HomeMy WebLinkAboutBLD1989-00479 .ILDING PERMIT Af 'LICATION
„ efferson County Build - Department,P .O . Bcx 1220'0t iowrsen. : .= WA 98368
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1 LOCATION tAt(e \(,� Z�cl t'IU)--1 [u1 Lk, (1_htE. '1_,-1o.AAcc
Ili SPECIFIC LrCATION SITE JDDRESS 7 1 +4300 1(? \ ( Iv" 1 0 I) $,31f,,
POSTAL DISTRICTS /SUBDIVISION •
Sec ?L-T ?(AZ'
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
QOD .A14 PARCEL NUMBER -r '.c{ 1I { Gw Lci 1 / 4 SECTION . `
Q at• 2 PARCELSECTION` 2 A. TOWNSHIP„ NORTH RANGE 'I YV WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT ISQUARE FOOTAGE
✓❑ SINGLE FAMILY ( J NEW BUILDING MAIN FLOOR 20A7-'( (40
❑ MOP I LE HOME kJ ADD I T ION 2ND FLOOR 7GIL�1 4497I
❑ MODULAR HOME W ALTERATION BASEMENT 0
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT 0
GARAGE 0 REPLACEMENT GARAGE 0
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL v
MULTI - FA!4ILY 0 RELOCATION,'MOVING INDUSTRIAL b
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL SIZE 4Sc (Ll $ 3 5 1(if 'ZD
❑ INDUSTRIAL YEAR 45u �{
❑ HOTEL/MOTEL/DORMITORY - $ 16 �j6
NUMBER OF UNITS MAKE (�] $8
r'
'COTHE ' - SPECIFY ESTIMATED COST OF r 0 al $o
A0t0 T'uex 5f1, IMPROVEMENTS
3 TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP P-
�� $ $• Z I 4 Cs-0
SELECTED CHARACTERISTICS OF BUILDING
Q.` E" 14, ! .D
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL L "WOOD FRAME I"ELECTR I C I TY ❑ COLLECTIVE SOLAR F 3 O 1 I"-
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR JEFFERSONGY
0 STPUCTURAL STEEL 0 GAS 0 COAL P?!'"IPRPTry(ifis;IatPI
1 ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES Z. TOTAL LAND AREACO
DEPARTMENTAL REVIEW
f H ALT1• DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS I
_ "—i gct ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS �,�
/ff( tEl INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 2;,,,,,,,,
(- APP 3OVED DATE T
0/ INDIVIDUAL WELL NUMBER OF EXISTING BA HROOtIIlls I.i*PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY )
APPROVED DATE E11 PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
EI YES NAME OF ADJACENT WATER BODY
.....— 4i ,
E t ❑ NO 1 t t
APPROVED DATE BANK HEIGHT 2- h-3 "' SETBACK D-1 S
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH (PO -- 20• ((... t,4“,1,,,,1 Q• IO I
NAME OF PUBLIC ROAD SQ. 1 O 1 .-.
1 NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO 'eXt7htnr-
IDENTIFICATION
� �
NAME �`MAILING_( ADDRESS ( ZIP yT rEL (N0
_., O'WNER `EtMC+- tAl ve ZZ'3O� S� aL.ItNL. `J w� �j(72'CJ ME 8'-Frt•(1 /
Sttuo•-1 SI 14 300 •S R tot .. :f.. ,, _ �iFs'3Z(_, 76�' 3ce3
v = Ter- 7c6 4c2 — ad / S
P,c.o-, tip l'_G - 3cf 14% ?A„-k AViScQsg, cJa (,3C?
T'HC OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
IGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPR• go BY PERMIT FE S
A P • V E D ' r� 2 £J BASE FEE • INSPECTION
1` BLDG SURCHARGE .-/, PLAN CHECK .
ENERGY SURCHARGE $ Pl G a.b
JeFfrftsox COftI iy L — TOTAL
PIANNIpPj DEPT REFUND DATE DATE ISSUED
_ 9 1 i NUMBER � � ��,,-yam
j BUILDING OFFICIAL L}/��E
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