HomeMy WebLinkAboutBLD1989-00472 (3t10. DING c 'ERMIT APPLICATION AI
Jefferson County Building DepartmentfP .O . Box 1220rt Townsend . WA 98368
SPECIFIC LOCATION SIT£ ADORES • _ SUBDIVISION
POSTAL DISTRICT / ,�.
p , t t't 1 DIVISION TAX NUMBER_
BLOCI{_
LEGAL DESCRIPTION LOT 1 / q SECT 1 ON
,,�°PARCE'L NUMBE�'.x�- u��_NORTH RAN `�`�' WM
PLANNING AREA
SECT I OIA : TOWNSH I
BUILDING INFORMATION r
BUILDING TYPE TYPE OF 1 MPROVEMENT SQUARE FOOTAGE /011 51,
7,6 I NGLE FAM I LYNEW BUILDING MAIN FLOOR `
S 1 NGLE F'Aht 1 LY 2ND FLOOR
❑ ADDITION
MODULE HOME ❑ BASEMENT
❑ ALTERATION
❑ MODULAR HOME CARPORT
❑ DETACHED/ATTACHED ❑ REPAIR
0REPLACEMENT ` GARAGE
GARAGE DEMOLITION ICOMMERCIAL
[] WOODSTOVE ❑ WRECKING/
❑ RELOCATION/MOVING INDUSTRIAL
O MULTI - FOFlLY _ ���
NUMBER UNITS^-,,,,,_„__ M O B IHOMES 0 $3 5
O 00MMERG I AL SIZE G'_- �"
O INDUSTRIAL 4@ $ 1 6
YEAR _..
❑ HOTEL/MOTEL/DORMITORY MAKE Gi @ $S
NUMBER OF UNITS__- _
O OTHER - SPECIFY , a $a
ESTIMATED COST OF
IMPEMEUTS TOT FAA �R h T VALUE
$ $
UBC OCCUPANCY GROI _ ._---- ---
SELECTED CHARACTERISTICS OF BUILDING
PR 1 NC I F"LE TYPE OF HEATING FUEL
—
P INCIPLE TYPE OF FRAME
ELECTRICITY ❑ COLLECTIVE SOLAR
WOOD FRAME PASSIVE SOLAR
0 WJODSTOVE CIElMANUFACTURED [1] GAS [�] COAL❑ RNFORCED CONCL ❑ OIL _�__. 0OTHER - SPECIFY
Li REE I CIFORED CONCRETE
❑ MASONRY ( WALL BEAR 1 IJG ) DIMENSIONS L/� TOTAL LAND AREA G� CC C
❑ OTHER NUMBER OF STOR I ES ,
DEPARTMENTAL REV 1 EW cr. ,. (/no-)f.ethc7
Q
HEALTH EPART"MENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
{ ( 1 UBL 1 C OR PR I VAT NUMBER OF EXISTING BEDROOMS
t 1 , / N I ND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 1 ND 1 V 1 Dull WELL
NUMBER OF EX1 ST I HG BATHROOM
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY
r as . . 4,u .,., ,...� ,»--- -�
IIAUE OF WATER SUPPLY �Eti�fc l)�(
APPROVED DATE PRIVATE ( -
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
/ ❑ YES NAME OF ADJACENT WATER BODY
1 NO
APPROVED DATE
BANK HEIGHT _,—.. SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME Ozr PUBLIC ROAD _
NAME OF PRIVATE ROAD „�-id do 4 0.7( Rd .APPROVED DATE
ROAD ACCESS PERMIT REQUIRED ❑ YES NO
IDENTIFICATION ziP 7'EL NO
—MAILING ADDRESS
NAME
-a. OWNER .r` 2 L I G.. .f v-- 1 l
C O N V'-e '4 (l-l'L 7Yfs/ arrTIC"1"T751 _ +T �3 % / e 1- r't 1
ARCH
A_E LAWS.
THE* OWNEROF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM� } TO ALL AF'PLICAF3L LAWS.
...- .......-.SIGNATURE OFAPPLICANT A F LICASION DATE T �N MER I C1C1M
2 OR CASH
'2,, yyCI / /0 n4y
- -
PERMIT rEr:s
APPRO BY „ /�� 11`ISF'EGTION
`!),..„, -� `ll') BASE FEE
A p , /7
BLDGSURCHARGE PLAN CHECK
NO 6U
.� ENERGY SURCHARGE 4,. (� TOTAL
, s1� f tt�l♦!flE {' r�
'PI'� � &([(�( ()��ST 8 I 1 1'dl.^',4Ez`"R REFUND DATE DATE 1 SSUED
BUILDING OFFICIAL i/l&/B9
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