HomeMy WebLinkAboutBLD1989-00386 .LDING ``'ERMIT APPLICATION ('
efferson County Building Department•P .O . Box 1220 Port Townsend. WA 98368•
LOCATION SPECIFIC LOCATION SITE ADDRESS 6, rn ayn^n
ri C �r IPrU
POSTAL DISTRICT.. /SUBDIVISION Ulf, M{sC,`F.y
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
(1 PARCEL N / 73c7�rJ!�" 1 / a SECTION
PLANNING AREA SECTION TOWNSHIP CX NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MORILE HOME 0 ADDITION 2ND FLOOR
f' -
❑ MODULAR HOME 0 ALTERATION BASEMENT 7
❑ DETACHED/ATTACHED 0 REPAIR CARPORT .�
GARAGE 0 REPLACEMENT GARAGE ,-/�
OODSTOVE 0 WRECKING/DEMOLITION COMMER9.4 L
MULTI - FAMILY ❑ RELOCATION/MOVING I NDl,1Si R I AL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE ---' ____16 @ $3 5
❑ INDUSTRIAL YEAR d] a7 $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $8
NUMBER OF UNITS
O OTHER - SPECIFY ESTIMATE COST OF 0 a $8
IMPRO MENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPE FY
❑ MASONRY ( WALL BEARING ) DIMENSIONS /
1 0 OTHER - NUMBER OF STORIES / TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D I SP AL NUMBER OF PROPOSED BEDROOMS
0 PUBLIC OR PR 1 V • E NUMBER OF EXISTING BEDROOMS
0 INDIVIDUAL EPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 I ND 1 V 1 DU WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
0 P --LIC ( NAME OF WATER SUPPLY)
APPROVED DATE ■ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
i ❑ YES NAME OF ADJACENT WATER BODY
cr
❑ NO
0 APPROV• • DATE BANK HEIGHT SETBACK
aJ� PU : IC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
--E NAME OF PRIVATE ROAD
nO APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME /��MAILING ADDRESS /y`ZIP�-yy� TEL
NO
OWNER rQ. I 31.�► J& . 1 �S// ---0 _ Ste_
Walt,
CONT / Y5"2..-"Zy67
STATE L I c'r sE NO I
ARCH
' HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
' t GNATURE OF APPLICANT APP CA�qN�DATE I REC�E 1 PT�NU�ER I CHF�.CtS P1U�Fk OR CASH
kJ, *1 , 0. & /J/ 7 `y/' ,7 l(\1�\-�C
APPROViD B PERMIT FEES/
dED BASE FEE INSPECTION
APP cjr.:16-24(...:
/`ID BLDG SURCHARGE PLAN CHECK
APR 7 919
.SZJENERGY SURCHARGE TOTAL
JIFF€ii & COUNTYOREFUND DATE c' ;;L
V SU
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