Loading...
HomeMy WebLinkAboutBLD1989-00473 • BODING e'ERf1IT APPLICATION Jefferson County Building Department""P .O . Box 122014 Townsend. WA 98368 LOGAT I ON �yy / / / SPECIFIC LOCATION SITE ADDRESS l : i..C'- I n kS/ /T b ©Oak/ /�/ �J ,4N ICI POSTAL DISTRICT--... /SUBDIVISIONw / LEGAL DESCRIPTION LOT _F3LOCK DIVISION_ TAX. NUMBER PARCEL NUMBER 1 / A SECTION PLANNING AREA SECTION ,33 TOWFFSH I P ., _NORTH RANGE J Y1/LSt WM BUILDING INFORMATION \6,1 r) )' L BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR ❑ MOBILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE WOODSTOVE Z /6-1/1 ❑ WRECKING/DEMOLITION COMMERCIAL O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOB tE !14JP�F S ' `� `i ❑ COMMERCIAL �.' 0 @ $3 5 SIZE �// �� 0 INDUSTRIAL YEAR_ K� $ 1 8 r 0 HOTEL/MOTEL/DORMITORY MAKE a7 $8 `fit NUMBER OF UNITS " . ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $FI I MPROVEUENTS TOTAL FAIR MARKET VALUE Zr UBC OCCUPANCY GROVE, $ $ SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ❑ WOOD FRAME 0 ELECTRICITY ❑ COLLECTIVE SOLAR • ❑ MANUFACTURED ❑ WO00sIOVE ❑ PASSIVE SOLAR O STRUCTURAL STEEL ❑ GAS ❑ COAL ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY — ❑ MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES____.... _ TOTAL LAND AREA DEPARTMENTAL REVIEW _ HEALTH DEPARTMENT TYPE OF SEWAGEDISPOSAL .°IJ 1BER OF PROPOSED BEDROOMS ❑ PUBLIC OR PRIVATE NUMBER OF EXI ST I NG BEDROOMS • INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM fic', APPROVED DATE I U INDIVIDUAL M WELTL ) NUMBER OFEXISTING RATHRO�.Y.S _.-,., 4r�' PUD TYPE OF WATER SUPPLY ' ❑ PUBLIC ( NAME OF WATER SUPPLY,), ---- APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLYa — ,4 PLANNING DEPT . WITHIN SHORELINE JURISDICTION ❑ YES NAME OF ADJACENT WATER BODY 0 ❑ NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD V:) NAME OF PRIVATE ROAD ' APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO IDENTIFICATION ti ,I''� NAME //�'; J Q x^� MAILING ADDRESS ZIP TEL NO OWNER 1-0-AT JY'�./GL"�!� fL,�.�'�. `io $' J Qo L D,s-M,-c t F°' ks / CONT FLEE `STALE LF-C"'LITS"E -fl JJ I ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; SIGNATURE OF APPLICANT APPLICATION DATE NEC 1 T NUMBER CHECK NUMBER OR CASH ' APPRO ED Y,.. PERMIT FEES '� C \ k, //� BASE FEE INSPECTION tilAPp 0 5 —A J BLDG SURCHARGE PLAN CHECK l ENERGY SURCHARGE S TOTAL JEFFERSON C0I7`INTy REFUND DATE DATE 1 SSUED CANNING&BLoG r _..,. 9 I i [IUPr1E3ER / q � 1 BUILDING OFFICIAL