HomeMy WebLinkAboutBLD1989-00104 • ..
' ILDING t:'ERMIT APPLICATION
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Jefferson County Building Department1T .O . Box 122071Fort Townsend, WA 98363
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SPECIFIC LOCATION SITE ADDRESS c5' -, .
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POSTAL DISTRICT /SUDDIVISIOU f
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER.«Tro7P, pD... ; , , 4 SECTION iv)
PLANNING AREA SECTION it) , TOWNSHIP ,,,--, NORTH RANGE / WM
BUILDING INFORMATION
7/LDING TYPE TYPE, or ImpRovEmr,r4T SQUARE FOOTAGE
SINGLE FAMILY NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT ---
GARAGE 0 REPLACEMENT GARAGE ,
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF uNiTS
---- MoBILE HOMES
O COMMERCIAL - ,„,„
SIZE _ I, 7/ a $35 53/%0
O INDUSTRIAL YEAR _. k3iDiti @ $ 16 -414: CYC-'
O HOTEL/MOTEL/DOnmiTORY
MAKE 0 @ Ss
NUMBER OF UNITS
O OTHER - SPECIFY 0 $8 @ 1
EsT I MATE COST or
u BC OCCUPANCY GRoU7 _, $1 MpHO ,M_ENTs ______
_ TOT_pi„-,pie frLIR _RARKET VALUE
$ C---)8•1 ‘ -) r
SELECTED CHARACTERISTICS OF BUILDING
-- —--
I PRINCIPL5, TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
0- WOOD FRAME
,biOLECTRICITy 0 COLLECTIVE SOLAR
p MANUFACTURED - —:)oDSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL. 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
---
O MASONRY ( WALL BEARING ) DimENSIONS
1 I ,
O OTHER - NUMBER Or STORIES TOTAL LAND AREA,i:
DEPARTMENTAL REVIEW REVIEW /
HEA -TH ,DEPARTMENT TYPE OF SEWAGE DISPOSAL \NUMBER OF PROPOSED BEDR•• _
}.
( ( U CI C 6 0 P L I C OR PRIVATE
I V 1 DUAL ( SEPTI C )
INa2 riurneur OF EXISTING BEDROOMS
NUMBER OF PROPOSED BATHROOM
APPROVED DATE
-1 ND I V I DUAL WEL L NUMBER OF EX I ST I rn BATHROOm
— t----- - __,--:_,------
PUB TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY),_
_
PLANNING DEPT. -I TWIT IN SHORELINE JURISDICTION
4. f .vt_ o--(jy, YES NAME OF ADJACEu wAT -n 5DYbo_11
1--/..-------ir
------
0 NO
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Ap ROVED DATE BANK HEIGI-- (44(,,tW , SETBACK 6a.
, ..._
PUBLIC WORKS DEFT ROAD RIGHT-OF -WAY WIDTH .._
NAME OF PUBLIC ROAD
NAME OF PRIW:TE ROAD
APPROVED DATE ROAD ACCESS pERNIT REQUIRED 0 YES 0 NO
--
IDENTIFICATION >30\> t\-e .."..,,.. 76s--3 2.7.2..
— _ —
- NAME ' 1 _ , _ _ MAILING ADDRESS ZTP TEL NO I
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CONT 0 - —at( qt9.2a.5 -76 —
, ,„ mopLi? Ilizs 7° d lc frmoto ,322-
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ARCH — _ ------- -
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGErZE TO CONFORM TO ALL APPLICABLE LAWS.
-.....-.- ,
SIGNATURE OF APPLICANT
14ld. Arp ICAT O'l AT RECEIPT Numpmn CH(E.g UMBER OR CASH
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"DFFC sok 19 E 7 ;in5
FEE's
BASE FEE.
....__4_L7 BLDG SURCHARGE . INSPECTION
PLAN CHECK
PLANNING&8LOG[AT ' P ENERGY SURCHARGE' $ -
i TOTAL
911 Num= REFUND
DATE DATE ISS ED
-
BUILDING OFFICIAL
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AP OVED CiDAOCIp
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PLANtONG&8 G DEPT
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