HomeMy WebLinkAboutBLD1989-00578 •UILDING , 'ERMIT APPLICATIO•
rJefferson County Building Department•P .O . Box 1220.Port Townsend . WA 98368
LOCATION M1 ((,,..�� •
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SPECIFIC LOCATION SITE ADDRESS �j 78 c j 1 ( ( �y
POSTAL DISTRICT h /SUBO-TV I S I ON iF'�('lc,(ih". ),)11- ;"\ 9
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER:5()Z2q OF ,�Z..! 1 / 4 SECTION
4 � s L \ WM
PLANNING AREA 4 SECTION �.' 1 TOWNSHIP c� ��'"� NORTH RANGE
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
O MO[.? I LE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
*-..
WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ >>MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES $35
SIZE
( 0 INDUSTRIAL YEAR
❑ HOTEL/MOTEL/DORMITORY Cl] $ 16
NUMBER OF UNITS MAKE A @ $8
` J ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
LT WOOD FRAME \`lLl ELECTRICITY 0 COLLECTIVE SOLAR
f— 0 MANUFACTURED ;III❑ WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS ❑ COAL
O REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROF'r?SED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD 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
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION _
-•( NAME r�/ 1/ �] MAILING ADDRESS (-�( ZIP TELL��//,NO
OWNER b( n n y
i1(1 l�\Uw P �.nc) 1 i3 13' -IP��--LC 7 / )
CONT
STATE LICENSE NO 1 ..
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SI ATURE OF APPLIC :NT APPLICATIONf DATE RECEIPT NUMBER CHECK NUMBE OR CASH
•
! A P -D Y PERMIT FEES�
`,/ I ,*5. ( /) BASE FEE INSPECTION
A P P '' • ` D tir <3, .sr) BLDG SURCHARGE PLAN CHECK
AY 9 19?' --.011,4 I
ENERGY SURCHARGE C— `
)� TOTAL
JEFFERSON COUNT; 9 1 1 NUMBER REFUND DATE I
DAT C /-49Cif
,L)
PLANNING &BLDG DEFT' (JBUILDING OFFICIALV % 6
APPROVED
D,)1
Oe_
MAY 9 1989
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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