HomeMy WebLinkAboutBLD1990-00908 - CANCELLED Jefferson County BuildirSDepartment•P .O . Box 1220e•'t Townsend. WA 98368
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LOCAT►ON /` l
POSTALDISTR 1 CT l/' � �
SPECIFIC LOCATION D
UBD V 1 ION��cC 11'e, y r l ' `
LEGAL DESCRIPTION LOT 5 /l BLOCK_, DIVISION TAX NUMBER
PARCEL NY► ER r( 5"(���JCJOVS / 4 SECTION t ' i
PLANNING AREA;' SECTION -K1 ,-�:+ TOWNSHIP ? % NORTH RANGE I L.J WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY / ❑Imo NEW BUILDING MAIN FLOOR
O MOnILE HOME ! ' ADDITION I(-^ )(/L' 2ND FLOOR
❑ MODULAR HOME i�❑ ALTERATION BASEMENT
DETACHED/ATTACHE 0 REPAIR CARPORT ry
GARAGE 0 REPLACEMENT GARAGE .' 43li
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES❑
COMMERCIAL SIZE @ $40
0 INDUSTRIAL
0 HOTEL/MOTEL/DORMITORY YEAR 0 a7 $20
NUMBER OF UNITS /
MAKE ( {/ q� $10 ---:', 3--( (f)
❑ OTHER - SPECIFY ESTIMATED COST OF / yJ @ $10
IMPRQVEMENTS TOT L AIR MARKET VALUE
UBC OCCUPANCY GROUP $ $ 5l _
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOL (
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL (_-OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
O INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
❑ INDIVIDUAL WELL NUMBER OF EX I ST#1GG BATHROOM
_mis
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE .MJRISDICTION
O YES NAME QF•--"ADJACENT WATER BODY
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER ;11
4.1) v r\((:,,c)
CONT l 1
,514, -
STATE LICENSL NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI,4NATURE OFF PP 1 NT APPLICATI ri DATE R CE,�IPPT� NUMBER CHECK NUMBER OR CASH l:'1 '1Y7.---)/q /
APPROVED BY PERMIT FE S
, C BASE FEE J INSPECTION
6(z, BLDG SURCHARGE 1I C) PLAN CHECK
/ ' C
ENERGY SURCHARGE 4 (
r TOTAL
911 NUMBER REFUND DATE I DATE ISSUED
BUILDING OFFICIAL
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