HomeMy WebLinkAboutBLD1989-00556 UILDING 'HMI; APPLICATIO410
Jefferson County Building Department,P .0 , Box 1220*Port Townsend . WA 98368
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SPECIFIC LOCATION SITE ADDRESS , 12,9
POSTAL DISTRICT ' /SUBDIVISION P3 )"0111) C4/ 10 / Cl-
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LEGAL DESCRIPTION LOT ---1— BLOCK DIVISION TAX NLIC16 Eli
PARCEL NUJABER 00 i(.9% c•••? OC-LS 1 ,/ 4 SECT ION \
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PLANNING AREA SECTION f_..7 TOWNSHIP .71 NORTH RANGE / LI, ,
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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 MODIJ-1---AHOME 0 ALTERATION BASEMENT
_.-
r,7,00ETACHEDYATTACH 0 REPAIR CARPORT
,.-
GARAGE 6 .,) , ) 0 REPLACEMENT GARAGE
Qr) 0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
i\r) 0 COMMERCIAL MOBILE HOMES
E
0 $35
a
SIZ . '
c-,..., 0 INDUSTRIAL
4
0 HOTEL/MOTEL/DORMITORY YEAR ,,,,--
@ $ 16
MAKE ' )0 @ $8
'\,_ NUMBER OF UNITS
O OTHER - SPECIFY V1 @ $6
ESTIMAIED COST OF
I
I 'OVEMENTS TOT7IL _TA-q2 IP UBC OCCUPANCY GRO / ) ._ MARKET VALUE
* ' K
C..1- SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
TNCIPLE TYPE OF FRAME _---
WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR ----
,
__.2 0 MANUFACTURED D WOODSTOVE 0 PASSIVE SOLAR'
ea 0 STRUCTURAL STEEL U GAS 0 COAL--
, ---
O REINFORCED CONCRETE 0 OIL --- 0 OTHER - SPECIFY
---
O MASONRY ( WALL BEARING ) ,...--
DIMENS-IONS
0 OTHER - NI.1141gER OF STORIES TOTAL LAND AREA
DEPAR' MENTAL REVIEW
' • -
HEALT; DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
vl \•,- - 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
O INDIVIDUAL ( SEPTIC ) NUMBER OF PROPCED- BATI-MOOM ,
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHF?OOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
O NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS pEPT ROAD RIGHT-OF -WAY WIDTH
---
NAME OF PUBLIC ROAD
i-------------- NAME OF PRIVATE ROAD
AP-PROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
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--- IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
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OWNER '
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f::) 1 A)S.C/IN--- p__--
----
CONT -
Ce/4" -- STATE Lierrir="17
ARCH
1 ----
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
NATURE OF APPLICAF APPLIrTir )TEIPTN9.MBERCHECKNUMBEROR CASH
/H - ...'4'''''. 3\1 --(1i ' 7.3.. --S 3s_s
AP-RO , i ell PERMIT FEES
A P Prt 7oR, CAT) BASE FEE INSPECTION
Lie ----0 BLDG SURCHARGE PLAN CHECK
rf Tirif'411111
JEFF ',Se GOV '‘'
_ ENERGY SURCHARGE $ Ac,_.) . k__.3, _..).
PLANNING&BLDG DEPT
TOTAL
9 I I NUMBER REFUND DATE DATE ISSU-
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BUILDING OFFICI L '-
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