HomeMy WebLinkAboutBLD1989-00545 LAVING 'ERMIT APPLICATION 0
Jefferson County 9 eP Building D artment'P .O . Box 1220'Port Townsend. WA 98368
LOCATION yy / `, i
SPECIFIC LOCATION SITE ADDRESS [.?,'i r CQ
L.
POSTAL DISTRICT, /SUBDIVISION
LEGAL DESCRIPTION LOT• —/O BLOCK' (W DIVISION TAX NUMBER
L N PARCEL. B )( il&C 1 / 4 SECTION
PLANNING AREA _ _-, SECTION 3 f TOWNSHIP
(!�G� -- �OWNSH I P NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT / SQUARE FOOTAGE
❑2SINGLE FAMILY ❑ NEW BUILDING . MAIN FLOOR
a MOP, ILE HOME 0 ADDITION ,/ 2ND FLOOR �%'
❑ MODULAR HOME ❑ ALTER TION/ BASEMENT ✓
❑ DETACHED/ATTACHED ❑ REPAIR/ CARPORT /�
GARAGE 0 REPLlkcEMEUT GARAGE //.
❑ WOODSTOVE ❑ WRECK I I1G/UEMOL I T I ON ' COMMERCIAL
❑ MULTI - FAMILY 2ELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS_V) T,�
0 COMMERCIAL MOBILE k HO/MES__.. {, $3 5
SIZE d 0 h. 5i Z_._' ,�..__KJ
T ❑ INDUSTRIAL
YEAR /F61C �S r,/ p� $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE �_T K-1 @ $8
! NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF - 0 @ $8
rJ IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROV L� $ �!5
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
,,MANUFACTURED 'WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS [] COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
fV/ 0 MASONRY ( WALL BEARING ) DIMENSIONS
S ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
CC DEPARTMENTAL REVIEW -^
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMFlER OF PROPOSED BEDROOMS
❑ PUBLIC OR F'R I VATE NUTABFR OF EXISTING BEDROOMS
i I IRO I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY 'ff'`�
" ' PUBLIC ( NAME OF WATER SUPPLY) i_�^ 'L
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY)
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PLANNING DEPT . WITHIN SHORELINE .,URISDICTION
} ❑ YES NAME OF ADJACENT WATER BODY
l// ❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS F'T: RMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION a —
NAME
�..j/ MAILING ADDRESS ZIP
l TEL NO
f_
O /� C
WNER j�11 L Lr4 � ( t !6X, 7 I a--... .l/ .J'? ( ..' S- /
CONT
-5 TA r 1""L'T'ttirs—r" No I
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
-----;S ,! TG{RE O "se1P L,1 CANT APIsL I AT I O ,C ATE RECEIPT NUMB R CHECK NUMBER OR CASH
APPROVED BY PERMIT FEES CO
/SThi BASE FEE INSPECTION
i. STBLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE .$ 7( S� TOTAL
9 1 1 NUMBER REFUND
°9( /� 1 DATE
O 7 !3�ED
1
BUILDING OFFICIAL AO
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