HomeMy WebLinkAboutBLD1989-00613 WILDING .'ERMIT APPLICATION
Jefferson County Building Departm'ent®R.O . Box 1'22 •Port Townsend. WA 98368
LOCATION j
SPECIFIC LOCATION SITE ADDRESS Z lq�� l 0 1
r� POSTAL DISTRICT f l /SUBDIVISION
1 BLOCK DIVISION TAX NUMBER
LEGAL DESCRIPTION LOT 1 / 4 SECTION
PARCEL NUMBER ..$ 0 -
PLANNING AREA JJ SECTION , "5 �"- TOWNSHIP Q \ NORTH RANGE r' (kJ WM
tg.) BUILDING INFORMATION
Cr BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ��'
tO ❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR
0M-OnILE HOME ❑ADDITION 2ND FLOOR7—
� ❑ MODULAR HOME ❑ ALTERATION BASEMENT
0 DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING. INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL S I ZE ' (Q C� - a 5
❑ INDUSTRIAL YEAR (q 3 0 $ 16
0 HOTEL/MOTEL/DORMITORY MAKE GU e 0 $8
NUMBER OF UNITS„_
0 OTHER - SPECIFY @ $8
ESTIMATED COST OF
/4z:, IMPROVEMENTS T AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $
i SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
( / �❑_jWOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
'
I` LC ANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
" 0 STRUCTURAL STEEL GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
�. ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
<a:
DEPARTMENTAL REVIEW • _
HE LTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS..'
7 ❑ PUBL I C OR PR I VATE NUMBER OF EXISTING BEDROOMS
I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD T PE OF WATER SUPPLY '
PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO ____.---
APPROVED DATE BANK HEIGHT -------- SETBACK
PUBLIC WORKS DEPT ROAD"R I GHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD ...�
-- NAME OF PRIVATE ROAD
8
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
.,..
-I DENT I F I CAT I ON (y0
MAILING ADDRESS ZIP TEL NO oe
/' NAME MAILING
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N OWNER � ! V?\� ! [ G-
COIJT 767 Ab
g-1'A'i`� LTC:E N 5 k. NO I V)
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI NATURE OF APPLICANT Arl. ICATI DATE RECEIPT NUMBER CHECK NUMBER OR CASH
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k,'>. _ ,f1„:"1. i c 1 ,f 'S-.- 7 G) 5- S----- c7R3,Q-c(
PP O BY PERMIT FEES
M r�
73' 00BASE FEE I NSPECT ION
' A P Sa S ) BLDG SURCHARGE ��y PLAN CHECK
f g ENERGY SURCHARGE $a S� TOTAL
„Wigan=WY (0 , CA / 9 1 1 NUMBER DATE DATE I S D
BUILDING OFFICIAL ' REFUND
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