HomeMy WebLinkAboutBLD1989-00387 BUWING ERMIT APPLICATION
Jefferson County Building DepartmentoP .O . Box 1220sPort Townsend, WA 98368
„LOCATJ ON CiI
SPECIFIC LOCATION SITE ADDRESS 91 POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOTilAUBLOCK I DIVISION TAX NUMBER /7,7?-5-60-41°
- / PAReiL NUMBER , T734-00 HO 1 / 4 SECTION
PLANNING AREO SECTION__ - TOWNSHIP ,.i) IA NORTH RANGE 1 ‘..A-.
.- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
N( MODILE HOME 0 ADDITION 2ND FLOOR
Li MODULAR MODULAR HOME 0 ALTERATION BASEMENT Il
O DETACHED/ATTACHED 0 REPAIR CARPORT Nyi
GARAGE 0 REPLACEMENT GJ" AGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY cl RELOCATION/MOVING INDUSTRIAL i01,-1
NUMBER OF UNITS -----
MOBILE HOti_ES
O COMMERCIAL
SIZE 14 k(a 0 a $35
O INDUSTRIAL
YEAR y2 0 @ $ 16
0 HOTEL/MOTEL/DORM I TORY
MAK E e.t4 0 @ $8
NUMBER OF UNITS
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY FC GROU 2717 I $ $
,
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0 WOOD FRAME & ELECTRICITY 0 COLLECTIVE SOLAR
I 0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
Iia, STRUCTURAL STEEL n GAS 0 COAL
.L.:- 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
Qr—I 0 MASONRY ( WALL BEARING ) DIMENSIONS
O OTHER - NUMBER OF STORIES r TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDMXWS ,2,
CD kL-•(AN--- 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
/2--, )d,INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM F
4 APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
U,PUBLIC ( NAME OF WATER SUPPLY) Ni-y,
(...7 APPROVED DATE All PRIVATE ( NAME OF WATER SUPP
No) PLANNING DEPT .
WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
t)c-/ Ip4,„NO
Cr APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH --..
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
.1) APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
Cid NAME ••••^
MAILING ADDRESS ZIP TEL NO
OWNER 1
I e ,. -4 61R3_39 (A t 7
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OcnAQ-clraw .
CONT
-' 1AT-1 Lic7111------------±
ARCH
t L _
THE4R OF T IS B I , G AND THE UNDERSIGNED AGREE TO courom, TO ALL APPLICABLE LAWS.
SIGN, RE OF APPLK APVLIC T1ON DATE RECEIPT NumeEn CHECK NUMBER OR CASH
23
APPROVE B PERMIT FE S
‘1 . 0(1)1 Emsc FEE INSPECTION
P V 1-4 5-D BLDG SURCHARGE _ PLAN CHECK
AUG 2 8---- „ ENERGY SURCE LARGE $ 17 Cl,50
TOTAL
JEFFERSON PLANNING COUNTYY-
--' -----,
--- 9 II NUMBER ()-Rerun DATE PT I s
k13113 01
BUILDING OFF0-I c I AL. ,
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JEFFERSON COUNTY
PLANNING&BLDG DEPT
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