HomeMy WebLinkAboutBLD1989-00575 4 . ,
BIDDING ERMIT APPLICATION
Jefferson County Building Department*P .O . Box 1220,Port Townsend, WA 983684
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SPECIFIC LOCATION SITE ADDRESS ' AA c \l ( ( _0 I elC7
P ICT /SUBDI.VISION
LEGAL DESCRIPTION LOT BLOCK DIVISI TAX NUMBER
+/PARCEL NUMBER*3 VISECTION
PLANNING AREA SECTION _' TOWNSHIP NORTH RANGE_' ft.,
ti+--. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW I3IJILDING MAIN FLOOR
❑ MOP. ILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE U REPLACEMENT ` GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ' COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES❑ COMMERCIAL SIZE , --0 a 35
❑ INDUSTRIAL YEAR 0 r, $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 a $8
NUMBER OF UNITS w,
62/0T ER - S'EGIFY ESTIMAT • • COST OF $8 "'"
1 IMPR+ CEMENTS T. AL FAIR MARKET VALUE
UBC 'CCUP N GROUP $
of w 4f7 i
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOvE ❑ PASSIVE SOLAR
❑ STRUCTt:' AL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - -ECIFY
❑ MASONRY ( WALL BEARING ) D I ME;JS I ONS
❑ OTHER - NUMLiER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT - TYPE C.F SEWAGE DIS +SAL NUMBER OF PROPOSED BEDROOMS
0 PUBLIC OR PR I V E NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL EPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ I ND I V I DU WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF • TER SUPPLY
❑ PUB C ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME or WATER UPPL SY ,. _ WY <x__ -...IRI
PLANNING DEPT . THIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED 1 - TE BANK HEIGHT SETBACK
PUBLIC YORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD ._..
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS �W��
ZIP T E L NO
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/ O WNER �� � - / .-_.-
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C O N T % / 1 V V \ -k%lJ L i/� r 01 4�9V.( i 3
L.Ll� J s f I.L./1.- I CETME ITu f°'— s e L
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HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
HU
A ICAION DATE R£ IPT BER CHECK M B OR CASH
1 CsNAT URE OF fA jPL 1 CA T PP K pi
APPROVED BY PERMIT F S/ G� 113 l S — / &3Jfl
A B SE FEE / INSPECTION
BLDG SURCIfAF2GE PLAT 56 GSA
tO
l 1ENERGY SURCHARGESTOTAL
COON Y
PLANNING$Bll)G UFPT REFUND DATE D TE ISS ED
91 1 NUPrtBER //�)�/ �J
BUILDING OFFICIAL y v ` ` 6 9
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