HomeMy WebLinkAboutBLD1988-00200 BUILDOG PERMIT APPLICATION
Jefferson County Building Department*P .O . Box 122041Port-','ownsendo WA 98368
1' LOCATION .. •
SPECIFIC LOCATION SITE ADDRESS ,_,
POSTAL DISTRICT _/SUBDI ISION
LEGAL DESCRIPTION LOT BLOCK �j DIVISION TAX NUMBER C-'/
PARCEL NUMBER -7/ ,�//7y 1 / 4 SECTION
SECTION /7 TOWNSHIP NORTH RANGE / C,C _WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE 4 �J
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR /2-X/C' = // 2'1
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES / L / ^� ran
SIZE
l /,�y�,_� p� $3 5 �j !1 (�G
❑ INDUSTRIAL �.{
YEAR 0 pJ $ 16
❑ HOTEL/MOTEL/DORMITORY
NUMBER OF UNITS MAKE 0 @ $8
❑ OTHER - SPECIFY . ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL Fpl MARKET VALUE
UBC OCCUPANCY GROUP $ $ (
SELECTED CHARACTERISTICS OF BUILDING Co`o.4 .,...,. F�oAk\No..�
P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAf�
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL --="��
❑ REINFORCED CONCRETE ❑ OIL ciSO1SER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA_
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS—
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
ERIr
PUD TYPE OF WATER SUPPLY �--�
❑ PUBLIC ( NAME OF WATER S WPLY) -
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY1� mw - -awa
PLANNING DEPT . WITHIN SHOREL JURISDICTION
❑ YES NA OF ADJACENT WATER BODY
Er NO❑ NOO
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 T E L NO
OWNER it� OD G7C L - 9' 'r)(� ,7� S--
_ -� . 3`/
� y-
^'�-"� (
\JA *.......*
T SATE L I CENSE NO
i
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ARCH
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'THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF
! /APPLICANT APPLICATION I RECEIPT NUMBER I
CHE NUMBER OR CASH
LfCL'�'� ' c�(
APPROVED BY PERMIT FEES
BASE FEE INSPECTION
/i BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ 3 < TOTAL
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
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