HomeMy WebLinkAboutBLD1989-00395 BUI•NG ; 'ERMIT _APPLICATION •
Jefferson County Building Department 'P .O . Box 1220BPort Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS , 11
POSTAL DISTRICT t /SUBDIVISION
LEGAL DESCRIPTION LOT,N BLOCK �4 DIVISIO TAX NUMBER
PARCEL NU ER I / 4 SECTION—
PLANNING AREA SECTION TOWNSHIP NORTH RANGE /- WM
BUILDING INFORMATION
I
BUILDING TYPE TYPE OF IMPROVEMENT i SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING / MAIN FLOOR
❑ MOI.3I LE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
G AGE ❑ REPLACEMENT GARAGE
WOODSTOVE ❑ WRECKING/9 MOLITION ' COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATI'N/MOVING INDUSTRIAL
, : NUMBER OF UNITS /
MOBILE FIf MES i
0 COMMERCIAL �35
0 INDUSTRIAL SIZE
YEAR L ] a $ 1 6
O HOTEL/MOTEL/DORMITORY
4 —2
NUMBER OF UNITS MAKE /� $8
0 OTHER - SPECIFY $8
ES' I MATED COST OF
- I,4PROVEMENTS TO AL FAIR MARKET VALUE
C UBC OCCUPANCY GROG
I
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PFZ/Y'NCIPLE TYPE OF FRAME
El WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS ❑ COAL
O REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) ~ DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT I TYPE OF SEWAGE DISPOSAL NUMBER OF PROF D BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF ISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMB OF PROPOSED BATHROOM
APPROVED DATE
❑ INDIVIDUAL WELL BER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF ER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAM OF WATER SUPPLY
PLANNING DEPT . WITHIN SHO LINE JURISDICTION
❑ YLS .. ME OF ADJACENT WATER BODY
-- .
NO
APPROVED DATE BANK HEIGHT SETBACK
S::'�..:,,�,,k PUBLIC WOR DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
2" NAME OF PRIVATE ROAD
PROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING AC:DRESS ZIP ,T/EL NO
OWNER r'1�/'J _ -�,.-• �: 1'1 -f-/-`. ..-7
No .i Ct
„if__ , .. "/ '
CONT
STATE L I C'E lsL Nu -
r
ARCH
TH ..,OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
'71)tURE OF AP,R!_.f CANT APP LI(CAT1 4. E ' RECE,_3--IPTMBER CHECK j%MBER OR CASH
id.
APPROVED BY E MIT -EESS
APPROVED ,e BASE FEE INSPECTION
/ BLDG SURCHARGE PLAN CHECK
Nov 2 1 1989 ,--> Cy" S ,
ENERGY SURCHARGE 1. TOTAL
JEFFERSON COUNTY
PLANNING&MG DEPT 9 1 I NUMBER REFUND DATE DATE I SSUUEE/D
BUILDING OFFICIAL // / (
1
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pR VED
JEFFERSON COUNTY
PLANNING &ROG DEPT
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