HomeMy WebLinkAboutBLD1989-00522 I3UI ING 'ERMIT APPLICATION
Jefferson County Building D partment.r .O . box 1220•Port Townsend . WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS
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LEGAL DESCRIPTION OCK / DIVISIONTAXNUMBER �PACEL R �� U a-' 1 / 4 SECTIONPLANNING AREA TOWNSHIP .I7 NORTH RANGE, ir ('4 w1.1
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 /ADDITION �� 2ND FLOOR
❑ MODULAR HOME LTERATION BASEMENT
❑ DETACHED/ATTACHED EPAIR CARPORT
GARAGE REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ICOMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL 1
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE _ a $35
❑ INDUSTRIAL YEAR 0 41 $ 16
O HOTEL/MOTEL/DORMITORY MAKE Ct] $8
NUMBER OF UNITS ---T'
❑. OTHER - SPECIFY ESTIMATED COST OF 2-a--0 a ($II) 67 r)r)
e9 o `� MPROVEMENTS I
$ TOTAL—FAIR MARKET VALUE
UBC OC UPA Y G OUP $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
(5 0 MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
�•! 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
( '' 0 MASONRY ( WALL BEARING ) 1 DIMENSIONS
e��34 0 OTHER NUMBER OF STORIES TOTAL LAND AREA
C DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D 1 SPOSAL NUMBER OF PROPOSED BEDROOMS
/ 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
r� 0 I ND 1 V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
-. APPROVED DATE ❑ 1 ND I V 1 DUAL WELL NUMBER OF EXISTING BATHROOM ,
QC PUD TYPE OF WATER SUPPLY
O PUBLIC `( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
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PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O 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 0 YES 0 NO
IDENTIFICATION
— NAME \ MAILING A D D R/g.$S o ZIP TEL NO
OWNER JaI1 " t "' , 1l(Q / ( /��- % IK2 %) / G CONT
S FATE LICENSE ND -
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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E� APPL CANT APPL,
T 1 ON ATE IRFFiNUM(17� I CHEC AUMBE OR CASH
AAP TM '-,: P RMIT F g.
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7 BASE FEE INSPECTION
AR 6 9:1,
BLDG SURCHARGE PLAN CHECK
JEFFE'SON COU'' `�PLANNING&81DO DEPT ` ENERGY SURCHARGE TOTAL
911 NUMBER ' REFUND DATE DA 1
BUILDING OFFICIAL 1 ���
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APPROVED
MAR 6 1989
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JEFFERSON COUNTY
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