HomeMy WebLinkAboutBLD1989-00483 2 DING`i'ERMIT APPLICATION 0
Jefferson County Building Department•P .9. Box 1220'Port Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT / UB I I S I ON --
LEGAL DESCRIPTION LOT �-�—^ BLOCK DIVISION TAX NUMBER
�,. PARCEL NUMBER ! 7_ > / ^� 1 / 4 SECTION
PLANNING AREA SECTION 5 TOWNSHIP -', (J NORTH RANGE / 6= WM
BUILDING INFORMATION
'., BUILDING TYPE T, PE OF IMPROVEMENT SQUARE FOOTAGE
'.. , ❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR
❑ MOIIILE HOME ❑ ADDITION 2ND FLOOR
❑ MOD ir HOME 0 ALTERATION SEMENT
DETACH 'D/ATTACHED 0 REPAIR 1 l
GARAGE C� �o 0 REPLACEMENT ()Cr �U 64-4
z- ❑ WOODSTOVE-� ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS M
❑ COMMERCIAL MOBILE HOMES @ $35 / U
SIZE
/ � (J
❑ INDUSTRIAL n
YEAR q1 $ 16 �/
❑ HOTEL/MOTEL/DORMITORY MAKE 0 q� $g
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 a@ $8
/�- IMPROVEMENTS AI
UBC OCCUPANCY GROUP / / $ $
SELECTED CHARACTERISTICS OF BUILDING
CO PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0
6 WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
Z MANUFACTURED ) ❑` WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL
AS 0 COAL
❑ REINFORCED CONCRETE ���///❑'''O```IL 0 OTHER - SPECIFY •
Q0 MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
(5 HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS
0 PUB I C OR PRIVATE NUMBER OF EXISTING BED'•'•
lam-' ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOS- % BATHROOM
APPROVED DATE
0 I ND I V I D UA L WELL NUMBER OF T I NG BATHROOM
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER S - 'LY)
APPROVED DATE 0 PRIVATE ( NAME OF W . ER SUPPLY
asmwzlsaewrwrawet=xmagemwas
�- , PLANNING DEPT . WITHIN SHORELI - JURISDICTION
0 YES NAM •F ADJACENT WATER BODY
ti 0
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WOR DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
• PPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME , ` MAILING// / ADDRESS ZIP TEL NO
OWNER70.ale
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ARCH
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THE OWNER OF THIS = ILDI G AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.,, ,
SIG G R _ OF�PP;/1 'T / / A 1 ATE I3 / 23
1PT UjBER CHECK NUMBER OR CASH
1/% I !
APP- • D BY PERMITL \FEES
A P :" (. Q)f BASE FEE INSPECTION
oa ` BLDG SURCHARGE PLAN CHECK
MAY E D 3 �d 1UNT • ENERGY SURCHARGE Sc R i
PtANNING DN&BLDG �
TOTAL
JE DEPT 8 1 1 NUMBERREFUNDREUND DATE DATE ISSUED
fNG
BUILDING OFFICIAL
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APPROVED
MAY 30
JEFFERSON COUNTY
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