HomeMy WebLinkAboutBLD1989-00484 13UILi? G erE; MIT APPLICATION A
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Jefferson County Building Departmeft*P :O , Box 1220*Port�iownsend. WA 98368
1 •
LOCATION
SPECIFIC LOCATION SITE ADDRESS , .. 5C> _t..,.c_ v``\ L'
POSTAL DISTRICT_IL /SUBDIVISION
LEGAL DESCRIPTION LOT ( BLOCK DIVISION TAX NUMBER
PARCEL NUMBER C178 YOo/2Y f 1 / 4 SECTION _
PLANNING AREA SECTION 7 TOWNSHIP "2e�1 NORTH RANGE I -=- WM
BUILDING INFORMATION
B ILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE ��
SINGLE FAMILY NEW BUILDING MAIN FLOOR
O MODILE HOME /0 ADDITION 2ND FLOOR 0 MODULAR HOME 0 ALTERATION BASEMENT / 'g((
O DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL SIZE t q� $3 5 is 5�IU
O INDUSTRIAL YEAR $ 1 6 1,_/0 HOTEL/MOTEL/DORMITORY MAKE 1/f' L/ VI @ $8 fy,752-
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL /FFAAIR MARKET VALUE
�Z-
UBC OCCUPANCY GROUP $ $'-�^----�-! ' 2
JC.J SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
Ny,WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
d 0 REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) , DIMENSIONS
1 ❑ OTHER -7 Z.c'•K 2 Y ,
(((��� NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
H LT DEPART (NTT TYPE OF SEWAGE VD AIDISPOSAL UTI N BRE OFPROPOSED BER DOOMS
1 ' ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
NUMBER
1 L INDIVIDUAL ( SEPTIC ) OF PROPOSED BATHROOM 02_,
A P OVED DATE I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
./ 0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY\
'‹) PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
Xf\ 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 ❑ NO
IDENTIFICATION
NAME MAILING ADDRESSA G/QQZIP TEL NO
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S'iA I E L I LENSE NO
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL (APPLICABLE LAWS.
S 1 GNATUR 'OF AP�1 CAN AF"P�fyA"T `� DATE ,RECEIPT NU/MBER CHECK NUMBER OR CASH
APPjO4ir • BY I PERMIT FEES
5-M5() BASE FEE INSPECTION
1 - BLDG SURCHARGE gam-66 C-
-S PLAN CHECK
�Ul g89 �� ENERGY SURCHARGE ` TOTAL
JEFFEIISON COUNTY \ _
PLANNING&BLOG DEPT 9 1 1 NUMBER REFUND DATE pA E6SS
BUILDING OFFICIAL 7'* i i f •
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