HomeMy WebLinkAboutBLD1988-00429r •
gLDING PERMIT APPLICATION
Jefferson County Build!" Departme.nt•P :O . Box 12204krt Townsend, WA 98368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS /
POSTAL DISTRICT PT- . /SUBDIVISIONLIP-eSJVCgtILLE.E,4--)
LEGAL DESCRIPTION LOT /t BLOCK DIVISION ,--- TAX NUMBER
PARCEL NyMBER 1 / 4 SECTION
SECTION IS TOWNSHIP : ; (.-) NORTH RANGE t--&) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
ygi SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR 3 ce 9 z,s7-7
. ,
0 MOBILE HOME * ADDITION tAD T1-12,-ELE 2ND FLOOR
---
() 0 MODULAR HOME
perAcHED/ATTAcHED 0 ALTERATION BASEMENT
REPAIR
O 0
CARPORT
c) GARAGE D REPLACEMENT GARAGE
K) 0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
Li MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
- -- 0 COMMERCIAL MOBILE HOMES '—
SI ZE
0----- 0 INDUSTRIAL
YEAR 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
$8
NUMBER OF UNITS MAKE VI
O OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UDC OCCUPANCY GROUPE $
$
,
SELECTED CHARACTERISTICS OF BUILDING -t-)
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME -y4 ELECTRICITY n COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING )
DIMENSIONS
D OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOZ7777-'
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
,,14 INDIVIDUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
Li INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
•1111116111r
PUD TYPE OF WATER SUPPLY
CI PUBLIC ( NAME OF WATER SUPPLY
e• t APPROVED DATE D PRIVATE ( NAME OF WATER SUPPLY)
\ ,
.... , PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
sc)
S--
)( NO
APPROVED DATE BANK HEIGHT SETBACK
E ,
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
) NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED n YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO .
..___
OWNER r ' L
( 0110_12-0 (A)• 0 BOX 2 ve ?c)/2_7-- 76 t 0 nse n c/.-
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CONT cuve 1 I p. 0
'
ST TE CreMN O SE N
-L.-Cn ets°Ti: ,441 c-- CV C - CU ct,c h %36 5-
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI ATURE OF AP ICANT
--- APPLICA ION DATE RECEIPT NUMBER CHECK NUMBER 0 CASH
/ .7 ee- :-3( 37 1 , R cki-7
APPR V PERMIT FEES
A
/53.00 BASE FEE INSPECTION
El 2 1988 BLDG SURCHARGE PLAN CHECK
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JEFFERsON CWOOUNTY ENERGY SURCHARGE .$ / ,: c2 —C) TOTAL
PONMNG&B8PT
911 NUMBER REFUND DATE DATE/ ISSy •
BUILDING OFFICIAL h3A37
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APPROVED
DEC 1 2 1 ------_______Ia jej&---- .z- 40,2, "e 447,,, ,D
AFFERSON COUNTY �-�
PLANNING&BUM DEPT
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