HomeMy WebLinkAboutBLD1989-00370 f3UI•ING V JERMIT AF'PL CATION
Jefferson County Building Department*P .O . box 12200Port Townsend. WA 98368
SLOCATION
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SPECIFIC LOCATION SITE ADDRESS //CJ , dAPOSTAL DISTRIC /SUBDIVISION dot 1C P-P.i&j
LEGAL DESCRIPTION LOTOC< BLOCK DIVIS TAX NUMBER
PARCEL NU ER ( ,�O 00 *Oa / a SECTION
PLANNING AREA SECTION TOWNSHIP RTH RANGE 'r''. WM
BUILDING INFORMATION
`B I LD I NG TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
/�l —yy_ ,�
�NGLE FAMILY ❑ E,W BUILDING MAIN FLOOR 3 /6 /0'4
❑ MOBILE HOME , DDI T ION( `!Y4 ri��,� 2ND FLOOR 5!4/
❑ MODULAR HOME 0 ALTERATION arm/ C BASE E Tg
❑ DETACHED/ATTACHED 0 REPAIR ��
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES -
❑ COMMERCIAL SIZE ` a $35 5-6Q
❑ INDUSTRIAL YEAR
.`-` ❑ HOTEL/MOTEL/DORMITORY p� $ 16
MAKE / ` c 0 a $8 5 . ,
NUMBER OF UNITS G
❑ OTHER - t
�°� SPECIFY EST I P+f ED COST OF a $8 '70
IMP VEMENTS T ARKET VALUE
UBC OCCUPANCY GROU, ,-.2, $
SELECTED CHARACTERISTICS OF BUILDING
PR CIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME LECTRICITY 0 COLLECTIVE SOLAR
❑ NUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - J NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
VrgoiR7
H TMENT TYPE OF SEWAGE DISPOSAL ry NUMBER OF PROPOSED BEDROOMS❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 1
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOMmilmm ,
k) UD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ( PRIVATS ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION J
OVI
A YES NA EOF ADJ C T WATER DY
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
1
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
` (r\, Y"
NAME OF PUBLIC ROAD
,nJ) NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
di
IDENTIFICATION
NAME MAILING A D C.R E S S ZIP T E L NO
Ilermar
CONT i,, _
T E L I L-E'}17 r'Z'-7413
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
1(j TUR
F OF.1APP I CANT APP 1 L,'T 1 O 7 RGCs T NUM ER CIiECK/N R OR CASH
`� APPROVED BY PERM! FEES
0 r BASE FEE - INSPECTION
L.
!7 BLEG SURCHARGE PLAN CHECK
ENERGY SURCHARGE $3D ,51-) TOTAL
A 2 8 1989 5 1 1 NUMBER REFUND DATE �DATE ,IS UEDD
JENIN,, •1 \ p1NG OFFICIALlit. /
OIDG UtN /7/ (7`
A P FOM\V4 or., 11
AUG 2 8 1'44111A,
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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