HomeMy WebLinkAboutBLD1989-00418 ipILDINGr"'PRMIT APPLICATIONS
Jefferson County Building Department;P .O . Box 12200Port Townsend. WA 98368'
LOCATION �(�
SPECIFIC LOCATION SITE ADDRESS I LO I CC I(Mn2� QV t`/C�t
POSTAL D `
ISTRICT IDT /SUBDIVISION Cn ,P f' e
LEGAL DESCRIPTION LOT yl2 BLOCK 11-1 DIVISION -7 TAX NUMBER
PARCEL NUMBER 9,39 cool 4L1 1 / 4 SECTION
PLANNING AREA{ SECTION 13 TOWNSHIP :30 NORTH RANGE (21..1) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE'
SINGLE FAMILY NEW BUILDING MAIN FLOOR ,2ti X CIS
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT {{
GARAGE 0 REPLACEMENT GARAGE o rr����1-1 X i lQ
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE ' -24. `@ $38 '�0.32( J
❑ INDUSTRIAL YEAR '" q� $ 16
❑ HOTEL/MOTEL/DORMITORY ` 1 ,, f VJ'
MAKE ,--3r- -1 @ $8 ,- n7 2
NUMBER OF UNITS
❑ OTHER - SPECIFY tESTIM D COST OF 0 a@ $8
IMP V EMENTS TOTAL F j ift 1v1ARKET VALUE
UBC OCCUPANCY GROUP $ $ -`j ,,LL
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
`; WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
- 0 MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
E LTH EPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS l
r ar•g l / (� 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
`'4 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
_. APPROVED DATE 0 INDIVIDUAL WELL U
P M NBER OF EXISTING BATHROcm
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY
' APPROVED DATE X.PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
„, 0 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 6 ,96.. 7
NAME }/`r Gy!-p ~ MAILING
CA�I L I NGV� ADDRESS Q ZIP/ ,�TEELL.�..NOO
O W N E R ' e.LA 1 I \1 , ) t), n PC) , >C 0 J 2 1 1 T ,� I g�3l n j„
C O N T N L?P eron - 7/ ,,,„
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
IG URE s T APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
`.. APPROVED BY PERMIT FEES
t�715 .50 BASE FEE INSPECTION
i V E ® /
1 . o
L_ `/ BLDG SURCHARGE PLAN CHECK
2 )
4 8 l H ,l Jl
�h J ENERGY SURCHARGE $ `39' C) TOTAL
JEFFERSON COUNTY 9 1 1 NUMBER REFUND DATE I S
PLANNING &:ROC DEPT .,7
BUILDING OFFICIAL dll
APPROVED
AUG 2 4 99e9
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.IEFfERSON COUNTY
PLANNING&SLOG DEP'
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