HomeMy WebLinkAboutBLD1989-00542 410U1LDING rTRMIT APPLICATIOA
Jefferson County Building Department-P .O . Box 127F-Port Townsend, WA 98368
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LOCATJON
SPECIFIC LOCATION SITE ADDRESS /TE-.1 PCIA164
,,..,___ ,., _.:4,,,,,
POSTAL DISTRICT /SUBDIVISION Fl
LEGAL DESCRIPTION LOT I -.1- -... BLOCK DIVISION TAX NUMBER
LI , PARCEL Ny ER_ 1 / 4 SECTION
PLANNING AREA_ SECTION TOWNSHIP r2 NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
DikDETACHEOATTACHED 0 REPAIR CARPORT
GARAGE .5Che --c:g OM REPLACEMENT GANAGE 9 5
O WOODSTOVE 0 ECKING/DENOLITION COMMERCIAL 1
1
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
c\J NUMBER OF UNITS
MOBILE uomEs
0 COMMERCIAL $3s
N SIZE
O INDUSTRIAL
$ 16
kr , 0 HOTEL/MOTEL/DORMITORY
MAKE._ 5(3
NUMBER OF UNITS----
———
0 OTHER - SPECIFY $8
ESTIMATED , 'ST OF -----0 @
IMPROVEMENTS TOTAL MARKET VALUE
UBC OCCUPAICY1701 1
7 /3('
,__ — -----
- : —
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
cr. WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
CI MANUFACTURED 0 rOQDSTOVE 0 PASSIVE SOL
O STRUCTURAL STEEL 0 GAS 0 COAL ----
O REINFORCED CONCRETE 0 OIL ,...____O----OTHER - SPECIFY
O MASONRY ( WALL BEARING ) OWENS S
0 OTHER - NU 4n OF STORIES TOTAL LAND AREA
14Q DEPARTMENTAL REVIEW _ _ --- — —
-- --_—_—_--
HEALTH DEPARTMENT TYPE OF SEWAGE DISposAL r:i-UmBER OF pRopOsED BEDROCWIS,
O PUBLIC OR PRIVATE NUMBER OF EXISTING BED _MS
O INDIVIDUAL ( SEPTIC ) NrI*1BER OF PROPOS ATHROOM_
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF TING RotTHROGM
— — --- . -----,PUD TYPE OF 'ATER SUPPLY
U PUBLIC ( NAME OF WATER PPLY).
APPROVED DATE 0 PRIVATE ( NAME OF ATER SUPPLY)
PLANNING DEPT . WITHIN SHORE ,7, JURISDICTION
O YES N OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK_
PUBLIC WORKS DEPT ROAD RIGHT-or -WAY WIDTH
/- - NAME OF PUBLIC ROAD
NAME or PRIVATE ROAD --
--
APPROVED DATE ROAD ACCESS PERMIT REquIRED 0 YES 0 mo
.----'' --
IDENTIFICATION
---- ....
NAME MAILING ADD C: ZIP TEL NO
OWNER --C70 - S,S3-c-
/ rri '9g.214L
CONT '(----) -e
_
ARCH ^....'
THE OWNER or THIS BUILDING AND THE UNDERSIGNED AGREE TO comronm TO ALL APPLICABLE LAWS.
of APPLICANT APPL CATI A ATE R C- IPT w,p317._n cvmcK UMBT1OR CASH
. 4
- APP4OVED Y PERMIT FEES
APPR 1Ey 77,OD BASE FEE _ INSPECTION
,
h V 1 1 9u jp7
4,sD 13LDG SURCIWZGE — - PLAN CHECK
JEFFER VI ENERGY SURCHARGE $ I cZ,
TOTAL
PLANNING&SLOG OFP'
0. , fluT19ER -RErtmo DATE i DAT ISSUici
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BU I LD I NG OFF ICI AL * i I I
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)Z T $ I±---0- - ,��—►� 3 [ilikkt a v/
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AP .-fROVED
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941 6 1989
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