Loading...
HomeMy WebLinkAboutBLD1989-00438 •LDING 'ERMIT APPLICATION • Jefferson County Building Departm6nt•P .O . Box 1220SPort Townsend' WA 98368 1 N J • LOCATISPECIFIC O LOCATION SITE ADDRESS MMAR "t MINIM � _` ' POSTAL DISTRICT . _ /SUBDIVISION )1 fW L !,lC ir(Lt)Q LEGAL DESCRIPTION LOT 1 BLOCK DIVISION TAX NUMBER PARCEL NUM ER_ Do. �4-' 0 1 / 4 SECTION PLANNING AREA SECTION TOWNSHIP NORTH RANGE 64_)„_WM BUILDING INFORMATION BUILDING TYPE TYP OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR ❑ MOBILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME 0 ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES r�5 ❑ COMMERCIAL SIZE @ $35 ❑ INDUSTRIAL YEAR q`) $ 16 ❑ HOTEL/MOTEL/DORMITORY MAKE �j 0 @ $8 4D,3--`C (NUMBER OF UNITS 111 OTHER - SPECIFY ESTIMATED COST OF 0 Ci) $8 "-kr . IMPROVEMENTS UBC OCCUPANC GROUP TOTAL FAIR MARKET VALUE $ $� SELECTED CHARACTERISTICS OF BUILDING `------ PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL g.iOOD FRAME 0 ELECTRICITY 0 COLLECT .af SOLAR %. ,) 0 MANUFACTURED 0 WOODSTOVE ❑ IVE SOLAR ❑ STRUCTURAL STEEL 0 GAS ❑ COAL 0 REINFORCED CONCRETE ❑_9 ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA ) DEPARTMENTAL REVIEW HE HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS �y �1 n/ 0 PUB L 1 C OR PR 1 VAT E NUMBER OF EXIST 1 NG BEDROOMS /(� -'f'f 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM A ROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM___ PUD TYPE OF WATER SUPPLY O PUBLIC "( NAME OF WATER SUPPLY) APPROVED DATE �RIVATE ( NAME OF WATER SUPPLY J) PLANNING DEPT . WITHIN SHORELINE JURISDICTION O 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 ------- ZIP TEL NO NAME ��('�`� MAILING ADDREE'SS -924 OWNER - ��_��)`R�--F; A� f D Y ` (//{/,,,�y. -G(`�J 1✓ 1 ` ' • ,a4) 4�'�`6 i J •� � /1�1 M� �l 4. a 1 CONT ._t, l .0 (/1 V oC f ), 1 w� �•, -P.A4SL yaii; ..A ji..L,... rm mei .0 ARCH QLS THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. SIGNATURE OF APPLICANT /�1 1) 1ATEIR4 I CHECK K NUMBER CASH APP � " PERMIT FEES 2 -D O BASE FEE INSPECTION 4 .-) � BLDG SURCHARGE PLAN CHECK f 23lin ENERGY SURCHARGE ��/ TOTAL , ^-iRSOK.E 1e 1� REFUND DATE DATE 1 SSVED �����,��gt�G©EP? �{ 9 1 1 NUMBER BUILDING OFFICIAL , ♦ 0 / / I► / E,� s- 0 %'a"3 k or, , ‘%ki o �C Re' , /- k 1 ..s:,.,• ''''.1,e,,,. *--s....—.„......„......„.... / / c. 3 l t„ 7/ T /,.,--"( / k) O / i P. / / / ' % fir ` / Ii I b, 11 / 'b o I o ' . k / tr ‘.) 7 . o 4 l Ai 1 r e 4 / C .;‘)1 / / to ; / ..... / ket o '' i y / 'e. I o CT) \ .:11 G (11 11 z.s r t ' \ \,‘", ., \ APPROVED FEB 2 s j 6- man Pt 811061,107 = e, , - AVV- 3( 1 0 ladik 31 6-141— 1 9 5' 1 to CD)C.-