DEPT . WITH SHORELINE, JURISDICTION
❑, YES NAME OF ADJACENT WATER BODY
C1 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 D YES ❑ NO
IDENTIFICATION
S'-‘tNAME MAILING ADDRESS ZIP T ELl�"VOWNER . A J /7� ,,
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CONT Lf f` `� "�S sf — '-3% ' J c
S` A' E L �C:�7J �
ARCH
THE OWNER OF THI BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
s/( SIGN URE O A4'1 T '�' APPLICATION D TE RECEIPT NUMBER CHECK NUMBER OR CASH
/4
APPR D BY PERMIT FEES
APPROVE '?'15 BASE FEE INSPECTION
DEC 15 1989 BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE . C'
JFFFERSPA COUNTY '� TOTAL
PLANNING &BLDG DEPT
9II NUMBER REFUND DATE DAT_ ISSUED
!ow—
BUILDING OFFICIAL 7� /./ I
APPROVED
DEC 1 5 1989
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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