HomeMy WebLinkAboutBLD1989-00529 *DING ERMIT APPLICATION 0
Jefferson County Building DepartmentvP .0* Box41220ePort Townsend. WA 98368
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LOCAT I ON ‘
SPECIFIC LOCATION SITE ADDRESS 14 ay.S,.>1../171 Cj A
tr CA.)
POSTAL DISTRICT j" / ISUBDIVI .tION , riftc ..s
LEGAL DESCRIPTION LOT BLOCK ( 0, DIVISION TAX N MBER
:cL SI:c T
PARCEL
N0Niza.ER ? --- S (. C)k',/ i 4, } 1 / 4 SECTION
PLANNING AREA -•
TOWNSHIP NORTH RANGE. / ad WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAG7 /c/
INGLE FAMILY ( NEW BUILDING MAIN FLOOR
..,..._
0 MOBILE HOME
O MODULAR HOME 0 DITION 2ND FLOOR
0 ALTERATION BASEMENT i 3L-i9
NJ 0 DETACHED/ATTACHED 0 REPAIR CARPORT
4V) GARAGE 0 REPLACEMENT GARAGE
“---) 0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
' )--- 0 MULTI - FAMILY
NUMBER OF UNITS 0 RELOCATION/MOVING ANDUSTRIAL
MOBILE HOMES
O COMMERCIAL ailb @ $35 ttAND
SIZE
O INDUSTRIAL
YEAR 4.0.1 @ $ I 6
0
MAKE [A @ $8
NUMBER OF UNITS HOTEL/MOTEL/DORMITORY
ED COST OF
O OTHER - SPECIFY 0 @ $8
ESTIM
IMP OVEMENTS TOT , A.4...R KET VALUE
UBC OCCUPANCY GROU $ c
P
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
4-P INCIPLE TYPE OF FRAME
WOOD FRAME
- --_.
(-_ ,Z_LECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED WOODSTOVE 0 PASSIVE SOLAR
Cr- 0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE
0 OIL 0 OTHER - SPECIFY
(.1-3* 0 MASONRY ( WALL BEARING ) DIMENSIONS
O OTHER - NUMBER OF STORIES TOTAL LAND AREA
IQ DEPARTMENTAL REVIEW
\.). HEALTH --1 N D I V I DUAL ( S E P T I NUMBER OF PROPOSED BATHROOM
DEPARTMENT TYPE OF SEWAGE DISPOSA4_ 't,IMBER OF PROPOSED BED :3ROOMft"
I 1 01 i /S CI 0 PUBLIC OR PRIVATE 13 0 NUMBER OF EXISTING BEDROOMS
r
7c-- 9,
CT- APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
_ MIMIOROW.
PUD TYPE OF WATER SUPPLY
7*PUBLIC ( NAME OF WATER SUPPLY) LI/VI'
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPI,L.c1=6.608.8,===....=.„...n....
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
CQ APPROVED DATE 0 NO
BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
OPf 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
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CONT .3,f....7-
--- , STAT-E LICEITTr-NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
N.s\NNZNATURE OF APPLICANT AprLI ATO DATE RECEIPT MBER I CHECPS NUMBER OR CASH
C
1
i -7
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/ NOV
E/ \ PERMIT FEES
571 , A \--.-:
.9.SA ,) BASE FEE INSPECTION
NOV 9 1
_., BLDG SURCHARGE PLAN CHECK
AFFERaMC AiTY t,)
N
PLANMNG&BLOGDEPT ENERGY SURCHARGE $,4,31 (la)
-`-, TOTAL
I (-) ,CA.) 9 I I NUMBER REFUND DATE I DAfIg.4
BUILDING OFFICIAL II
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MOM&SLOG OEM
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