HomeMy WebLinkAboutBLD1989-00603 ILDING PERMIT APPLICATION
Jefferson County t..._ , N, ing Department*P .O . Box 122 ',.Port Townsend, WA 98368
I • LOCATION
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SPECIFIC LOCATION SITE ADDRESS r.,y moo i.ts
POSTAL DISTRICT 4.-- /SUBDIVISION 01j.rtNeko_iee-A--c--kTP---4-c1-5
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LEGAL DESCRIPTION LOT 67 BLOCK DIVISION TAX NUMBER t
PARCEL NUMBER Crie-700 °66.4 1 / 4 SECTION
SECTION TOWNSHIP c,-L\ NORTH RANGE / 6: WM
BUILDING INFORMATION
—
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
s'. .. r
ItSINGLE FAMILY ANEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE n REPLACEMENT GARAGE
0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS----
MOBILE HOMES
0 COMMERCIAL
SIZE Lf110 @ 535 63167°E7'---
0 INDUSTRIAL
YEAR 0 @ $ 16
0 HOTEL/MOTEL/DORMITORY
MAKE
NUMBER OF UNITS
O OTHER - SPECIFY VI @ $8
ESTIMATED COST OF ;
UBC OCCUPANCY GROU IMPROVEMENTS TOTA K
,L FAIR MARKET VALUE
--------- --.
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
M., WOOD FRAME X.- ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE n PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
1\ . D MASONRY ( WALL BEARING )
DIMENSIONS------
0 OTHER - NUMBER OF STORIES / TOTAL LAND AREA00
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DEPARTMENTAL REVIEW
- HEALTH DEPARTMENT- TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
EE
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
S(2_Q. kEZZA-csk...,<E .tt
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY '].)
yrPUBLIC ( NAME OF WATER SUPPLY) COL. rilpi-4-.S Dec
APPROVED DATE LI PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
LI YES NAME OF ADJACENT WATER BODY
'.-
X NO
APPROVED DATE BANK HEIGHT SETBACK
------
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES F] NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO ,
OWNER /1 .
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MFIv WNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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si ATURE OA CANT
APPL CATION DATE RECEIPT NUMBER CHECK NUMB.'R OR CASH
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Aiwitidimmill
I , P, • ,ED BY PERMIT FEES
D BASE FEE INSPECTION
A P P -,' .Y
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imp--- 4,„ i , t 00
/Y',(-)° BLDG SURCHARGE PLAN CHECK
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ENERGY SURCHARGE $ C/1?c _ EA_
TOTAL
10 Ct
911 NUMBER REFUND DATE 1 eT z J/TID
PLANNING FES°&N BCLODUGNIT
BUILDING OFFICIAL
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