HomeMy WebLinkAboutBLD1989-00583r BU•ING '`'ERMIT APPLICATION
IN
Jefferson County Building Department0P .0,. Box 1220.Port Townsend . WA 98368•
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SPECIFIC LOCATION SITE ADDRESS <( 4 wZ
POSTAL DISTRICT /5 BDIVISION
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LEGAL DESCRIPTION LOT_ �" OC D I V��1�S lI ON TAX NUMBER
PARCEL NUMBER `'' / :›6 5—�/ 1 / 4 SECTION
PLANNING AREA
SECTION 2c; �
TOWNSHIP - NORTH RANGE ) E- WM
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BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
1 '1 '.1
❑ SINGLE FAMILY �] NEW BUILDING MAIN FLOOR
❑ MOF.? ILE HOME 0 ADDITION 2ND FLOOR
BASEMENT 1 ?'j,Z_._ t�r�;,laos•\
❑ MODULAR HOME ❑ ALTERATION ,
Q DETACHED/ATTACHED ❑ REPAIR CARPORT a" .' `lC
GARAGE } EKG--� 0 REPLACEMENT GARAGE
'WOODST'OVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
;00
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES❑ COMMERCIAL II 5SIZE @ $35 40,3Le
❑ INDUSTRIAL YEAR I 0@ $ 1 6 9, Zah
❑ HOTEL/MOTEL/DORMITORY MAKE ( I5 Z0 $6
NUMBER OF UNITS
❑ OTHER SPECIFY ESTIMATED COST OF $8
IMPROVEMENTS TOTAL FA �RMARKET VALUE
UBC OCCUPANCY GROUP1) $ �`�/T tt $ 14"9/g 6,
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
��. 0 WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
) 0 MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
S
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
, 0 MASONRY ( WALL BEARING ) DIMENSIONS�' r 0 OTHER - �7 NUMBER OF STORIES � TOTAL LAND AREA13 '-.
DEPARTMENTAL REVIEW
HEA H DE RTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS I
/'C 0 PUBLIC OR PR I VAT NUMBER OF EXISTI�#G BEDROOMS
7
-� I ❑,�- 1 ND 1 V 1 DUAL ( SEPT IC ) NUMBER OF PROPOSED BATHROOMAPPROVED DATE gib 1 ND 1 V I DUAL WELL NUMBER OF EXISTING BATHROOM
P TYPE OF WATER SUPPLY _ . —
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE L] PR I VAT ( NAME OF WATER SUPPLY 'tvUl u '-I--)'.,• '.,3
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
10 ( 1P4---- Q NO
APPROVED DATE BANK HEIGHT SETBACK ! ----
PUBLIC WORKS DEPT TROAD RIGHT-OF -WAY WIDTH — --�
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD -•-
, Y- APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES [] NO
IDENTIFICATION
NAME
MAILING ADDRESS ,z I P TEL NO
(('' 1 tt `/ ./ '""'
a-,,, OWNER \, `\v 1 \\CAL Ki /A-\/lt.) 18031 - � �
VVV 1Y �..�
, lot
437
CONT )G.pE {i '_SourC.:<_S t0 i‘v y ac-c- v C-:Zcs�.. t- 2 '6 .3 _ t
• S i A T L I C.`E y S IE ND i�olgire!...r-1 1 Z JS 9 —
ARCH -----
7
THE OWN R P BUI • .-•G D THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIG • APP. C AL 1 C TI ATE RECEIPT NUMBER I CHECK NUMBER OR CASH
/ j4 C `�/ ` �'//
APPR•ArD BY PERMIT FEES
APPROVED L ( L-.. BASE FEE INSPECTION
I S ,Cry BLDG SURCHARGE PLAN CHECK
cll 15 +Aa9 ,
3-So ENERGY SURCHARGE C ist✓0 TOTAL
Ft k.. .
P... i.UUNTY
FlA'lNlyl 3l06 DEPT ____EL.40 8 1 1 NUMBER REFUND DATE DAT !SS
BUILDING OFFICIAL /U�
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