HomeMy WebLinkAboutBLD1989-00456 1
t3S_DING , 'ERMIT APPLICATION
Jefferson County Building DepartmentoP .O . Box 1220J1Ort Townsend, WA 98368
rLOCATION SPECIFIC LOCATIONE SITE ADDRESS ( ! i C tallL-\(_\ '-' r I;LA
POSTAL DISTRICT 'V /SUBDIVISION j 1 �-..k '�
LEGAL DESCRIPTION LOT Z-o BLOCK DIVISION�/ ! TAX NUMBER
PARCEL NUMBER 99c, c o ,34J 1 / a SECTION
- ter: WM
PLANNING AREA SECTION r ,j TOWNSHIP NORTH RANGE ! ','-
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE /C! _ 7(-)
SINGLE FAMILY '{ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT e'54
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT I GARAGE �� ;>
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES C� /'
❑ COMMERCIAL SIZE /` / VI q`�. $3 5 L-j L /-
❑ INDUSTRIAL YEAR UJ p( $ 1 5
❑ HOTEL/MOTEL/DORMITORY MAKE , 0 chi $8 6 ._S
NUMBER OF UNITS r{ r
❑ OTHER SPECIFY ESTIMATED COST OF S�k' Lu $ (G II 7 '
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $--_``
SELECTED CHARACTERISTICS OF BUILDING JJ�pLL —
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
S WOOD FRAME 0, ELECTRfCITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL ,4/-- e4 n
❑ RE 1 NFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY '77 Z" -
Cl MASONRY ( WALL BEARING ) DIMENSIONS {� !/
❑ OTHER - NUMBER OF STORIES / `�� `�TOTAL LAND AREA
DEPARTMENTAL REVIEW A „� /2 3.6 —. .
HEALTH DEF'ARTM N,T TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDRG'M OS j
O/r At,---- 2/6/f' ❑ PUBLIC OR PR I VATE NUMBER OF EXISTING BEDROOMS
C' ( ISI, I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE J'❑ I ND I V I DUAL WELL _ NUMBER OF .EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
la. PUBLIC ( NAME OF WATER SUPPLYI =LC. : m...,.r._
`, APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPL
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PLANNING DEPT . WITHIN SHORELINE JURISDICTION
$ Y ❑ YES NAME OF ADJACENT WATER BODY
_,_..,J6/ ❑ NO
tie+,�a ,,.. APPROVED DATE BANK HEIGHT SETBACK a
---• PUBLIC WORKS DEPT _-ROAD RIGHT-OF -WAY WIDTH ,,,_
/,1 47i NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
A. OVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
QNAME MAILING```���ADDRESS ZIP T E L( NO
OWNER �- �^i 1- - Li� - �L. l st� _ 3€
CONT ,/ yy 5- �``' 4/4)0,2 ZilG� ,I.
TAl- L.I C.�N S E. N0 5/ z--\ 7
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ARCH
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGN URE OF A}ILICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH •
\ AP D BY PERMIT FEES
r ]
A P E ; J I t. S O BASE FEE INSPECTION
-a, J BLDG SURCHARGE PLAN CHECK
B
c"-% 6 L
f g 1 �i^, ENERGY SURCHARGE $ TOTAL
JEFFERSON& 1C06 Y I L• CX_ REFUND DATE DATE ISSUED
Pr-An1�IHr&BLDG DEPT � 9 1 1 NUMBER
BUILDING OFF ICIAL 0'2 f l 7/89lc i ~
1
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