HomeMy WebLinkAboutBLD1989-00372r VI., r75n09 [3UILG ERMIT APPLICATION
410
Jefferson County/ Building Departmmeente,P .. C , Box 1�22(�0.Porrt Townsend . WA, /98368
LOCAT I Or1_ ' 7 Y1t(E'5 SC74 1 �C� C T\/1 )'Vt4 Cu WI `N Vefel-eef `vim\ cm.. B a}eVA'v .RA,
SPEC I F I C LOCATION SITE ADDRESS (dos 6 B eZt r v"f, L�G4 • -TT, LuaCtt'u
POSTAL DISTRICTCWIVVVi(U* 0SUBDIVISION
R, w.,-t 'e.w 5kor-t' F'1u..t-
LEGAL DESCRIPTION LOT 2- BLOCK DIVISION TAX NUMBER
XPARCEL NUMBER So2I 073 009 1 / 4 SECTION
PLANNING AREA SECTION 7 TOWNSHIP .-lb NORTH RANGE ; (`_�WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY KNEW BUILDING MAIN FLOOR -1 7C17,._
❑ MOBILE HOME ❑ ADDITION D FLOOR
❑ MODULAR HOME ❑ ALTERATION BA EMENT
❑ DETACHED/ATTACHED ❑ REPAIR CAR ORT
GARAGE ❑ REPLACEMENT GARA
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ICOMMER IAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTR AL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES 212 fi $35t?
SIZE y
❑ INDUSTRIAL YEAR @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE
[A
NUMBER OF UNITS /f W'' $8
k\c' 0 OTHER - SPECIFY ESTIMATED COST OF @ $8
`/ y IMPROVEMENTS TOTA FA j,R MARKET VALUE
C OCCUPANCY GROUP UB $ $ arL Sj(Q}()
,( SELECTED CHARACTERISTICS OF BUILDING
V PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
` J� WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
li ❑ MANUFACTURED ' WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
\- ( 0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER NUMBER OF STORIES I TOTAL LAND AREA
\,
DEPARTMENTAL REVIEW
H AL DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS a ,
/ H 5 . ( ❑ i'UBL I C OR PRIVATE
VATE
' ,i iUd/1D 1 V 1 DUAL NUMBER OF EXISTING BEDROOMS
( SEPTIC )C ) NUMBER OF PROPOSED BATHROOM /
APPROVED DATE I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC `( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
?PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ 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
NAME MAILING S �C'�[ADDRESS 9�/-{ZIP TEL NO/
0
i 1( �� ma-�c. l(/�.p��.,, (77:7 _.►���...•
sp i 00?o T tt srd1E Lp>=1trs-E
ARCH
r
THE OW ER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
;I �e OF g APP 21 E I REC P UM/B/ER ' CHEC,.K NUMB j200R CASH
APP VE BY PERM T FEE lC(.
PA
. } o2(0 BASE FEE INSPECTION
I ` N' ---9
V BLDG SURCHARGE PLAN CHECK
Milt 4 19t9 I 6
" ENERGY SURCHARGE d
JEFFERSON COUNTY 'P , ,(3.-• `-'�' TOTAL
PL3P%r'1 P 8t BtOG OPT 9 1 1 NUMBER REFUND DATE i DATE I S EP
. BUILDING OFFICIAL fl //{
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