HomeMy WebLinkAboutBLD1989-00475r
DUI' nING , 'ERMIT APPLICATION
Jefferson County Building�epartment' P .Q, Box 12200P, Townsend. WA 98368
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LOCATION CI SPECIFIC LOCATION SITE ADDRESS mVT
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POSTAL DISTRIC6f�' '/SUBDIVI S I ONl"
c LEGAL DESCRIPTION LOTS, ,, ,tC,OCK - r DIVISION,. _ TAX NUMBER lam/"
„ `` PARCEL NUMBER c��� 1 / A SECTION
m^ ._ PLANNING AREA SECT I ONO�}�3" TOWNSM I F��` NORTH RANG& WM
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BUILDING INFORMATION
-�{( ,j` BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
`4 ` J -❑ SINGLE FAMILY KNEW BUILDING MAIN FLOOR
' ❑ MOBILE HOME 0 ADDITION 2ND FLOOR
0 MOD,_ HOME 0 ALTERATION BASEMENT
E DETACHED . TTACHED 0 REPAIR CARPORT T 7
G' 0 REPLACEMENT GARAGE C . S ` )
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES {/''
0 INDUSTRIAL SIZE lu a $35
k 0 HOTEL/MOTEL/DORMITORY YEAR
a $ 1 6 yy'�� l
NUMBER OF UNITS MAKE7. $B ( �C�G
0 OTHER - SPECIFY ESTIMATED COST OF I 8
.,y � d IMPROVEMENTS T(/ A MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
t `P'f WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
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❑ MANUFACTURED ❑ WOODSTOVE % PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
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0 OTHER
NUMBER OF STORIES I TOTAL LAND AREA
DEPARTMENTAL REVIEW
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HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROrOSED BECROOMS /
�Cs VOJ ' 1 ( i/ - 0 PUBLIC OR PRIVATE
❑ INDIVIDUAL I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHS
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EXISTING Fill°X!
I�_96 /��I"�' U TYPE OF WATER SUPPLY
' OPply 0 PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER. PPLY)M�
PLANNING DEPT . WITHIN SHORELINE J SDICTION
0 YES NAME OF JACENT WATER BODY
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS „ra'E1'T P'Irtp RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
A OVED DATE ' ROAD ACCESS PERMIT REQUIRED ❑ YES _ NT NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER Met)& C'Fret. zev vZD701 / /14vy /0/ - ( vi/c .ve. O�... 7$3J Nome.
CONT f2").fety (42 5-6-----
ARCH a g c( rC j\,
THE OW OF T - BUJ'/• I NG AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
Ni •FL 1 �.T APPA 1 A 1 Oit► i RECE 1 PT NUttER CHECK ,NUMBER OR CASH
APP- B P RMIT FEES
Ii i" BASE FEE INSPECTION
11 2 1 19r9
I. J 0 BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE d i y ✓
D�C�
PLANNING&SLOG DFV1 I' TOTAL
911 NUMBER REFUND DATE I DAT ISS
BUILDING OFFICIAL
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