HomeMy WebLinkAboutBLD1989-00463 (3UILDT IG . 'ERMIT APPLICATION k( IeK. f l ( /�- t1
' Jefferson County Building DitTartment40P .O . Box 12200PoreWbrinsend. WA 98368
LOCATION p--,L- C1uD14 - ner R(30le Will e- " Si* /*
SPECIFIC LOCATION SITE ADDRESS `/No +1n C��ld, e Oar --
POSTAL DISTRICT /SUBDIVISION hVteY rkev- Oar
LEGAL DESCRIPTION LOT 7 BLOCK DIVISION TAX NUMBER
PARCEL NUMBER Fo,V/7"- p 1 / 4 SECTION
l PLANNING AREA SECTION 7 TOWNSHIP �O/Y NORTH RANGE / 6" WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ANEW BUILDING MAIN FLOOR a 9 5'0
, ❑ MOBILE HOME 0 ADDITION 2ND FLOOR '7 • c"D
•
❑ MODULAR HOME 0 ALTERATION BASEMENT
X DETACHED/ATTACHED 0 REPAIR CARPORT _.
GARAGE 0 REPLACEMENT GARAGE iil n J. 5
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
` ` g MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
.,1
NUMBER OF UNITS MOBILE HOMES .���}�/ �2j C
❑ COMMERCIAL SIZE
nL.s:.L1— a $3 5 q Jq lo�5o
❑ INDUSTRIAL
YEAR r/7`1 50 a $ 1 6 I 5f.. .et
❑ HOTEL/MOTEL/DORMITORY MAKE 0 a $8
NUMBER OF UNITS L/�/�g� /_
❑ OTHER - SPECIFY ESTIMATED COST OF , J -- --/J,,� (07 @ $8 Jk 00
IMPROVEMENTS TOW FA I R A T VALUE
UBC OCCUPANCY GROUP'/ $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
XWOOD FRAME x ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL zero C.IearavJCe.
O REINFORCED CONCRETE 0 OIL MOTHER - SPECIFY -Fih01?IQ.'c.L.--
4Y 0 MASONRY ( WALL BEARING ) DIMENSIONS
�' , ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
N .
DEPARTMENTAL REVIEW
ci
HEALTH D PARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 47"
, PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM �p
APPROVED DATE
Cr 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM --
PUD TYPE OF WATER SUPPLY ,, �(}}��
(7- X PUBLIC `( NAME OF WATER SUPPLY) L/t�Dt o� lithei-H-S
4 APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY?
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PLANNING DEPT . WITHIN SHORELINE JURISDICTION
'"10 0 YES NAME OF ADJACENT WATER BODY
XNO
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 0 YES 0 NO
IDENTIFICATION
—_ NAME Q� ('��ry+�� / �/�� �}MAILING�^ ADDRESS [�f ZIP TEL NO
O MN
E R j c R W oco toS, too 1 1 I P1.+C/Cr�P�1Pi ta.,�� Sta " L ,
1--�--. Lb{ r t.„oc.J U I qn6 Li31-.)/01
A
CONT I R cct TA,. rtEv •
ARCH
r
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGN tOF A :Ve
APPLICATION ATE ( RECEIPT NUMBER CHECK NUMBER OR CASH
g/2 S./
OVED BY PERMIT
/ERM I��T�FEES
�
1//1/J-Tr C l / BASE FEE INSPECTION
£/,•5 BLDG SURCHARGE PLAN CHECK
Aus �9ag /3� =�' $ &g S )
� ENERGY SURCHARGE
TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEPT 9 1 1 NUMBER REFUND DATE ACT /6
BUILDING OFFICIAL