HomeMy WebLinkAboutBLD1989-00495 (BUILD• PERMIT APPLICATION
Jefferson County Building Department*P .O . Rox 12200Port Townsend . WA 98368
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LOCATION
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SPECIFIC LOCATION SITE ADDRESS -Li C�
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POSTAL D I STR I CT_ /SUBD�/I S I ON
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER (igt OOa '/ 1 1 / 4 SECTION
PLANNING AREA SECTION (� TOWNSH I Pof ,,s_NORTH RANGE!/U WM
BUILDING INFORMATION CC
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
O MOGi1LE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
c '. 0 DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
N f WOODSTOVE ❑ WRECKING/DEMOLITION COMME" IAL
LJ ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE ^": e�i $ b "----
\. 0 INDUSTRIAL YEAR @ $ 16
❑ HOTEL/MOTEL/DORMITORY NUMBER OF UNITS MAKE VJ @ $8
❑ OTHER - SPECIFY ESTIMATE ► COST OF 0 c1t $8
IMPRO MENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTI S OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
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❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECT-I-VE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE _L-I-- SSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
O REINFORCED CONCRETE ' IL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BE G ) DIMENSIONS
( ❑ OTHER NUMBER OF STORIES TOTAL LAND AREA
ARTMENTAL REVIEW
-"— HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS '
ty4-s ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING B.F—ROOMS
_ ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROFOSID B.A RO THOM�
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER O -EXISTING BATHROOM
PupTYPE OF WATER SUPPLY /
❑ PUBLIC ( NAME OF WATE --°'SUPPLY)
2 APPROVED DATE ❑ PRIVATE ( NAME OF ATER SUPPLY -
PLANNING DEPT . WITHIN SHOREL JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
I ❑ N /
`✓ APPROVED DATE ..---"-BANK HEIGHT SETBACK
PUBLIC WORKS • -T ROAD RIGHT-OF -WAY WIDTH
^l NAME OF PUBLIC ROAD
�` NAME OF PRIVATE ROAD
APP.; 4VED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
DENTIFICATION
NAME , MAI
LING ADD ESS Z
I P ' TEL/ NO
OWNER J /1 1 20v1
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CONT ,_„
STATE L (CENSL NU
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ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED/CA/g,ATE
AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S I GN1 ,RE OF APPL I T APP RECEAPT ER CHECK?UMBER
OR CASH ,
Lam/ -, 2✓')/(E����`J
APPRO ED 1Q% PERMIT FEE
A7a,, 0Q ASE FEE INSPECTION
1 1989
3 _<`a-7 _4LDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE $SIT ,(23-0 TOTAL
PLANNING&BLDG DEPT
911 NUMBER REFUND DATE DATE
BUILDING OFFICIAL l; '
APPP, OVED
MAY I 1919 /3-3-2 1P-er)Aft if.e"
JEfi i•J':.:.)ijw COUNTY
RAMOS&MG DEFT
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