HomeMy WebLinkAboutBLD1989-00464 l3UILj�NG '`'ERMIT .APPLrCATION
Jeifierson County Building DDeepartmentaP .O . Box 1220sPor� r ��" '
t Townsend. WA 98368
LOCAT 1 ON ' �(� �L0
SPECIFIC LOCATION SITE ADDRESS ,,Sj ill G'lneV' A ade.6,
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT 1 ;f BLOCK
DIVISION TAX NUMBER
r� ' PARCEL NUMBER �,,1-,! 7"+-" Q0 1 / 4 SECTION
PLANNING AREA SECTION
__; �.TOWNSHIP � NORTH RANGEr -
/ WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT
0 SINGLE FAMILY SQUARE FOOTAGE
l NEW BUILDING MAIN FLOOR ) �-7- 50
®,' 0 MOBILE HOME 0 ADDITION
0 MODULAR HOME 2NDFLOOR �� 7SO
❑ ALTERATION BASEMENT
Q DETACHED/ATTACHED 0 REPAIR
GARAGE CARPORT
0 REPLACEMENT GARAGE WC _$
❑ WOODSTOVE , ❑ WRECKING/DEMOLITION COMMERCIAL
MULTI - FAMILY 0 RELOCATION/MOVING
NUMBER OF UNITS,.... ..... INDUSTRIAL
❑ COMMERCIAL MOBILE HOMES 1,� /
❑ INDUSTRIAL SIZE
9_3'-/_A r@ $36 Z3GJ/�, , ' W/
❑ HOTEL/MOTEL/DORMITORY YEAR - ;I-y4 - @ $ 16 /`rjs90,
NUMBER OF UNITS MAKE �IIJ
$8
❑ OTHER - SPECIFY SS
ESTIMATED COST OF _L�@ $8 67 9
IMPROVEMENTS
UBC OCCUPANCY GROUP f $J $TOTA,��f I R gKFXeALUE
SELECTED CHARACTERISTICS// OF BUILDING // j r�
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
[1 WOOD FRAME (� ELECTR 1 C 1 TY
~" 0 MANUFACTURED �❑\ 0 COLLECTIVE SOLAR
WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS
0 REINFORCED CONCRETE 0 OIL ❑ COAL. ZQlLO 'tit / i
C� 0 OTHER - SPECIFY ,, ,
❑ MASONRY ( WALL BEARING )
`� 0 OTHER DIMENSIONS
NUMBER OF STORIES ,' , TOTAL LAND AREA
DEPARTMENTAL 'REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS •jL
'` 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS —
APPROVED DATE 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 1(rr.
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM r-
PUD TYPE OF WATER SUPPLY / . , / 1
0 PUBLIC ( NAME OF WATER SUPPLY ( WV--12C,J (Na-{e2
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLA NING DEPT W HIN SHORELINE JURISDICTION
r YES E OF ADJACENT WATER BODY
iaikt ,-A-3?ko
f> NO
APPROVED DATE 7)r, 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 ❑ NO
IDENTIFICATION
NAME
P
MAILING ADDRESS ZIP TEL NO
eSo oS ,, r� S 37
- p-L- i s r l_ mac.) 4 / ,,0
CONT Pep_ReJa ' '0 —a//l e--
RCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATU OF AP
[CAT APP - ICTION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APP /� 0�0
/ V Y PERMIT(�FEUJES
` BASE FEE
o INSPECTION
BLDG SURCHARGE `7`-.11, (O PLAN CHECK
101 1 . " I S-42 ENERGY SURCHARGE z /0
saAt
�j —
TOTAL
" T "r;" I( .2. 9 1 1 NUMBER REFUND DATE D BUILDING nr0'J3 AL r /1 suED