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Home My WebLink AboutBLD1990-00170 BU1L1 1NG `'Ellin APPLICAI lUN i Jefferson County Building partmentSP .O . Box 1220•Po], Townsend. WA 98368 1r • LOCATION - SPECIFIC LOCATION SITE ADDRESS POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER PARCEL NUMBER 1 / 4 SECTION PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR ❑ MOflILE HOME ❑ ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS ❑ COMMERCIAL MOBILE HOMES SIZE _____O q@ $40 ❑ INDUSTRIAL ❑ HOTEL/MOTEL/DORMITORY YEAR 0 $20 NUMBER OF UNITS MAKE 0 $10 ❑ OTHER - SPECIFY ESTIMATED COST OF VI a7 $10 IMPROVEMENTS TOTAL FAIR MARKET VALUE UBC OCCUPANCY GROUP $ $ SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR ❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL ❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS o ❑ OTHER NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ❑ P.UBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS 0/INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOMSmmor PUD TYPE OF WATER SUPPLY ®-UBLIC ( NAME OF WATER SUPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY) PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY •-N O 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 ❑ YES ❑ NO IDENTIFICATION NAME MAILING ADDRESS ZIP TEL NO OWNER CONT STATE LICMSE NO ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. SI NATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH �.6r'--2 2-2 z----- _-G l‘' .; I I AFRpp �_ , PERMIT FEES ��MM11 VC'f) BASE FEE INSPECTION BLDG SURCHARGE PLAN CHECK MAR 2 6 1990 ENERGY SURCHARGE TOTAL Jefferson County Planning REFUND DATE DATE ISSUED &Buildl 9 1 1 NUMBER BUILDING mgriin.nt 4.