HomeMy WebLinkAboutBLD1989-00458 41OLDING ',ERMIT, APPLICATION
Jefferson County Build : ng Departrient9r. O . Pox 1220*TL , Townsend. WA 98368
r , -7.
LOCATION ----
SPECIFIC LOCATION SITE ADDRESS C.Pn-trr-er-Detcrtr,/
POSTAL DISTRICT /SUBD I V I S ION 4r% ry,__--„...„_5;;;Zi.7,/ j."-iir•„
LEGAL DESCRIPTION LOT , j _BLOCK DIVISION TAX NUMBER
PARCEL NUMBER P)ollt1-)5"o(c2) 1 / 4 SECTION
PLANNING AREA SECTION /rt.) _TOWNSHIP :Z5r NORTH RANGE / 4„, WM
......-
BUILDING INFORMATION
- -
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE , ..
t
21 SINGLE FAMILY NEW BUILDING MAIN FLOOR .--':
D MOBILE HOME 0 ADDITION ZW,.) FLOOR r" .,
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR ICAPp4fillejt, PTC, ettert.
GARAGE 0 REPLACEMENT iGARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL 0 IC
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL .----
NUMBER OF UNITS 'a'•
MOBILE HOMES -
O COMMERCIAL SIZE =.-' (L1 2 $3 5 .2.c)
,
O INDUSTRIAL .„,-
O HOTEL/MOTEL/DORMITORY
NUMBER OF UNITS i lIk)
O OTHER - SPECIFY EST 0 @ $8 I TED COST OF
,..
IM OVEMENTS TOTA A MARKET VALUE
UBC OCCUPANCY GROU -1 $
•
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0, WOOD FRAME O' ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOvE D PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL D OTHER - SPECIFY
O MASONRY ( WALL BEARING ) - DIMENSIONS
0 OTHER - ' A
NUMBER OF STORIES TOTAL LAND ARE . ...A'
( . DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDR /
s), 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDR
:, ,., /-- q , 6\t- ---
..., - , , a INDIVIDUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM .
APPROVED DATE 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM—
PUD TYPE OF WATER SUPPLY
(7r- D PUBLIC ( NAME OF WATER SURPLYA_
......,,, APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME ' r ADJACENT WATER BODY
C..'
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC ViORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
- ----
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER .
,
.0",,,,-.4 ,---1- ,
5.-f
rico'
....
--, - r-1-
C 0 N T 4, 1,,Atei,,s-e, te:/ v C.I, 'Z, ,/2
5(ATE LTCRUE nu-
ARCH
---._ __--
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
14P-/66c) Oc4(1
........ -
APPROVED BY PERMIT FEES
APPROVE 3 43,a) BASE FEE INSPECTION
SEP 2 5 19139 cle,57')BLDG SURCHARGE PLAN CHECK
WOOENERGY SURCHARGE $
JEFFERSONCOWY ,: 557. )1. TOTAL
MANMNG &ROGDEPI
m. ry) $I 1 NUY1DER REFur4a DATE DATE ISSUED
BUILDING OFFICIAL
it- TO tit 69 71 ,618
„.......,
6-,c-IC .z-vc-.-_--LSo/v .F,/;18.?
p ��
v �
i1 T
� P7ecl
S r
l e
Q
ll J P�q/ .& 2
a
...<Cr C,\ -(1 1:. \C(1 2t 1
.
IL
C� /
T;✓2�a cr'4IZD�
V.
Sex
1
i
I
5
1
V --1 .
c f . 0I1 1
i
1 1
I 1
ool
1 1 1
i I
1 ! ,
1 1
1 1
D W.': iSC I