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HomeMy WebLinkAboutBLD1989-00435 faILDING ERMIT APPLICATION . . Jefferson County Building Departmentt,P .O . Box 1220/Port Townsend, WA 98368 — • r • '' . - 6ocATIoN ) , ..1.. V.C,7/t_ C4, /L---1 SPECIFIC LOCATION SITE ADDRESS POSTAL DISTRICT /SU 'VISION LEGAL DESCRIPTION LOT / BLOCK( _DIVISION TAX NUMBER /PARCEL NUMBER.' -7 CY I / 4 SECTION PLANNING AREA SECTION TOWNSHIP { ' NORTH RANGE /i/C.,./ WM BUILDING INFORMATION BUILDING TYPE TYPE,. OF IMPROVEMENT SQUARE FOOTAGE 0 SINGLE FAMILY QXEW BUILDING MAIN FLOOR C2 O MOBILE HOME 0 ADDITION 2ND FLOOR ,)( I 6 O MODULAR HOME 0 ALTERATION BASEMENT .,12;--'f ____- ---- /-- O DETACHED/ATTACHED 0 REPAIR ARPORT GARAGE 0 REFLACEMENT 1GARAGE ----- O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL ---------.--- -• NUMBER OF UNITS MOBILE HOMES , O COMMERCIAL - '' - -------,- _ O I NDUSTR I AL GO O HOTEL/MOTEL/DORMITORY --- -1- mAKE i @ $8 • "1.4'-.. •r- NUMBER OF UNITS , ---- Q3/0THER - SPECIFY FSTIM1YCOST OF UBC OCCWANCY GROUP !T S $ $ -- TO4*/*W .MARKET VALUE---------- -- -- SELECTED CHARACTERISTICS OF BUILDING ---- ---- _ PRINCIPLE TYPE OF HEATING FUEL ------ PRI,VCIPLE TYPE OF FRAME --- • WOOD FRAME 0 ELECTRICITY 0 COLLE .1-1--Vt SOLAR 4 -; 0 MANUFACTURED 0 WOODSTOVE A..)SIVE SOLAR - 0 STRUCTURAL STEEL 0 AS ,,,..-------- 0 COAL O REINFORCED CONCRETE 0 0 0 OTHER - SPECIFY '-:-: 0 MASONRY ( WALL BEARING ) DIMENSIO'RS O OTHER - ----- NUMB R ER OF STOIES _ TOTAL LAND AREA - n DEPARTMENTAL REVIEW • - HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BE 07UBLIC on PRIVATE NUMBER OF EXIST . BEDROOMS 4Y INDIVIDUAL ( SEPTIC ) NUMBER OFPRZ5IOSED BATHROOM _-- APPROVED DATE 0 INDIVIDUAL WELL OF EXISTING BATHROOM 1111110•10,1r a_ 13 PUD TYP OF WATER SUPPLY PUBLIC ( NAME OF WATER SUPPLY)._ -2- APPROVED DATE U PRIVATE ( NAME OF WATER SUPPLY) __ 4_„ _, CO PLANNING DEPT . WITHIN SHORELINE JURISDICTION 0 YES NAME OF ADJACENT WATER BODY . --- ----- U/K10 APPROVED DATE BANK HEIGNT SETBACK _-- - , PUBLIC WORKS DEPT ROAD nicnT-(7,- -wAy wIDT1-1 NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES n NO ----------- --- -- , IDENTIFICATION --- ---- NAME MAILING ADone S ZIP TEL NO mm.- -.....-- t 4 _ Y,_-). - 9 -cc- - OWNER . . / .7:-2'-- tr* --2•--). J ,c4,1,-\ , M 7 ____ - ___ co N T • - " - -1-1-7 rk: ET1:7-1.,7: :;J"T-T- -- ‘ 1 -- ------ -- - ARCH .--,, --- -,- ---— ----- ( I i * " ' ------ THE OWNER OF THII., 1,/,:r0ING AND THE umv-tnsicHr:o AG. 17:% TO CONFORM TO ALL APPLICABLE LAWS, %.7 SIG AT 6)0 ( . ) / • - -' m-- — --.---.---- APPLICATION DATTZ 7irlArT mimp7:n CH7K B OR CASH . /7/8 .45Q" RMIT r APPROVE PE74E's I FE B1%1777: FEENSPECT ION A p p 70Z- .. "P7--' ----- E LD:3, SURCHARGE PLAN CHECK _,, ----- i e7: ; -1 , 8,9 ....,___ ENEFZGY SURCHN1GE $ /42 C . TOTAL Pi 4PFERR AVivi -04tr NG 4 ,owur ill NimBrR RKFUND DATE 1 DAr DDED 806 ti BUILDING aICIAL 1 1 9' K? ........... 4 iii.MMMNMMMMMMMMMNMMMIMMMMIIIMMIIIIIIIMMIIIMNIIIIIMMIIIMIIIINIK. 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