HomeMy WebLinkAboutBLD1989-00398 AI/ BUILDING , 'ERMIT APPLICATA,
Jefferson County Building DepartmentoP .O . Box 1220'Port Townsend / WA 98368
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LOCATION , •
SPECIFIC LOCATION SITE ADDRESS rarYlp Oisc___,•DVPAr-lj Rd.
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 701 .2243 1 / 4 SECTION
PLANNING AREA SECTION O20)\ TOWNSHIP ,. ; NORTH RANGE . WM
BUILDING INFORMATION
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BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY ELNEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
'y(019ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL ____JA @ $35
SIZE
O INDUSTRIAL
YEAR 774 @ $ 16
O HOTEL/MOTEL/DORMITORY
MAKE 0 @ $8
NUMBER OF UNITS i
O OTHER - SPECIFY vl @ $8
ESTIMATED COST OF
IMPROVEMENTS TOTALFAIR MARKET VALUE
' ?0
UBC OCCUPANCY GROUP /
, -
4
$ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
-
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE-SOLAR
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0 MANUFACTURED 0 WOODSTOVE O_RASSIvE SOLAR
C\1 0 STRUCTURAL STEEL 0 GAS _ - 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING )
0 OTHER - DIMENSIONS
NUMBER OF STORIES TOTAL LAND ARE0454
T-....,_
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
le:L IND f vIDuAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
EL INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
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PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY = . -
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PLANNING DEPT . WITHIN SHORELINE JURISDICTION
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0 ES NAME OF ADJACENT WATER NOBODY
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 ADDRESS ZIP TEL NO
0
OWNER
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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SGN URE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
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4r-r-/ L-- H / 02-8/8 9 4 B (443 lit,(:) 2
APPROV D PERMIT FEES
A P . ()(..) BASE FEE INSPECTION
EC ri.4,44, 4. 5-() BLDG SURCHARGE --- PLAN CHECK
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11111\k ENERGY SURCHARGEis?,5 0 TOTAL
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911 NUMBER REFUND DATE I 17/TE IS,.
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BUILDING OFFICIAL 5/1 '
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