HomeMy WebLinkAboutBLD1989-00539 fBUILDII'`'ERMIT APPLICATION
Jefferson County Building Department*P .O . Box 1220.Port 1jwnsend . WA 98368'
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LOCATION '3 +•✓
SPEC 1 F I C LOCAT ION SITE ADDRESS 4�5 l `1f,•- '✓, , .) / 6
POSTAL DISTRICT „; /SUBDIVISION .,/L..40-,* 4"t'.•,d wr
LEGAL DESCRIPTION LO'r LOCK DIVISION TAX NUMBER
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,' 3 / 90 0 O / / PARCEL NUM,B E R.4' '744,-7T20-/ 1 / a SECTION ,,,...;. .. wf'
7 N, a .;� WM
PLANNING AREA SECTION / (, TOWNSHIP NORTH RANGE
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
"'m+—
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT "" (1 „,,, 4,),e)
r,
GARAGE ❑ REPLACEMENT GARAGE 3 7
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES /
❑ COMMERCIAL SIZE $3 5 (. ./ 0'0
❑ INDUSTRIAL
r ❑ HOTEL/MOTEL/DORMITORY YEAR
MAKE .5�7 A $8 6
0-96
/
NUMBER OF UNITS i1
❑ OTHER SPECIFY ESTIMATED COST OF ���0 ICJ$8 �J
/"! IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU $ $_„�,.„,,,.-„„,,;,„A,_ .-..
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
®''WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
s''l ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER SPECIFY _ _�❑ MASONRY ( WALL BEARING ) DIMENSIONS 42/ T-11
,
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BE_D(ZCKNAS
❑'"'PURL I C OR PR I VATE NUMBER OF EXISTI NG BEDROOMS ! /
��I ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED RATHROO „�✓/
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM „q,
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY ,)R-
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
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PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH -7, ✓
NAME OF PUBLIC ROAD ,----
NAME NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES NO
IDENTIFICATION
NAME MAILING ADDRESS AA ZIP TEL NO
OWNER
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CONT --_ ..
STATE LICENSE NO
ARCH
THE OWNER OF HIS BUILDI .G AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
AT
S I GNAT Ei NT APPL1 CI O TE RECE,�„B�7 <U BER i
CHEC _NtER OR CASHAPP'�OV=D �' PERM( /F`EES
/4
• `✓0 BASE FEE INSPECTION
As P P R 0
E ' + 0 BLDG SURCHARGE PLAN CHECK
APR 2 5 1989 ENERGY SURCHARGE
ram TOTAL
JEFFERSON COUNTY /0 t / REFUND DATE DA E 1 S U D
PLANNING&BLDG DEPTd f 1 NUMBER i fJ
BUILDING OFFICIAL
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