HomeMy WebLinkAboutBLD1989-00592 BIDDING TRIM APPLICATION 10/ 42 _45'
Jefferson County Building Department'P .O . Box 1220IPurt Townsend. WA 98368
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LOCATION �/(D
SPECIFIC LOCATION SITE ADDRESS (tI i ktd-roSP, l/ri
POSTAL DISTRICT /SUBDIVISION B/ hew 0 /,',..,
LEGAL DESCRIPTION LO �� BLOCK DIVISION TA NUMBER
PARCEL NUMB R 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP
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NORTH RANGE / !_ ' WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE Q
(� J' SINGLE FAMILY KNEW BUILDING MAIN FLOOR /U ��
"V ❑ MOnILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
0 DETACHED/ATTACHED ❑ REPAIR C R TDP.C' K a 0D
GARAGE 0 REPLACEMENT GARAGE 5 3 7
0 WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
Q NUMBER OF UNITS
MOBILE HOMES
� 0 COMMERCIAL /rS 5oZIL( @• $3 5 (� /, U o
SIZE
�' 0 INDUSTRIAL YEAR 0 @ $ 16
0 HOTEL/MOTEL/DORMITORY /t
L MAKE CLQO0 @ $8 (/r
NUMBER OF UNITS �� rfI ,
❑ OTHER - SPECIFY ESTIMATED COST OF � 2y�7 $8 ��lG�
13- IMPROVEMENTS TOTA �FAIR //M�'�AR ET VALUE
UBC OCCUPANCY GROUP •3
$ $ � , ��1pO
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
gWOOD FRAME Af ELECTRICITY 0 COLLECTIVE SOLAR
` 0 MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
qs ` 0 STRUCTURAL STEEL ❑ GAS ❑ COAL �������11,,
\"_.) 0 REINFORCED CONCRETE 0 OIL )( OTHER - SPEC I FY'T�,-, ,(emu
❑ MASONRY ( WALL BEARING ) DIMENSIONS ��
❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREA(/)
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DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS oZ
r i / PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
/v ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 23/'
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM --
PUD TYPE OF WATER SUPPLY / Waite'?
i Xf PUBLIC '( NAME OF WATER SUPPLY) LG{ /..-0(Aj OJcckR
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
'
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH 3D
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME �y� (,{�(� { /n �y MAILING' ADDRESS (1� �/� P ZIP TEL NO
OWNER
' Pow Re 1� C'e . &D AA �PC�\mil. V P% _i Ng . �v 3�"'
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PA-. L(,_�L_o� cLs.
CONT ��S���� _ j,
SAE� i CEFI �
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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S 1 GNAT F AP ')C T ..ZZ___ A � � ON DATE - RECEIPTNUMBER IC NUMBER
UMBE H
Cy _ � jJOSS1
i AP OV PERMIT FEES
-3 Ic �/ BASE FEE INSPECTION
A P f S BLDG SURCHARGE PLAN CHECK
LJ U L 1 1989 ! 1 ENERGY SURCHARGE
T . ,2 ,5 J TOTAL
JEFFING & COUNTY /0 f, (\_i
PLANNING &SLOG OPT U g 1 1 NUMBER REFUND DATE DATE �1]ss
BUILDIIrG OFFICIAL -7// /
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