HomeMy WebLinkAboutBLD1989-00549 B'a DING 'ERMIT APPLICATION
Jefferson County Building DepartmentsP .O . Box 1220*Port Townsend . WA 98368
LOCATION 'y /� r
SPECIFIC LOCATION SITE ADDRESS r ?7 t (1 Cl ii (4.! ( _
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POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER CO
PARCEL NUMBER 70.Vr y/O/ — 1 / 4 SECTION 1
PLANNING AREA �` SECTION -( TOWNSHIP oC. / NORTH RANGES Lk ) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
/ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
`"'1❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL -----0 `� $35
SIZE
❑ INDUSTRIAL YEAR $ 16
� - ❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $8
NUMBER OF UNITS
0 OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
,r-M- IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
4 SELECTED CHARACTERISTICS OF BUILDING
KT-
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
(}-• 0 WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
`*--. 0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) DIMENSIONS
v 0 OTHER - NUMBER OF STORIES TOTA AND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC '( NAM,VOF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ) AME OF WATER SUPPLY _
PLANNING DEPT . WITHINORELINE JURISDICTION
❑ YES- NAME OF ADJACENT WATER BODY
NO
APPROVED DATE ,,, BANK HEIGHT SETBACK
PUBLIC WORK$''DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPRO///VED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
t NAME , MAILING/ ADDRESS ZIP
Z II P7�/� TEr/L,� NO
OWNER 10C X C-7 7. ', .� tJ 02 7S'�.
1 �► �l � . ,303'
CONT
STATE LICMNSE NO
ARCH
THE OrN/ER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
U E OF APP,LL ANT APP ICA 1 DA
TE PT NUMBER CHECK NUMBER OR CASH
C
APPROVED BY PERMIT�� FEES
S�V U BASE FEE INSPECTION
APPROVST)BLDG SURCHARGE PLAN CHECK
1M4.-
I1 ENERGY SURCHARGE l TOTAL
JgE.pFtF�E�R�SON�CO�UN�TEYp 9 1 1 NUMBER REFUND DATE D TE 1 S
PlBU�II:DI7VG OOFjF1CIAL I
` .�) r . ?' •
APPROVED
MAR 1 4 1989 - U- j r-Q- 1'1A � /%. 4
JEFEERSOP COUNTY
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