HomeMy WebLinkAboutBLD1989-00394 B ING,; 'ERMIT APPLICATION 40
Jefferson County Building Department *P .O . Box 1220wPort Townsend. WA 98368
LOCATION d f
SPECIFIC LOCATION SITE ADDRESS ��: Ak/4 J `� Z-�Cct. /L 44 y
POSTAL DISTRICT P 'L /SUBDIVISION)( 9/ �%�'L�?�✓S'�`4 .,
LEGAL DESCRIPTION LOT 5 BLOCK DIVISION II TAX NUMBER
PARCEL NUMBER ' ;.4. .!3 011 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP Gam¢,/`/ NORTH RANGE t:-_ WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE /�� 7
' ❑ SINGLE FAMILY [ ., NEW BUILDING MAIN FLOOR
❑ MODILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ' COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING ( INDUSTRIAL
NUMBER OF i,dN 1 T`' Jl ,- / v_
' MOBILE ,HOMES
❑ COMMERCIAL SIZE 0 a $35
❑ INDUSTRIAL YEAR 0r�, N@ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKEW @ $B
NUMBER OF UNITS
4011 OTHER SPECIFY ESTIMATED COST OF $$
Oro ZUOW\ C if,it)\t.\ IMPROVEMENTS
TOTAL FAIR MARKET VALUE
UBC OCCUPANCY 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 0 GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL rlOTHER - SPECIFY UNI-\(_
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREAS--
-
DEPARTMENTAL REVIEW \` I�
1,
HEALTH DEPARTMENT TY �OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS !
(l DEL L4TkAe. 1\w-t+t f ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
r 4 C��I "'s //Jf�6/�F ❑ f ND I V 1 DUAL ( SEr'TIC ) NUMBER OF PROPOSED BATHROOM
E rrzo v Fn t;!ATE
❑ I NO i V I D L.A L `ELL 4^�i NUT,,Efd or EX!ST Nr, TI-'r:OO 4
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY" --,,,,._,,,,_—__,
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
Z) ❑ 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 ❑ YES ❑ NO
IDENTIFICATION
NAME MAILIN? ADDRESS ZIP TEL NO
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CONT QC31--\t41_
s f A7Fr LI CtNSE NO
ARCH
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rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
`
I GNA / CAN':- APPLICAT ON DATE RECpE1PT NUMBER CHECK NUMBER OR CASH
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APPROVED BY PERMIT FEES
' �,: fri A� c /-e— BASE FEE INSPECTION
A �\ �� BLDG SURCHARGE PLAN CHECK
rL t3 t'' _._. ENERGY SURCHARGE $ 8,5 TOTAL O
.II: IrEMI'si I`aIL I J REFUND DATE DATE„' ISSUED
'I 9!t I%r Y-< 9 t 1 NUMBER ` �4✓
BUILDING OFFICIAL 'L 42 4.73/ �9C.
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