HomeMy WebLinkAboutBLD1989-00486 ILDING`$,"ERMIT APPLICATION ill
Jefferson County Building DepartmenteP .O . Box 1220sPort Townsend. WA 98368
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LOCATION )-
SPECIFIC LOCATION SITE ADDRESS3� ..Iahn( k1ti� �AochD
POSTAL DISTRICT C.901C, /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER , / .3V2 O/3 1 / 4 SECTION
PLANNING AREA SECTION 37 TOWNSHIP Z"^i NORTH RANGE /ail/ WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY _❑ NEW BUILDING MAIN FLOOR
❑ MOIIILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME ;`-" ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES
SIZE @ $35
❑ INDUSTRIAL
YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE
0
NUMBER OF UNITS / $8
❑ OTHER - SPECIFY ESTIMATED COST OF W @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU, $ /( 0°6 $
� e SELECTED CHARACTERISTICS OF BUILDING
t = P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
("5"
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - Z 2- �11c _
NUMBER OF STORIES TOTAL LAND AREA 3,
C -er, DEPARTMENT L REVIEW
' ---- HEALTH DE ARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
Al
ra- p
O PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
--',3 APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
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 ❑ YES 0 NO
IDENTIFICATION
NAME •/��/[�. MAIL ! G ADDRESS ZIP T E L NO
OWNER -, ���5 ' 'k_ `^lrl, 73o U I
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CONT 14)L//7i` `✓ ,t50.-_ Po A'x //&6 26
E SYATe, LICENS NO
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE L WS.
'SDI GNATU APP C NT, �. APPLICATIONDATE L7 /ç2J
PT NUM CHE!gUMBER^ O CASH
PPROV PE T 3
PP VE ®
BASE FEE INSPECTION
MAY t8 BLDG SURCHARGE PLAN CHECK
PLANNING&81b NT Nil
\ - ENERGY SURCHARGE sap p �7 TOTAL
P7 v1
9 1 1 NUMBER REFUND DATE DAT> :t-..0
iv BUILDING OFFICIAL. •, ,
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JEFFERSON COUNTY
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