HomeMy WebLinkAboutBLD1989-00519 UUILDw 'iG fRMIT APPLICATIO
Jefferson County Bullring Depar,tmentIP .O . r3ox lligtoPort Townsend . WA 98368
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LOCATION / / /� /
SPECIFIC LOCATION SITE ADDRESS �21 l ,7 ( �) M l/t , illP 1
POSTAL DISTRICT /SUBDIVISION I 1119 Al 4I4 _I
iliNV
LEGAL DESCRIPTION LOT / BLOC D)(�"}VL�J',ION TA NUh EER
PARCEL NUMBER 5- `_'0/ 1 / 4 SECTION
SECTION / TOWNSHIP (!�,& NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY /~^\ EW BUILDING MAIN FLOOR
' MOIJILE HOME 0 DDITION 2ND FLOOR
❑ oDULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS p
❑ COMMERCIAL SIZE PC -LFJ� ,
@ $35
❑ INDUSTRIAL
YEAR I ( P 4@ $ 1 6
0 HOTEL/MOTEL/DORMITORY YEAR
NUMBER OF UNITS .C.L L t 0 @ $8
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
' U UBC OCCUPANCY GROUT " ," $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
$ ❑ WOOD FRAME ~-ELECTRICITY ❑ COLLECTIVE SOLAR
.#,,,' ; MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
' ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES I TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEA TH D PARTMENT I TYPE OF SEWAGE DISPOSAL, BER OF PROPOSED BEDROOMSrJ
( 1 ❑ PUBLIC OR PRIVATE. '�jJ�S/ ,NUMBER OF EXISTING BEDROOMS
f � _ ' I ND I V I DUAL(JSEPT IC I c NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ 1 ND I V 1 DUAL WELL— NUMBER OF EXISTING BATHROOM® ,
PUD TYPE OF WATER SUPPLY /u //+ 62_ '4—(..,
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
ICJ ❑ 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 MAILING ADDRESS ZIP TEL NO
OWNER V,„ .p
____,_,; uu . S "yuisr ! � 1,0 :),71 OgktI lie, 1,)(-51/ Slv`t
CONT
STATE L I C ISL NIT-
ARCH
- 0
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
[SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
A VED BY PERMIT FEES
A P 3 v _ 75. CD BASE FEE INSPECTION
` ----' _ --' t)BLDG SURCHARGE PLAN CHECK
N 1 2 9
ENERGY SURCHARGE $r7<'r SR TOTAL
JEFFERSON COUNTY
PLANNING &BLOG DEPT 9 I I NUMBER REFUND DATE DAT I SSU
BUILDING OFFICIAL / / �`�,
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A
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0 %\"(\>\ *.
1 -
600 0,K be ,c '
APPROVED
JAN 2 igfig V ev7 a e Pete
JEFFERSON COMM,'
PUNNING&BLDG
3 ( d
C) RN,3.4v.- 4c- 5? KtiCill a'Lr4-t".-- VIt•••-. LSS t 444( "" kiraXiC
qta)( AA.c....K c.=•".Q.A.4
4.1 p thtk. 4- Ags 41.14,,.4 „ec.
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