HomeMy WebLinkAboutBLD1989-00553 BUILDING 'ERMIT APPLICATION
Jefferson County Buillig Department•P .O . Box 122Port Townsend, WA 98368
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LOCATION �
SPECIFIC LOCATION SITE ADDRESS 37o ,-v'' /`//GL,3,.-( /4,-
POSTAL DISTRICT ('� /SUBDIVISION
7 u
LEGAL DESCRIPTION LOT / „r BLOCK DIVISION TAX NUMBER
PARCEL NUMBER f I/O7_O((, 1 / 4 SECTION
SECTION /O TOWNSHIP 247/1 NORTH RANGE 16.) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE �/
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR 3 T
'❑ MOBILE HOME X ADDITION 2ND FLOOR
❑ MODULAR HOME /❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ICOMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS ,
MOBILE HOMES
❑ COMMERCIAL -. ,y),j
SIZE �(.: /
@ $35
❑ INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY YEAR 0 $ 16
NUMBER OF UNITS MAKE 0 $8
❑ OTHER - SPECIFY ESTIMATED COST OF p7 $8
i\ IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
,2-3
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
. ❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
1, ❑ MASONRY ( WALL BEARING ) DIMENSIONS r` •
' •
❑ OTHER
- NUMBER OF STORIES TOTAL LAND AREAL
DEPARTMENTAL REVIEW
HEALTH DEPARTM TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
o1/_xaY ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
/` /Y; "� ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
PROVED bATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
....!
PhD TYPE OF WATER SUPPLY
�•:r'' 0IhU..!-r 0 PUBL I C ( NAME OF WATER SUPPLY
. -PROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNI G DEPT . WITHIN SHORELINE JURISDICTION
i ❑ YES NAME OF ADJACENT WATER BODY
0 t(.-..,1N
❑ NO
- APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS ROAD RIGHT-OF -WAY WIDTH
n' v1- NAME OF PUBLIC ROAD
I ,s NAME OF PRIVATE ROAD
"APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
'
NAME MAILING ADDRESS ZIP TEL NO
OWNER p1-'L.1.){1 f 4.. lL `'- ! , "tt= : z4E. J4,, (i, , ,i. -aJL 73 2
j 1,41 1'v ti , 4/11-2_
CONT
ST-KM L I LT"NSE NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATU OF APPLICANT - APPLICITIO DATE RECEIPT NUMBER CHECK NUMBER OR CASH
> / �4/7�� / /Z7/ 13( 2 5 I 1831
APPR V BY PERMIT FEES
A p P - r BASE FEE INSPECTION
jay 3 5v BLDG SURCHARGE PLAN CHECK
"' O ENERGY SURCHARGE /,,,j 6
9$� , TOTAL
/3'JcfFFW�tt'COUNj1, 911 NUMBER REFUND DATE DATE I S UED
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