HomeMy WebLinkAboutBLD1989-00494 BIDDING 'ERMIT APPLICATION 0
Jefferson County Building Department*P .O .' Box 1220.Port Townsend. WA 98368•
LOCATION ` /� -
SPECIFIC LOCATION SITE ADDRESS A/GX/1P4/� ,7 4 A",ei 'Iio ,`.,./SL
POSTAL DISTRICT R /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 9551 670 Z 2 O/ 1 / 4 SECTION
PLANNING AREA SECTION 2 TOWNSHIP ..2 NORTH RANGE 2 L4€S1 WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOEIILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME j ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
rGARAGE 0 REPLACEMENT 1GARAGE
3WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
`t MULTI - FAMILY ❑ RELOCATION/MOVING IINDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE @ $35
❑ INDUSTRIAL YEAR ] @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $8
NUMBER OF UNITS
❑ OTHER SPECIFY ESTIMATED COST OF a $8
-,� IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUPrr/'/ $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAhIS PRINCIPLE TYPE OF HEATING FUEL
J
❑ WOOD FRAME ,„,„./ ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
E;"""' ❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE 0
OIL _---- 0 OTHER - SPECIFY
I� MASONRY ( WALL BEARING ) p LENS I ONS
-4..,,, 0 OTHER - , NUMBER OF STORIES TOTAL LAND AREA
;_ DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
`�_ 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
k ❑ PUBLIC ( NAME OF WATER SUPPLY)
�'{' APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑..NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
ti`
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0
NO
IDENTIFICATION
..----- • ZIP T E L NO
NAME �j. MAILING ADDRESS
OWNER
A6. e 0,t7 e SA A igh 4 . -2/e.*L.<A y re ds./' Ziie.")- v0/// VA sh Fey 20 79-G-'y9.,f /
CONT
S1X1E LIGINbE NO I
ARCH
1 I I
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIG TURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER Oik'-`0' 1
R
APPR tYE PERMIT FEES
IY;i 2 s:— BASE FEE INSPECTION
A P 3 S� BLDG SURCHARGE PLAN CHECK
f -7
M R.. �9�9 ENERGY SURCHARGE
.� TOTAL
JEfFERSON COUNTY
I' 911 NUMBER REFUND DATE DAT ISSU D
PLANN1Nu �HlOu DEPT � � /�
BUILDING OFFICIAL
- n
4
APPROVED
MAR 6 1989 /1.5-'9'r pze,„..... /-7-e4p.t
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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