HomeMy WebLinkAboutBLD1988-00411 BUILD• '`,''ERMIT APPLICATION
Jefferson CountyBuilding DepartmentPO . Box 1220.Portl
* ownsend, WA 98368
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LOCATION j �
SPECIFIC LOCATION SITE ADDRESS t1 'r),�S�l ,/ /
POSTAL DISTRICT 1�` / /SUBDIVISIONS .3Cy \ij`� -`„
LEGAL DESCRIPTION LOT (Q T7 BLOCK DIVISION TAX NUMBER
PARCEL NU BER q 1 750 ()� 1 / 4 SECTION
SECTION (_ TOWNSHIP C. NORTH RANGE WM
BUILDING INFORMATION
BUA LDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
NGLE FAMILYX NEW BUILDING MAIN FLOOR f y l-
❑ MOBILE HOME ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT /
❑ DETACHED/ATTACHED 0 REPAIR faJC /riC*�
GARAGE 0 REPLACEMENT GARAGE S( "
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL ((((
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES Q¢� /�
❑ COMMERCIAL O a $3 5 l(/ WIY )
SIZE
❑ INDUSTRIAL YEAR a $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 a@ $8 VY
NUMBER OF UNITS _ If
❑ OTHER - SPECIFY ESTIMATED COST OF c1� $8
" IMPROVEMENTS $,P/A-1. FAi MARKET VALUE
�C UBC OCCUPANCY GROUP / $ (a
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
t c if PR C1PLE TYPE OF FRAME WOOD_FRAME ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED `�i W• •OSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
/(''' ° 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
`COt DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
P U B L 1 C OR PR 1 VAT E NUMBER OF EXISTING BEDROOMS
ND I V I DUAL SEPT 1 Cj NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0. I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
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PUD TYPE OF WATER SUPPLY 6'L��—
X PUBLIC ( NAME OF WATER SUPPLY �� Z y t,LX3/
APPROVED DATE 0\PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
4'N.10
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 0 YES 0 NO
IDENTIFICATION
��, NAME iMAILING�� ADDRESS ZIP
Z I2P TEL NO
OWNER ?),dirA( �.� u.�2� ) ':' . .1/� C/ `a2
01�°C\. 41.,-tee d&(q
C O N Tr�,.r Cv- - �`
s i tcTti L I C G N S t NU 3 J'-
-7c'- ��c 1
ARCH /713
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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Nsi TURE 0 APPLICA APPLIC 1 DA E RECEIPT NUMBER CHECK NUMBER OR CASH
t �� . , ;�f 5(G7 2 1 3l s
/r APPR+VIED Y PERMIT�/�.°,+ f FEES
1111' jj P Q . D-1<C. ZD BASE FEE I NSPECT I ON
3,..5D BLDG SURCHARGE 11....
PLAAN CHECK
\AFtl. 1 4 19 tis, COJ / ENERGY SURCHARGE s5T 3 C I 1 ; TOTAL
JEFFER50N Cr)
-UNTy l V, CJ V 9 1 1 NUMBER REFUND DATE DAT��1 ssu D
PLANNING&BLDG DEPr
BUILDING OFFICIAL I 4
4(
TO 'l
APPROVED
DEC G" C/7/1�l lc
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