HomeMy WebLinkAboutBLD1989-00490 iAlex RAN�. BUILDING PERMIT APPLICATION -T"} I -t- \'
Jefferson County Building Department*P . O . Box 1220*Port Townsend, WA 98368
LOCATION i-+. L &i Loc,L) - -�'I Vier a ��r V- I1_a.�e, - ,Ni Ile 14
SPECIFIC LOCATION SITE ADDRESS_ �� ! - - ��+/j �
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POSTAL DISTRICT /SUBDIVISION VW fir11r{`)nr Vl I e
LEGAL DESCRIPTION LO1J BLOCK DIVISION TAX NUMBER
PARCEL NUMBER R aII7 - 1 / 4 SECTION
PLANNING AREA SECTION /7 TOWNSHIP c2t g NORTH RANGE / WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY KNEW BUILDING MAIN FLOOR , 91, 5.)
❑ MOrI i LE HOME ❑ ADDITION 2ND FLOOR 9-11-.5'Q
❑ MODULAR HOME ❑ ALTERATION BASEMENT �--"
g DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE R40.
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL .........
NUMBER OF UNITS 2
❑ COMMERCIAL MOBILE HOMES
SIZE �3�1 •� � a�. $95 Rr�'P�' /�/� `. J
❑ INDUSTRIAL C�-1i '@ $ 1 s !J 9 . n
• HOTEL/MOTEL/DORMITORY YEAR rrff
MAKE K, @ $
NUMBER OF UNITS L (n
❑ OTHER - SPEC I FY EST i MATED COST OF Via f0 @ $8 "� i i/, DO µ
IMPROVEMENTS j01T�� m �(r1f RKET VALUE
UBC OCCUPANCY GROUP�� , � �l ��y
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
XWOOD FRAME IX ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL 7PIrO eIezoP-colecf
❑ REINFORCED CONCRETE U OIL N OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES 2, TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS III
NI A
PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ I ND I V I DUAL ( SEP'T IC NUMBER OF PROPOSED BATHROOM 40)
APPROVE DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING QA"TIU2GNJr1
UPILIMOOr
PUB TYPE OF WATER SUPPLY L.t)' I '�._) -
X PUBLIC ' ( NAME OF WATER SUPPLY) LAT: L0 w aQ.k
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEFT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
xNO
APPROVED DATE BANK HEIGHT SETBACK
— '..J
PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH OO
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO ____
IDENTIFICATION
NAME MAILING" ADDRESS Zip TEL NO ��/
.179 - ems. (n°M _a rr lSn 13atf fa S- 'i -
)+ ' t---tan(Ou} J. (0 37-. /
CONT 4
* 12q_
ARCH
fHE OSNER • THIS [WILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LA►rS.
or
SIGMA OF A T APPLI ATIOY ATE 1 RECEIPT NUMBER I CHECK NUMBER OR CASH
D BY P. Rf.�IT FEES
Aoll
BASE FEE INSPECTION
'UG 2 2 198g BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY /� I ENERGY SURCHARGE 6+g-.D TOTAL
PLANNING&SLOG DEPT $
91 I NUMBER REI,UrlD DATE E E. _ 40
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