HomeMy WebLinkAboutBLD1989-00499I ,:.
BODING 'HUT APPLICATION 411
Jefferson County Building DepartmentvP .O . Box 1220sPort Townsend, WA 98363
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SPECIFIC LOCATION SITE ADDRESS
5;-
POSTAL DISTRICT /SUBDIVISION ----
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBE1 /90 o.„ :0 1 / 4 SECTION
PLANNING AREA SECTION / TOWNSHIP 4:4) 4 NORTH RANGE WM
BUILD G INFORMATION
BUI DING TYPE TYP F IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY LEw BUILDING MAIN FLOOR q
0 MODILE HOME 0 ADDITION 2ND FLOOR • —
0 MODULAR HOME 0 ALTERATION BASEMENT ..1
0 DETACHED/ATTACHED 0 REPAIR CARPORT _____
GARAGE 0 REPLACEMENT GARAGE ."---
0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL .
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
---- M HOMES
0 COMMERCIAL MOBILE
/ a $35
SIZE
0 INDUSTRIAL
YEAR / @ $ I 6 )
0 HOTEL/MOTEL/DORMITORY _
MAKE . . A @ 9/4, 3 /C)
NUMBER OF UNITS
0 OTHER - SPECIFY
AO @ $8 -710 70
ESTIWp#4D COST OF
IMP
UB PANCY GROU VEMENTS _1 ;0T 1KARKET VALUE
C OCCU <77., $
-1-4----
----
C,N SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRIf IPLE TYPE OF HEATING FUEL
... .4 OOD FRAME E TRICITY D COLLECTIVE SOLAR
0 MANUFACTURED OODSTOVE D PASSIVE SOLAR
(() 0 STRUCTURAL STEEL 0 GAS 0 COAL.
N.) 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
,
0 MASONRY ( WALL BEARING ) , --- /
DIMENSIONS
a 0 OTHER -
NUMBER OF STOR I ES c---- TOTAL LAND AI.
67* . -------
t,0 , DEPARTMENTAL REVIEW •
---
Cr HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED PEORCOM
(480,71‘ ;,.fa, a1... ic OR PRIVATE NUMBER OF EXISTIN%.7, BEDROOMS
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHDO?APPROVED DATE
D INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
_77 PUB TYP OF WATER SUPPLY
UBLIC ( NAME OF WATER SUPPLY
-.. . APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WIT N SHORELINE JURISDICTION
ES NAME QWDJACENr- TER BODY,'
0 NO
/ 7
APPROVED DATE BANK HEIGHT_c22______ SETBACK .39
T.IAMV.tgopmfWen....mell.....*101.5..1.8%men.monAveMnaaliVesi..1•MffmarrypernMia,n,rc ,....nmnpMftrAw
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
-- ---- .
NAME OF PRIVATE ROAD
--.
40 APPROVED DATE
ROAD ACCESS PERMIT REQUIRED D YES 0 NO
IDENTIFICATION
—
NAME MAILING ADDRESS • ZIP TEL NO
\j — —...........
OWNER VI ,
-, Tx)(Q4 Ca.j (4,/d7-77577-atif,
CONT ha Ao 4L-N1 0(9 I
. . . •. • --
, .: 7_,
a IL- _ 410v, • ‘.. 0— 1
ARCH
if
......— I —
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
,..............w
SIGNA WIE, •F APPLICANT /) APPL CATION DATE RE E T NUMBER CHECK NU”BER OR CASH
—
APPROVA. AY PE-MIt FEES
AP • RP
.....—a1). c.
BASE FEE
— INSPECTION
JU, 840NWIR
ink ,*----- ---BLDG SURCHARGE PLAN CHECK
PLANNINGB , CL_C,
JEFFERSO COUNTY
— ENERGY SURCHARGE $ &Ca C-7
& LDG OEN
TOTAL.
W 911 NUMBERnEruND DATE I or a SiaMO..141.41.,WAPOMBOO.PMON
DUILDING OFFICIAL ,_,_. 1 7 (,-.,
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