HomeMy WebLinkAboutBLD1989-00419 4IpUILDING ERMIT APPLICATION
Jefferson County Building Department•P .O . Box 121 •Port Townsend . WA 98368,
I LOCATION �{ •
SPECIFIC LOCATION SITE ADDRESS )0 �(,)I PPn a/A ) t/,, `- `
POSTAL DISTRICT / /SUBDIVISION
LEGAL DESCRIPTION LOT ' BLOCK (D I V I S Or
TAX NUMBER
PARCEL NUM ER � I
a h)! yc ( 1 / 4 SECT I ON
PLANNING AREA
SECT I ON TOWNSH I P 3 LJ NORTH RANGE C.X.. LIU WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING
MAIN FLOOR
0 MOBILE HOME ❑ ADDITION 2ND FLOOR
0-- 0 MODULAR HOME ❑ ALTERATION BASEMENT
c() ❑ DETACHED/ATTACHED ❑ REPAIR
CARPORT
Cr' GARAGE ❑ REPLACEMENT IGARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ' COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE � @ $35
❑ INDUSTRIAL
YEAR VI @ $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE w $8
'NUMBER OF UNITS
NIkO E SPECIFY 0 @ $8
ESTIMATED COST OF
^
ei iL�.0 I MPROV (�NTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY OUP
(�� _ $ 3a $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
�' ❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
'E 0 STRUCTURAL STEEL ❑ GAS -' 0 COAL
❑ REINFORCED CONCRETE ❑' �I1- 0 OTHER - SPECIFY
( ❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
.'. DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS------
,.,,,,-
O PUB L I C OR PR I VAT E NUMBER OF EXISTINY3 BEDROOMS
❑ 1 ND I V I DUAL ( SEPT I C ) NUMBER OF PROI- , ED'BATHROOM
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY : ""
❑ PUBL I C ( NAME OF WATER,,,.S-t1"PPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF .W-A ER SUPPLY ,
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
0,, NO
APPROVED DATE r 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
'•
Jill., c �f� T .-�y/� �,c 7
OWNER .\rr '" � �VC.°i r, ~! �.3 C) �',� a w
rc
CONT `� �
' .i STA E 33 TI CENSEl Na
CI
ARCH
,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF APPLICANT A L C i DATE RECEI P,T UMBER CHECK NUMBER OR CASH
I
APPROVED D PER(MII,T// ,,FEES
A P(�� (,11� ) BASE FEE INSPECTION
0 ( 3 176 ( /5 BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE TOTAL
G' 7 G,
PLANNING &BLDG DEPT $,, } // ✓�)
911 NUMBER REFUND DATE i f`-(//DAT/S E_00
BUILDING OFFICIAL 4
• •
-� zy FEI�SON COT_71\7TY
CE�T�T2 F=CATE OF
OCCUPANCY
OWNER: WALKER, FRED
703 JOHNS ROAD EAST, PARKLAND, NA
LEGAL DESCRIPTION AND ADDRESS
LOT 25, BLOCK 14, S13, T3ON, R2W
PARCEL 939601424
AREA APPROVED: SF RES I DENCE
AREA APPROVED COMPLIES WITH REQUIREMENTS
OF UBC FOR GROUP R DIVISION 3 OF
OCCUPANCY.
THIS AREA APPROVEWD FOR USE AS CLASSIFIED
ABOVE.
BUILDIN C DATE
1/3/89
MICHAEL AJAX
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