HomeMy WebLinkAboutBLD1989-00569!! C3UIIING ; 'ERMIT APPLICATION410
Jefferson County Building Department•P .O . Box 1220SPort Townsend. WA 98368
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LOCATION _
SPECIFIC LOCATION SITE ADDRESS , Vi e- (:'�'7�
a i
POSTAL DISTRICT /SUBDI,V)2SION )/ / (.x I&L
LEG
AL DESCRIPTION LOT BLOCK K) TAX /NUMBER
PARCEL N MBER 1 / 4 SECTION
PLANNING AREA it SECTION ��.-' TOWNSHIP �� NORTH RANGE WM
~ BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
�INGLE FAMILY ❑ NEW BUILDING MAIN FLOOR ', ) Ic
� rn
"�� 0 MOIJ 1 LE HOME ADD( T ION j,,C._)
\ 2ND FLOOR
':J ❑ MODULAR HOME ❑ ALTERATI N c� BASEMENT
- 0 DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES ('�
❑ COMMERCIAL C 'p� $3 5 /774Q LJ
SIZE
❑ INDUSTRIAL YEAR 0rr $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE UI C1) $ B
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 0@ $8
IMPROVEMENTS TOT AIR MARKET VALUE
UBC OCCUPANCY GROU , ' 2 $ $ .�U
42
SELECTED CHARACTERISTICS OF BUILDING
P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME J. ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED I- WOA,)q$ Q ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 G S `J ❑ COAL
�,, y ❑ REINFORCED CONCRETE ❑ OIL 0 OTHER SPECIFY
qrp ❑ MASONRY ( WALL BEARING ) DIMENSIONS
`" ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
\ DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMSi"5
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
'® INDIVIDUAL ( SEPTIC )
NUMBER OF PROht.r'ED BATHROOM
1 APPROVED DATE t INDIVIDUAL WELL NUMBER OF EXISTING BATH-ROOM
�* k /1,/9PUD TYPE OF WATER SUPPLY
\.,� ❑ PUBLIC ( NAME OF WATER SUPPLY)APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
.--. Ii4)-
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLICjjWORKS DEPT ROAD RIGHT-OF -WAY WIDTH
11A�/(/
n N /-A NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER �_ A
7 f')� age;
CONT
---- STATE LICENSE ND I
� II
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE F APPLICANT , APPL (,� DATE ( RECEIPT NUMBER CHECK NUMBER OR CASH
V�" C�
APPROVED BY P *IT FEES
BASE FEE (9- C JO INSPECTION
,.7.iS BLDG SURCHARGE PLAN CHECK
' ENERGY SURCHARGE J�� TOTAL
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL 6
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