HomeMy WebLinkAboutBLD1989-00589 b LDING ERMIT APPLICATION 411
Jefferson County Building Department.P .9,. Box 1220sPort Townsend. WA 98368
LOGAT I ON P (>�'6(1J " �•CJV�` r�
SPECIFIC LOCATION SITE ADDRESS I /
POSTAL DISTRICT � ,_' .._ /SUBDIVISION }
F
LEGAL DESCRIPTION LOT ZZOLOCK
DIVISION TAX NUMBER
PARCEL NUMBER 1 / 4 SECTION HD
PLANNING AREA SECTION \ Jp TOWNSHIP 1 2. N NORTH RANGE_-_j E WM
`'j BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT
L'3' SINGLE FAMILY SQUARE FOOTAGE
[} iVEW BUILDING MAIN FLOOR \-13C�
,N ❑ MOI] I LE HOME ❑ ADDITION 2ND FLOOR S33
0 MODULAR HOME ❑ ALTERATION
0 DETACHED/ATTACHEDBASEME ec
REPAIR CA-RPa�'r.�ec
❑
'' GARAGE ❑ REPLACEMENT GARAGE �jp�❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES
❑ INDUSTRIAL SIZE @ $3 5 if`-(acFe,,
❑ HOTEL/MOTEL/DORMITORY YEAR
NUMBER OF UNITS
MAKE Q� $ 1 6 �
$B
❑ OTHER - SPECIFY
ESTIMATED COST OF ------0 $8
UBC OCCUPANCY GROU ) r IMPROVEMENTS
/j C4, ��� T' ,yt��, RKET VALUE
SELECTED CHARACTERISTICSI OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
P'� [�-�VY00D FRAME
L�' €LECTR I C I TY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE
0
PASSIVEOA SOLAR
❑ STRUCTURAL STEEL
0 GAS 0 COAL
0 REINFORCED CONCRETE ❑ OIL,
❑ MASONRY ❑ OTHER - SPECIFY
' ( WALL BEARING )
❑ OTHER DIMENSIONS
�1_ NUMBER OF STOR RI ES vG TOTAL LAND qR EAM)
DEPARTMENTAL 'REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 3
�/j�/� / IN PUB L I C OR PR I VATS NUMBER OF EXISTING BEDROOMS
APPROVE DATE 0 ► ND i VI DUAL ( SEPT 1 G ) NUMBER OF PROPOSED BATHROOM
N
❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUB 1 C ( NAME OF WATER SUPPLY) hC-,I, l-tJC11 C:Ak
APPROVED DATE ❑ PRIVATE ( NAME OF WATER S UP.
`P-L-Y)
PLANNING DEPT , WITHIN SHORELINE JURISDICTION ..._,
\ / k�/T`T�' ❑ YES NAME OF ADJACENT WATER BODY
{�I`•1 ` ❑ NO
APPROVED DATE BANK HEIGHT '
SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
36 /
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED
❑ YES ❑ NO
IDENTIFICATION
NAME
OWNER MAILING ADDRESS ZIP
TEL NO
c �sb r es o,r S - Q131=5 -Z/D
CONT
S r'A I E LICENSE ' NO I
• RCH
THE OWNER OF THIS
y1 BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA OF A 4 LAIN
Jj/ APPLI ATI DATE RECEIPT NUMBER CHEC►( NVMBER OR CASH
1
PPROVED I B y
�
PERMIT FEES�-
A � � -7- ,Sl ABASE FEE
INSPECTION
MAY 1 0 1989 ` S BLDG SURCHARGE
PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE
ptee,hr?DiO BtOG OEM V TOTAL
l..'k..1i I I NUMBER REFUND DATE DA E ISSUED
BUILDING OFFICIAL
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