HomeMy WebLinkAboutBLD1989-00433 •UILDING . 'ERMIT APPLICATIO•
Jefferson County Building Departmeft+P .O . Box 1220.Port Townsend. WA 98368
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LOCATION // / ,
SPECIFIC LOCATION SITE ADDRESS /- �X 0 ) • F./-W k
POSTAL DISTRICT H /SUBDIVISI r CAM CO P
LEGAL DESCRIPTION LOT BLOCK i GDIVISION TAX NUMBER
PARCEL NUMBER C/10 st�S'7( I 1 / 4 SECTION
PLANNING AREA SECTION 31-1 TOWNSHIP 30 NORTH RANGE RC) WM
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 ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
_GARAGE ❑ REPLACEMENT GARAGE
WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
O COMMERCIAL SIZE @ $35
O INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $8
NUMBER OF UNITS
O OTHER SPECIFY ESTIMATED COST OF $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUr
'� $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
O REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
iNcf ❑ OTHER - NUMBER OF STORIES TOTAL, LAND AREA
4..0
DEPARTMENTAL REVIEW
14(
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS
O PUBL I C OR PR I VATS NUMBER OF EXISTING BEDROOMS
O 1 ND I V 1 DUAL ( SEPT i C ) NUMBER OF PROPOSED BATHROOM
i APPROVED DATE
❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
{ -' ❑ PUBLIC ( NAME OF WATER SUPPLY)
v APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
20 PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
Cf:i
❑ 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 0 NO
IDENTIFICATION
a^ NAME • +{ 1 MAILING ADDRESS- ZIP TEL NO
OWNER
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CONT
S'I'ATE LICENSE NO I
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIG TURE OF APPLICANT APPLICATIODATE RECEIPT NUMBER CHECK NUMBER OR CASH
1 ��/J 7/1 /Aa vL2 OS'/17789 137aci '/ �(/7
iCFP ED =Y / PERMIT FEES
A t < (N BASE FEE INSPECTION
3. ��J BLDG SURCHARGE PLAN CHECK
AY 1 ;67,747441111111 99 ENERGY SURCHARGE $
P ,213 TOTAL
Jt:Ff REFUND DATE DATA SS{U
Pl RNA N&B DG L�imj 9 1 1 NUMBER I
/ / �A
BUILDING OFFICIAL ,3 4,
ki-ArA/A-/-
MAY
JEER
It 6 Ott
A MEMBER OF THE SEARS FINANCIAL NETWORK 2313 E.SIMS WAY
PORT TO W N SE ND,WA 98368
COLDW«.l. BUS (206)385-4111
BANKER 0 RES.(206)385-4301
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FORREST ALDRICH, CINDY V.THAYER
INC.
A IC. Associate Broker
ItALNlWwn°L3
An Independently Owned and Operated Member of Coldwell Banker Assldential Affiliates Inc
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