HomeMy WebLinkAboutBLD1989-00602 (34 DING p 'ERMIT APPLICATION 0
Jefferson County Building Department•P .O . Box 1220.Port Townsend. WA 98368
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LOCATISPECIFIC LOCATION SITE ADDRESS "T I o/e` e p7 g„...Q,
JPOSTAL DISTRICT L_ /SUBDIVISION
LEGAL DESCRIPTION LOT 1 BLOCK (VISION TAX NUMBER
PARCEL NUMB R `'I f- S I / 4 SECTION
PLANNING AREA SECTION t�� TOWNSHIP A NORTH RANGE jr- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT'
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
ARAGE 0 REPLACEMENT GARAGE
Nid:OODSTOVE lti C 1' 0 WRECKING/DEMOLITION ( COMMERCIAL
MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES �-{,
❑ COMMERCIAL SIZE @ . 35
❑ INDUSTRIAL YEAR I/J i1 $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE M @ $8
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIM ED COST OF /70 $8
IMP VEMENTS T TAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP,IZ, $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SP- IFY
0 MASONRY ( WALL BEARING ) DIMENSIONS
O OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPO • L NUMBER OF PROPOSED BEDROOMS
O PUBLIC OR PR I VA NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( S ' -T I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 INDIVIDUAL ' ELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF W. ER SUPPLY
cZt 0 PUBL ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ P- VATE ( NAME OF WATER SUPPLY
PLANNING DEPT . THIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED D E BANK HEIGHT SETBACK
PUBLIC YORKS 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
MAILING ADDRESS ZIP TEL NO
/^,NAME �
OWNER , �I/ i� � ig � � .! V` i �•-.
CONT T.
STATE LICENSE. NO [
ARCH I
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
E OF APPL I CA APPL I AT DATE RECFAPT NUMBER CHECK NUMBER OR CASH
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AP ROV BY PERMIT FEES
APP
D \Fi ( S, BASE FEE INSPECTION
5 cr) BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE
Qi SZT) TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEPT 9 1 1 NUMBER REFUND DATE DAT I S „yED
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