HomeMy WebLinkAboutBLD1989-00467 illJILDING '`'ERMIT APPLICATION
Jefferson County Building DepartmentsP .O . Box 12 ort Townsend. WA 98368
LOCAT 1 ON t L6C l4., C T.
SPECIFIC LOCATION SITE ADDRESS POSTAL DISTRICT f) /
/SUBDIVISION+ \41yCP- 1
LEGAL DESCRIPTION LC�T 3) BLOCK / DIVISION \S TAX NUMBER
�� PARCEL NUMBER ��o6 COO 351 1 / 4 SECTION
PLANNING AREA__ SECTION -;?..-(7 TOWNSHIP 30,-1 NORTH RANGE 1Ls? WM
BUILDING INFORMATION
B ILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAGE, `
SINGLE FAMILY NEW BUILDING MAIN FLOOR �l //
51
❑ MOf.? ILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE C
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES❑ COMMERCIAL STYE _ / S
@. $35 - ) )
❑ INDUSTRIAL YEAR 0 @ $ 16 ' /
❑ HOTEL/MOTEL/DORMITORY MAKE S $8 y/ 2y
NUMBER OF UNITS
❑ OTHER SPECIFY ESTIMATED COST OF W a� $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU;,r3 $ $ ?jgo_Q
SELECTED CHARACTERISTICS OF BUILDING
P INCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ► ELECTRICITY 0 COLLECTIVE SOLAR
", U TOVE 0 PASSIVE SOLAR
MANUFACTURED ,\J
0 STRUCTURAL STEEL 0 GAS ���� 0 COAL
❑ REINFORCED CONCRETE 0 OIL liKOTHER - SPECIFY 1`.' `'S—L 1
❑ MASONRY ( WALL BEARING ) DIMENSIONS
C, t 0 OTHER
NUMBER OF STORIES , TOTAL LAND AREA-3AA
DEPARTMENTAL REVIEW r
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS15 2.
.moo L I C OR PRIVATE NUMBER OF EXISTING BEDROOMS j
1 ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM e-;L,,,,
APPROVED DATE
0 INDIVIDUAL WELL _ NUMBER OF EXISTING BATHROOM Y PUD TYPE OF WATER SUPPLLk
UBL I C ( NAME OF WATER SUPPLY)
APPROVED DATE C❑' PRIVATE ( NAME OF WATER SUPPLY
?
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ NO
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 MAILING ADDRESS ZIP TEL NO
NER _ /(.', )
CONT _. c3q6v elk,
STATE LICENSE NO CA577 PeP0,
is 6...1,,,e
ARCH
1 / -
THE OWN , OF MI-AS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGN U/RRE OF APPLICANT APPLICA ION ATE RECEIPT NUMBER CHECK NUMBER OR CASH
4 - - -
7 � , 77 137 W /S 7
A P-ROVED BY PERMI /EES
APPi3 V E ® . 1-5:3 Sa BASE FEE INSPECTION
AY 89
3.J BLDG SURCHARGE PLAN CHECK
_� / ENERGY SURCHARGE q 7. ,A,JEF MI N G UNTY ` __`-
PLANNING&BLDG DEPT . TOTAL
Vv
/L? ` 9 1 1 NUMBER REFUND DATE 4' Jd7 I S
BUILDING OFFICIAL
(0Y//7/
.