HomeMy WebLinkAboutBLD1989-00496 (3•DINGERMIT .APPLICATION •
Jefferson County Building Department•P .O . Box 1220iPort Townsend. WA 98368
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LOCATION }'ICC GC/t_
SPECIFIC LOCATION SITE ADDRESS 1(e-k>'l Sy-v-cc'1- f ). ,�,,n�
POSTAL DISTRICT /SUBDIVISIONC .Pl.QL%h
LEGAL DESCRIPTION LOT BLOCK 1 I ION . TAX NUMBER
el PARCEL NUMBER 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE_, WM
BUILDING INFORMATION ��'"`
B ILDING TYPE
SINGLE FAMILY
TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ NEW BUILDING MAIN FLOOR
❑ MOnILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED g REPAIR a CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ICOmMER_Q1AL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES , '
❑ COMMERCIAL ��] $35
SIZE❑ INDUSTRIAL {YEAR $ 16
O HOTEL/MOTEL/DORMITORY MAKE A @ $8
NUMBER OF UNITS
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
9clef. C,vkr�.tx.;.IS IMPROVEMENTS
UBC OCCUPANCY GROUP $ �/ QOU. b-e) $OTAL FAIR MARKET VALUE
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
-WOOD FRAME gi, ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS ❑ COAL
O REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
O MASONRY ( WALL BEARING )(84 DIMENSIONS
O OTHER
NUMBER OF STORIES (/ TOTAL LAND AREA
1
f� DEPARTMENTAL REVIEW
�„ e) HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER'OF PROPOSED BEDROOMS
�✓ 0 PUBL 1 C OR PRIVATE NUMBER OF EXISTING BEDROOMyS-------
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED ROOM
P PROVE D DATE U(c�-_ . INDIVIDUAL WELL NUMBER OF EX NG BATHROOMS
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER S LY) _
_.S APPROVED DATE ❑ PRIVATE ( NAME OF W R SUPPLY mm+mre=6,nr+e=..wwenwniro
CO PLANNING DEPT . WITHIN SHORELINE -JURISDICTION
0 YES NAM ,,.O ADJACENT WATER BODY
0
APPROVED DATE o BANK HEIGHT SETBACK
PUBLIC WORKS„..B'EPT ROAD RIGHT-OF -WAY WIDTH
--- NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
/ PROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
-" IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER O�iLrt�OWYY�AA, -. J'S'S 3
y� % (�_—� 4 -.CONTt td E P✓ta$ ' +G'fi 6 /�%� l lL� _(�,�2Z1'•VPA/ ' D I
L 4-
ARCH
f . 4
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA URE 0 APPLIC.NT a APPLI ATI N DATE RECEIPT UMBER CHECK NUMBER OR CASH
7
. _,,---eD
A all PPR•� _' PERMIT FEES
;' jr V0 BASE FEE INSPECTION
MAY 19 illy S. S L BLDG SURCHARGE PLAN CHECK
JEEEERSp,J CCUNTY ' ENERGY SURCHARGE s )
MANMNG v� . ✓✓✓ TOTAL
&BLOG "
DEP
911 NUMBER REFUND DATE i OAT ISSUED
BUILDING OFFICIAL
V
APPR 0 V E
MAY I a 1989
JEFFERSON COUNTY
Pt AVOW'&SIOG DEPT
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