HomeMy WebLinkAboutBLD1989-00453 , UILD [NG ;,'ERMIT APPLICATION .
. 0 Jefferson County BuLing Wartient'P .O . Box 124PAITownsend. WA 98368
r
LOCATION
SPECIFIC LOCATION SITE ADDRESS I / I �� '�� : %
POSTAL DISTRICT P __L - /SUBDIVISION
LEGAL DESCRIPTION LOT �.�.../4"-- ) BLOCK D I V I S I O TAX NUMBER
VPARCEL NUMBER -7 gR3 � /7 41O1 / 4 SECTION
PLANNING AREA ,SECTION,-.23 TOWNSHIP-5 NORTH RANGE /e WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NW BUILDING MAIN FLOOR
❑ MOBILE HOMEEr--ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL
❑ INDUSTRIAL SIZE Aa $35
❑ HOTEL/MOTEL/DORMITORY YEAR
�y� c� $ 16 _
MAKE ���__`T _� $8 -G!(.�
E4UMBER OF UNITS 0
TIIElR�- SPECIFY EST I MA D COST OF 1u $8
�'!"} t ) 'do t jr. y-
IMPR EMENTS
TOTAL AIR MARKET VALUE
UBC OCCUPANCY GROUP
3 $ .� $ ?& C*
f
V SELECTED CHARACTERISTICS OF BUILDING
A.,
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL •
'
''' . Lod' WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE 50L
C� ❑ MANUFACTURED ❑ WOODSTOVE ❑, F?ASs,.L -E-"S AR
❑ STRUCTURAL STEEL ❑ GAS -- COAL
❑ REINFORCED CONCRETE ❑ 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
l
eF" .,<
DEPARTMENTAL REVIEW
" HEALTH DE ARTMENT TYPE OF SEWAGE DISPOSAL NUIr113ER OF PRorr.)SED BEDROOMS
{ ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROV D DATE
- ❑ 1 ND I V I DUAL WELL NUML1E9 OF EXISTING BATHROOM
`""<:, PU TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
APPROVE b DATE
❑ PRIVATE ( NAME OF WATER S U P P L Y � ."�.,..�...,..•..a...,.,,...�.,w,..�.,.....,,.
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
• NO''F
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
esor� 1 117- ) 7-
CONT
s3A .I
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S 1 JIT TORE �F APPLICANT APPL CAT 3 TE I44J
RECEI BER CHIEC,R OR CASH
APPt2• .D BY 1\ P—�RMMII FFr,ES
A P 'I \ 4iG._✓ (Jt/� BASE FEE I NSPECT ION
/ BLDG SURCHARGE PLAN CHECK
JIN2
ENERGY SURCHARGE $
TOTAL
JEFFER$ON CODNTY ��.
PCANNIN.&BLDG DEPT i 911 NUMBER REFUND DATE 1DDA E SSUED
BUILDING OFFICIAL a I
'C/ �M