HomeMy WebLinkAboutBLD1989-00492 L3UIlONG 'ERMIT APPLICATION -pu x - PfnA/ /1 _I
Iefferson County Building Department'P .O . Box 122OePort Townsend. WA 98368
LOCAT 1 ON L/" ! f�/ ,/ fps! e/w'�.V.Ic�
SPECIFIC LOCATION SITE ADDRESS Soq-f f ■ ee Wa. D�TPU✓ ' o J ,,
POSTAL DISTRICT /SUBD I V I S IrOIN2-n ner' Rsoi v ilf.
LEGAL DESCRIPTION LOT /w BLOCK G DIVISION TAX NUMBERPARCEL NUMBER (? 2 '
/l7W-/.22,/ 1 / 4 SECTION
/
PLANNING AREA SECTION 7 TOWNSHIP a a- NORTH RANGE / E- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ,.. ., ��
❑ SINGLE FAMILY ANEW BUILDING MAIN FLOOR 3 �T
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR 971-` 0
❑ MODULAR HOME ❑ ALTERATION BASEMENT
% DETACHED/ATTACHED 0 REPAIR CARPORT r - 5--"9 c�
GARAGE 0 REPLACEMENT GARAGE (S O 0
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
p( MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES s�
❑ COMMERCIAL SIZE „ .3f''5�VJJ/i a $3 5 'R3�q/./.50 F
❑ INDUSTRIAL YEAR 77J i S 1 6 I )1D7r '+0Q K
O HOTEL/MOTEL/DORMITORY MAKE KI a7 $8
NUMBER OF UNITS / "'
$
❑ OTHER - SPECIFY ESTIMATED COST OF ___ @ $8 YP 'c2/00
UBC OCCUPANCY GROUP �i IMPROVEMENTS TOT/j,(rLFA Ij ¢� n VALUE
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
X WOOD FRAME kvf ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE Z.----
0❑ STRUCTURAL STEEL 0 GAS ❑ COAL zero Olt lif i
❑ REINFORCED CONCRETE 0 OIL X( OTHER - SPECIFY --arrive
O MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 'AIL
xV X PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
/Y ❑ i ND 1 V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM 6
APPROVE ATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM,
PUD TYPE OF WATER SUPPLY � /))
KPUBLIC NAME OF WATER SUPPLY ��WW ( g '
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
i.a.rsw.wc�ses ..........
PLANNING DEPT . WITHIN SHORELINE JURISDICTION Y
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED DATE BANK HEIGHT SETBACK \3
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH `�
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NONa
IDENTIFICATION 1\
NAME MAILING ADDRESS ZIP TEL NO
OWNER pore &,s,
nuraS CO AA ParS e Bal Rd, • ScrVc -
3105� 37/a/
�?4-. L!� �C.ni eta Q 98 `�
CONT S(OW., -
7C 1r E T7 S E D r
try
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S I GN/,•TORE` OF�PPI,- AN APP IC T 1 ON DATE RECEIPT N BER CF ECK UMBEROFI,
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APP• • •�. P R ITT/;FEES
A . . ,e ,F `7 �1� BASE FEE INSPECTION
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U 1$' ',SZ BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY /S ,U ENERGY SURCHARGE $639fS i S7T TOTAL
PL.4NN1Nf.&BLDG DEPT r� �,-`�` �P
!/ J �U 9 1 1 NUMBER REFUND DATE 1 DATE�I SLUED
BUILDING OFFICIAL 7I%
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JEFFERSON COUNTY
PLANNING&SLOG DEPT
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