HomeMy WebLinkAboutBLD1989-00605 03UILDING e'ERMIT APPLICATIOA
Jefferson County Building DepartmentrT40 . Box 1111T1IPPort Townsend , WA 98368
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Locaii2u__ ____ i_
SPECIFIC LOCATION SITE ADDRESS i ?(, __,C)_74/ (i )
POSTAL DISTRICT °--"or,....._ ., /SUBDIViSION
LEGAL DESCRIPTION LOT_ BLOCK DIVIelON TAX NUMBER
PARCEL NuMBER91777777- 2 1 / 4 SECTION
PLANNING AREA _ SECTION. -1 TOWNSHIP _7,),P NORTH RANGE P?..7 WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR_HOME 0 ALTERATION BASEMENT
.1jDETACHEDi)ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY D RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS ......._
---- MOBILE HOMES
O COMMERCIAL ..'' --
, 0 @ $35
SIZE7___
O INDUSTRIAL
YEAR N„,, 0 @ $ 16
O HOTEL/MOTEL/DORMITORy
MAKE ..)(c.7-) 0 @ $8 5D-eb
NUMBER OF UNITS
D OTHER - SPECIFY 0 @ $8
EsTIMAT D COS OF
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UBC OCCUPANCY GROU1 IMP VEMENTS TOTNAIR MARKET VALUE pAA
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SELECTED CHARACTERISTICS OF BUILDING
-pRTNqIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
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EYWOOD FRAME 0 ELEcTRICI 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 ASSIVE SQL-AR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL __ID OTHER - SPEY
O MASONRY ( WALL BEARING ) E
DIMNS_I-CINS
O OTHER - NUmBER or STORIES TOTAL LAND AR A
DEPARTMENTAL REVIEW . _,HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL - UmeER OF pROpOSED BEI:sr/60MS
DtCixit,.', 0 PU L I C OR PR I vAT E NUMBER OF--E.X.-F ST I NG BEDROOMS
ND I V I DUAL ( SEPT I C ) r4UM BEE (I---r--3F -" pR-c;- "ED--BAT HROOM
APPROVED LJATE n INDIVIDUAL WELL _..--1516-4BER OF EXISTING BATMR-OOM
.0.......,
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 017IvATE ( NAME OF WATER
PLANNING DEFT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
.
D. NO
APPROVED DATE BANK HEIGHT SETBACK
..,
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC RoAr -- .
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES D NO
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IDENTIFICATION
----. ._ --- --- ---- -
NAME MAILING ADDRE N
SS ZIP TEL O
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OWNER
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LX_OX /,-/.1- .rn-......._ /
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CONT rp3 JIA Slail7 -/- ja
rE--LITS
/a2
ARCH
- . -
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
,-,.------ ,.. _ , ---- - - -
SIG TUB- F PPLI,CANT APPLICATION DATE RECEIPT rvm ER CHECK NUMBER OR CASH
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l / i 7 B '-if i I (--), 0-D------
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:: ED BY \ PERMIT FEES
A P , 0 1) \ 8/ BASE FEE INSPECTION
CD '
OCT 1989 __ HA
le LD:'01 SURCRGE PLAN CHECK
1 c-e)
, ENERGY SURCHARGE $ Y,•?. 9
AFFERSON COUNTY , TOTAL
NANNING&BLDG UP"'
911 NUMBER REFUND DATE I DATE 1277
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BUILDING OFFICIAL /0/0_3
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OCT 231999
JE€FERSON COUNTY
PLANNING &BLGG DEPT
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