HomeMy WebLinkAboutBLD1989-00133 IILDING t'rRMIT APPLICATION
Jefferson County Build in g e P D artmentP .O . Box 1220 rt Townsend. WA 98368
__LOCATION _
_____ CATION Z v R L r l C d u n T _
SPECIFIC LOCATION SITE ADDRESS__ _
POSTAL D ISTRICT I .,,,,,/SURD I V I S I ON
BLOC : DIVISION TAX NUMBER
-t-
LEGAL DESCR 1 PT I OPI LO C %� 1 / SECTION
1 OPI
PARCEL NUMBER S � x I E WM
SECTION.ON 7 TOWNSHIP_ .7-('�( NORTH RANGE. /
PLANNING AREA . .
BUILDING INFORMATION _
B 1LD1NG TYPE
SINGLE FAMILY
TYPE OF IMPROVEMENT SQUARE FOOTAGE
NEW BUILDING MAIN FLOOR
A ❑ yND FLOOR
❑ MOBILE HOME ❑ ADDITION
❑ MODULAR HOME ❑
ALTERATION BASEMENT
CARPORT
• DETACHED/ATTACHED ❑ REPAIR
TGARAGE ❑ REPLACEMENT GARAGE
f5U WOODSTOVE //
1 RL f(Pf.0 ❑ WRECKING/DEMOLITION COMMERC I AL
MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL �___R,�._ $35
SIZE r --- -
❑ INDUSTRIAL YEAR _ II] cat $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE ___ _, 0 @ $13
NUMBER OF UNITS_ ,_„_ - � $B
r--
❑ OTHER - SPECIFY ESTIMATED COST OF
I MPROVT 7!EN TS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ �� $,
.
SELECTED CHARACTERISTICS OF BUILDING ^�
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
U MANUFACTURED - 0 WOODSTOVE ❑ PASSIVE SOLA ,_
❑ STRUCTURAL,.,-S i"EE ❑ GAS ❑ CAA
❑ OIL OTHER SPECIFY
❑ RE1NFf1RCED CONCRETE
❑ mAS`ONRY ( WALL BEARING ) D I MEi NS
❑ OTHER NUh. ER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIE - _ - �.._
HEALTH DEPART T TYPE OF SWAGE D I SPOSAL NUMBER OF PROPOSED BEDRoQm
❑ PUB L I C OR PR I VATE NUMBER OF EXISTIP &ROOMS,
a I ND I V I DUAL ( SEPT I C ) NUMBER OF P ED BATHROOM
APP: •VED DATE 11 INDIVIDUAL WELL NUMBS F EXISTING BATHROOM „_Ad
PUD TYPE OF WATER SUPPLY
❑ PUBL I C ( NAME OF WATER SUPPLY
APP' .VED DATE / PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
j ❑ YES NAME OF ADJACENT WATER BODY
--❑ NO
PPROVED 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 ❑ YES ❑ NO
IDENTIFICATION TEL NO
NAME M A I L I N G ADDRESS ZIP TE
OWNER -^^-." 2_0 W A L C0.,1 qT
CONT c",(..
T'F;T -L:1 Ll U fE 3
R C H -----
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
.- IGNATURE 0- AP ICA, APPLIC TI N DATE RECEIPT NUMBER CHECKNUMB R OR CASH
I o`v l r _ app
s3/
D BY PERMIT FEES
BBASE FEE INSPECTION
APP ,° 'f D ��
iCT \1:89 l'>...--7----''
-.
BLDG SURCHARGE PLAN CHECK
��►� ENERGY SURCHARGE 1, 2-- — TOTAL
JEFFERSON JiP` \ ��^
pl•,r.'iIN:= Ps SLOG DEPT 9 I I NUMBER REI' UND DATE A'r/� ,S¢
BUILDING OFFICIAL w_ _ `/0 17/
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at 989
40aHERS IN CI UN
pt &BLDG DEPT
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