HomeMy WebLinkAboutBLD1989-00087 (I) ��Sr¢ LING ERMIT APPLICATION j�/ /��; 6" NA \9
.!-: fferson County Bui ldir Depalitmen,t,P . O. fox 1220.St Townsend, WA 98368
.,
LOCATION B VIL V! LL- Al/E - SIr - to e..Gf
SPECIFIC LOCATIO SITE ADDRESS
OSTL._ DISTRICT /SUBD I V I S I ON_�
Icy.-n um a
EGAL DESC IPTIOgOYj� BLOCK DIVISION TAX NUMBER
°o�/ PAR t UMBER -, -/i1/J - ry 1 / 4 SECTION
PLANNING AREA SECTION �t/p TOWNSHIP n NORTH RANGE / Wry
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
/7/ ,,❑ SINGLE FAMILY 1 NEW BUILDING MAIN FLOOR
MOBILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
nQ _
❑ DETACHED/ATTACHED ❑ REPAIR c R Q4'TD jn -2
GARAGE 0 REPLACEMENT GARAGE 5".c C/_
'
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES / /_
❑ COMMERCIAL SIZE /7/6' 0 g $3 5 (oC .C(on
❑ INDUSTRIAL YEAR {, a� $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0Z $AUJ a7 $8 S '
NUMBER OF UNITS `-'�j
❑ OTHER - SPECIFY ESTIMATED COST OF 06A @ $8 "qg
IMPROVEMENTS TOT�rL/;A �M KET VALUE
UBC OCCUPANCY GROUpp 2 $ $ ((/i�!(W.,
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
'( WOOD FRAME ] ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL p OTHER - SPECIFY 4i
❑ MASONRY ( WALL BEARING ) DIMENSIONS /
• 0 OTHER - NUMBER OF STORIES ( TOTAL LAND AREA/ n
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS „sZ
N/ ,i4 PUBL 1 C OR PRIVATE NUMBER OF EXISTING BEDROOMS —
❑ 1 ND 1 V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM a-7
APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM —
PUD TYPE OF WATER SUPPLY \ �� �� �)/y
PUBLIC ' ( NAME OF WATER SUPPLY) L--u1)LOGO Wvl
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
KNOO
APPROVED DATE /\ BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH .-0 /
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
NAME '�(1�C /^/� /,(� /MAILING
{ pA I L I N G ADDRESS '/ ZIP T E L NO
OWNER ` f�,SQ c St l(!Di ' ! ��i ��QA!��: -LLL/ r '13.7¢21dl
P-4-. LipLo ui �t ►31
--
CONT O,V112 ,) _
-
ARCH
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THE OWNER F THIS UI LDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
//
SIGN OF Y �®1 �t O DATE i RECEIPT 3.3 �NUMBER � CHECK 0. NUMBEROR CASH
7
P V _.BY P RM I T FEES
AP \ ` 97,a) BASE FEE INSPECTION
``� �� 66/D BLDG SURCHARGE PLAN CHECK
OCT }g89 ENERGY SURCHARGE d C S-A-)
$ TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEPT 9 1 I NUMBER REFUND DATE DAT I S D
BUILDING OFFICIAL IU0
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OWNFR -POPF RFSOURCFS PHONF : 437-210-
MATLTNG AD.OR : 60M PARAOTSF RAY Rn
: SUTTP. 4
: PORT Luninw WA 98365
CONTRACTOR . . :NO CONTRACTOR PHONF :
MATLTNC ATTOR :
CONTR . LTC #: FXPTRATTON DATE :
P ARCFL NO. . . : 931q00-017
LEGAL DFSC . . : STR 16-28-01 FWM, TAX #
LOT 17 , RLOCK RAY VTFW VTLLAC3F
O ESCRTPTTON OF TMPROVFMFNT : single family residence
) Fontind/Setbacks (Shoreline Setback) /Mnbile Nome Rinckina:
) Foundation :
) Underground Plumhina/Underarnund Tnsulatinn :
) Framind/Plumbinc/Chimney:
) Tnsulatinn :
) Sheetrock
) Sewage "flispnsal System Final .
) Final /Occupancy Approval °
L /0 A(/
CALT, 355-q141 24 HOURS TN ADVANCF TO SCHFI1NT,F iNSPFCTIONS .
Offirp Hours q a . m . to 5 nm .
Tnspectnr ' s Rnurs q in
24 Hour Recorder for insnpctinns .