HomeMy WebLinkAboutBLD1989-004771 lc',
BI DING 'k 'ERf9IT APPLICATION
Jefferson County Building Departmentf.0 .' Box 1220'Ort Townsend. WA 98368
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LOCATION (�}
SPECIFIC LOCATION SITE ADDRES k) I `�-lj
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISIO TAX NUMBER
PARCEL NUMBER a— 1 / 4 SECTION
PLANNING AREA SECTIONc. TOWNSHIP NORTH C-RJAI Wm_
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTAG✓Z
❑ SINGLE FAMILY ' NEW BUILDING MAIN FLOOR ,(O `)Z()
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
MODULAR HOME 0 ALTERATION BASEMENT
❑ ACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL SIZE 0 a $35
0 INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY YEAR - $ ig
NUMBER OF UNITS MAKE 0 @ $8
O OTHER SPECIFY ESTIMATED COST OF $3
UBC OCCUPANCY GRO IMPROVEMENTS TO$ OhF`�n
U� .�' AA ET VALUE
SELECTED CHARACTERISTICS OF BUILDING
liPRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
1 ❑ OOD FRAME �J ELECTRICITY 0 COLLECTIVE SOLAR
' MANUFACTURED 7o WOODSTOVE ❑ PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) DIMENSIONS � //
�"' � 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA -T-( )
Kl DEPARTMENTAL REVIEW
`%, HEAL -H D PARTMENT TYPE OF SEWAGE DISPOSAL ( 1 BER OF PROPOSED BEDROOMS ?
" % /t
� 0 PUBLIC OR PRIVATE�t`F ' MBER OF EXISTING BEDROOMS
11 Z' INDIVIDUAL ( SEPT I C ) L QG—NUMBER OF PROPOSED BATHROOM
APPROVED DATE INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
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PUD T -E OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
13 61-'
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLI WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
��`���\\\��`������JJJ\\\JJJ y Pr NAME OF PUBLIC ROAD
.. Y0 Ili NAME OF PRIVATE ROAD
NAPPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
u. IDENTIFICATION
'\ N A M E MAILING ADDRESS At!/Z I P T E L NO
OWNER .. L✓ �J �, 61 J �Q-, - +,
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woe uy _ i _ Milt i �(A
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ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLEBL LAWS.
ZN*QTUR 8 APPL I C T APPL I AT DATE R,F 1 P ER CHECK�NI,J�S L:a �R CASH
A PROVED BY , PERM T FEES
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A P P p V E BASE FEE INSPECTION
i46 ' LDG SURCHARGE _,_,_,- PLAN CHECK
JEFFERSON COUtW ENERGY SURCHARGE
PLANNING&SBA fj€f�T �x � �, TOTAL
911 NUMBER REFUND DATE ZM:.I
SJSU DBUILDING OFFICIAL
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