HomeMy WebLinkAboutBLD1989-00444 •JILDING ERMIT APPLICATIO•
efferson County Building Department•P .O . •Box 1220"Port Townsend. WA 98368
•LOCATION
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SPECIFIC LOCATION SITE ADDRESS - 1 "`-�--``.� ���YL �'� . ✓�_
POSTAL DISTRICT/SUBDIVISION �
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER /p
PARCEL N,,U---MBE 0 C7, ' 1 / 4 SECTION _
PLANNING ARE.�1 SECTION ` TOWNSHIP NORTH RANGE . WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
/
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR .,,'"
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT //
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
"ARAGE ❑ REPLACEMENT GARAGE//
'""'ilik WOODSTOVE ❑ WRECKING/DEMOLITION ICOMMERCIAL
❑ LTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL 0 @ $35
SIZE �' r�
❑ INDUSTRIAL YEAR Vr{,, p� $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE !, UJ@ $6
NUMBER OF UNITS �i-
❑ OTHER SPECIFY ESTIMATEDFfCOST OF 0 a@ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
.
SELECTED CHARACTERISTJCS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
Cs 0 STRUCTURAL STEEL ❑ GAS 0 COAL
�►'6..J 0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
V 0 MASONRY ( WALL BEARING ) DIMENSIONS
...D... t ❑ OTHER - , NUMBER OF STORIES TOTA LAND AREA
DEPARTMENTAL REVIEW
r `"' HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBEJYOF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BPTHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF`'WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
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APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
\ V APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
f�'vJ0 T NAME MAILING ADDRESS ZIP TEL NO
'ic 1 OWNER -3 T) 1C_-. 2)1. i t Ci
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64,77,
CONT
S I ATE LTC1`IISE, NO I .....
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
4.72rE747/7LICANT AP ,LAAT _,. tIfTE IREC ci��,NUMB R 1CHECK ramp OR CASH
' APPROVED BY PERM I' F ES(/ (/
BASE FEE INSPECTION
AP V E D `
�, ? .'BLDG SURCHARGE PLAN CHECK
r°-
A Z B 1989 ENERGY SURCHARGE $, ,57 /; TOTAL
1€fk HSf1N f,C1yNT16 9 1 1 NUMBER REFUND DATE DAT I
Pl.9M!ftJt,eo PIRG UP1 . ,
BUILDING OFFICIAL I
APPROVED \
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MAR 2 8 1989 ......,,"-
JEFFERSON COUNTY
PLANNING&BLDG OEPT
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