HomeMy WebLinkAboutBLD1989-00590 (3UIIOING 'ERMIT APPLICATION •ly / —/
Jefferson County Building Department'P .O . Box 1220sPort Townsend. WA 98368
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LOCATION / ' /
SPECIFIC LOCATION SITE ADDRESS E/ G(J/1JdY,OSP, _P1. • ef LGf ()LDW
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT 25 BLOCK / DIVISION TAX NUMBER
PARCEL NUMBER/ Eo)--/� ,2 — �y 1 / 4 SECTION
PLANNING AREA SECTION /fllJ TOWNSHIP cR g} NORTH RANGE / C , wM
kre BUILDING INFORMATION
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BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE/�/
Qp(SINGLE FAMILY NEW BUILDING MAIN FLOOR
MOBILE HOME /❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
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� ❑ DETACHED/ATTACHED ❑ REPAIR r�/P Q ,-<? �--.-
C GARAGE ❑ REPLACEMENT GARAGE rj(r)(i
k() 0 WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES ,//�� /
❑ COMMERCIAL $3 5 lJ 00
SIZE � � rC(
❑ INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE , affa 0 @ $8 � �..C� ,
NUMBER OF UNITS �
❑ OTHER - SPECIFY ESTIMATED COST OF SQ� a1 $r3 �� �' {
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IMPROVEMENTS TOTAL FAIR MAP KET VALUE
UBC OCCUPANCY GROUP
^ $ $ h � (o///
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
g WOOD FRAME u ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL �
❑ REINFORCED CONCRETE ❑ OIL OTHER - SPECIFY 1 i/1f da-4.2../
0 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 —
,J ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM___
PUD TYPE OF WATER SUPPLY /, \ ( p �
N PUBLIC '( NAME OF WATER SUPPLY) LccrLOGo Lark le_
_
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
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PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
xNO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH ,: 0
NAME OF PUBLIC ROAD ,
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
NAME.(' /,y''/�(�C /,,/� /(/( ��y}., �yM+eA�'II LING ADDRESS / Grp ZIP /y/TE7L�/NO
OWNER
+ ` ReSo rcvS to n M 't"C.V I I.Q cliq, . �i.c.e--k. 3 `�10/
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CONT CtO-e/ -
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ARCH
THE OWNER OF THIS UILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATUR OF AP V fY' APP ICAI&ON ,DATE RECEIPT CLUMBER ICHEC,K NUMBER OR CASH
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R VEOl l(.s E PE M / S
( jj�� 7/ 1V BASE FEE INSPECTION
J\ 91k,
�>i BLDG SURCHARGE
PLAN CHECK
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JEFiERSGIV ,OUNT4 \ ENERGY SURCHARGE $ _m. 7. S� TOTAL
Pl!r,.n++N,; &MG DEPT
911 NUMBER REFUND DATE I DATE ISSUED
BUILDING OFFICIAL V/"
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