HomeMy WebLinkAboutBLD1989-00530 BUI•NG 'ERMIT APPLICATION •
Building D artment'P .O . Box 1220'Port Townsend . WA 98368
Jefferson County ui g e p •
LOCATION '
SPECIFIC LOCATION SITE ADDRESS roc ' /�Q/fdr 5
rG- 7
POSTAL DISTRICT 6aRc /SUBDIVISION i f
LEGAL DESCRIPTION LOT BLOCK X'N,t „, D 1 V I S 1 ON:sr NA ' TAX NUMBER rtp
PARCEL NUMBER w61 ? ,4 071 1 / 4 SECTION
PLANNING AREA SECTION , :" TOWNSHIP a 6 NORTH RANGE ! ' ` ., WM
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE yyx-7-41
.151 SINGLE FAMILY NEW BUILDING MAIN FLOOR /2_32 p
❑ MOBILE HOME ADDITION f'-444 6v - 2ND FLOOR
❑ MODULAR HOME ❑ ALTERAT I ONA& CQ 1"'IOJJe BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL elq
SIZE v-1 `'- 'y - ,
❑ INDUSTRIAL YEAR W @ $ 16
❑ HOTEL/MOTEL/DORMITORY �{{,
NUMBER OF UNITS MAKE ' _x2 W Q3 $8
❑ OTHER SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TO7 SFAIR MARKET VALUE
UBC OCCUPANCY GROUP $
f•3 t
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
/, wOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
k4r ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
�" ❑ MASONRY ( WALL BEARING )
DIMENSIONS'
f'\ ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
z N
DEPARTMENTAL REVIEW
HEALTH DEPAR M NT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
�J, 5k ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
// r q�� ❑ I ND 1 V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM
(" APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
j PUD TYPE OF WATER SUPPLY
❑ PUBLIC . ( NAME OF WATER SUPPLY)
APPROVED DATE Li PRIVATE ( NAME OF WATER SUPPLY
' PLANNING DEPT . WITHIN SHORELINE JURISDICTION
, j ❑ 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 ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TELNO
OWNER ;,7 `X" kut , I C7i55 1( 0
CONT
STATE L I C'NSE NO 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
.
SIGN/ RE OF/APPPL I A/NNT APPLICATION�JDAyTE RECE PT NUMB R CHE(C�.1/i NUMB R OR CASH
3-1 bio
APPROVED BY i PERMIT FEES
‘ \ 1
A P O V�E E //7 BASE FEE 2'5 INSPECTION
141 3 S ' BLDG SURCHARGE PLAN CHECK
JEFFEMWNVAIM�9 ENERGY SURCHARGE /47 TOTAL
PLAMilO G?$L1+81WW
911 NUMBER REFUND DATE D,TE I _;)
BUILDING OFFICIAL c
116.
V `
(.73,/ ��
APPROVED
APR 3 ' Rq - C> (S g tc) 6\c_
JEFFERSDly COUNTY
PUNNING&BLDG DEPT
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