HomeMy WebLinkAboutBLD1989-00572 B` DING PERMIT APPLICATION 40
Jefferson County Building Department®P.O . Box 1220•Port Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS 2.65Q TF-P ,Ma1LtLVC1-vrtt '�42.-+o
POSTAL DISTRICT N..Nik.o`o.,.1,>/SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVI ION TAX NUMBER
PARCEL NUMBER dZl -332-+ ^ 57-3) 1 / 4 SECTION
SECTION 3 3 TOWNSHIP —3a NORTH RANGE / C WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ,�/�,
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR 2SZ r/It -zu
❑ MOBILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME , ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
O MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL {
❑ INDUSTRIAL SIZE W $35
0 HOTEL/MOTEL/DORMITORY YEAR 4 $ 16
1 NUMBER OF UNITS MAKE 0 $8
bsl OTHE SPEC -Elm-`` ---- ESTIMATED COST OF 0 @ $8
\\O,,v, CPC- Ct � IMPROVEMENTS
UBC OC UPANCY GROUP____-- $ i8 Oq0 TOTAL FAIR MARKET VALUE
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SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
�1``1) ❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
/ ' 0 OTHER - NUMBER OF STORIES Z TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS _"
❑ ,PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 3
XI ND I V 1 DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM / 1t vls1)
APPROVED DATE ❑ I ND I V I DUAL WELL _ NUMBER OF EXISTING BATHROOM Z.
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Coe9 TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE (PRIVATE ( NAME OF WATER SUPPLY) (,, ) e_� ( 2Uj
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 D'1 YES NAME OF ADJACENT WATER BODY
� y (((0` NO 1?:744,\.-..o T-\
CO APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD L {aS-1 MA"-�t0.\S-L6i4. I2.6.--
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
—• NAME MAILING ADDRESS ZIP TEL NO
OWNER
�N.��\p.�.o Z 6 S� L il-�--tip-�&s'C V--a l�� �� '-
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CONT
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIGNATURE OF APPLICANT APPLICATION DATE ECEIPT NUMBER CHECK NUMBER OR CASH
x 4 ?--6--88 I 337
A PRO ED BY PERMIT FEES
A P R 7F?+00 BASE FEE INSPECTION
3•5 BLDG SURCHARGE PLAN CHECK
APR 2u g ENERGY SURCHARGE /?
2 .
JEfF AUW C1 TOTAL
MAW 911 NUMBER I REFUND DATE DATE
BUILDING OFFICIAL
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