HomeMy WebLinkAboutBLD1989-00598 BUILDING ,'ERMIT APPLICATION
Jefferson County Building DepartmeotaP .0 . Box 1220•Port Townsend. WA 98368
LOCATION
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SPECIFIC LOCATION SITE ADDRESS err
POSTAL DISTRICT /SUBDIVISION ea
LEGAL DESCRIPTION LOT BLOCK f DIVISION TAX NUMBER
PARCEL NUMBER ��T�S 7 I VC)0(4 1 / 4 SECTION
PLANNING AREA SECTION ( TOWNSHIP c- NORTH RANGE / (A ) WM
BUILDING INFORMATION �lf
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
WOODSTOVE 0 WRECKING/DEMOLITION ICOMMERCIAL
-° ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES
❑ INDUSTRIAL SIZE -----0 @ $35
❑ HOTEL/MOTEL/DORMITORY YEAR @ $ 16
NUMBER OF UNITS MAKE 0 @ $6
❑ OTHER SPECIFY EST I MAT£D COST OF 0 a $8
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IMP EMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE 0 PASS oLAF2
tj 0 STRUCTURAL STEEL 0 GAS - 0 COAL
F/� 0 REINFORCED CONCRETE ------
0 OTHER - SPECIFY
O MASONRY ( WALL BEAR--114"0 ) DIMENSIONS
0 OTHER
NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
S HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
� ,""s 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
C?,:._, APPROVED DATE 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
---_` PUD TYPE OF WATER SUPPLY am.
0 PUBLIC ( NAME OF WATER SUPPLY).,
APPROVED DATE "�
/ ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE .JURISDICTION
,4 0 YES NAME O-P'ADJACENT WATER BODY
0 NO
APPROVED DATE /..= BANK HEIGHT SETBACK
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PUBLIC WORKS-'"DEPT ROAD RIGHT-OF-WAY WIDTH
� NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
-APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
0,1(fuS......A .NAME, a n Gd
ADDRESS �'( I'i.X/ Ii�� �`f
NO
OWNER � 7ZI P TEL
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CONT
TTATE LILETTSL NO 1
ARCH
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T E OWNER OF THIS BUILDING AND THE UNDERSIGNEDJJJ AGREE TO CONFORM TO ALL APPLICABLE LAWS.
GNAT - OF PPLIC / APPLI/CAT TE RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PER IT,FEES
BASE FEE INSPECTION
PpRO U P SZ) BLDG SURCHARGE PLAN CHECK
A4 B 98 ENERGY SURCHARGE
TOTAL
t5 1-'i 9 1 1 NUMBER REFUND DATE D
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pIBUILDING OFFICIAL It/
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JAN 1 8 ;“
JEFFERSON COUNTY
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