HomeMy WebLinkAboutBLD1989-00113 BL'DING� . ERMIT APPLICATION
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Jefferson County Buildi Department*P .O . Box 1220ePr't Townsend. WA 98368
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SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK/,�pp�� DIVA/S O TAX NUMBER
• PARCEL N R (OC)R B� (mil 1 / 4 SECTION
PLANNING AREAL SECTION �TOWNSHIP( (C7 NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING / MAIN FLOOR __
❑ MODILE HOME 0 ADDITION 2ND FLOOR „„
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/D OLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION• /MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOfES
❑ COMMERCIAL (f( @ $3 5
SIZE
O INDUSTRIAL YEAR
$ 16
❑ HOTEL/MOTEL/DORMITORY
MAKE F @ $$
NUMBER OF UNITS
' OTHER S CIFY�r ry $8
L P�g ES ' IMAS"ED COSTV!lJ�u/ (�
T en.C4'i a CUR C' 'L t P E
UBC OCCUPANCY GROU , ,O
� T'TAL FAIR MARKET VALUE
SEL TED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPEC Y
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL 4UMBER OF PROPOSED BEDROOMS
9I0 11 ,90(� k 0 PUB L 1 C OR I VATE NUMBER OF EXISTING BEDROOMS
I ❑ I ND I V I DUAL SE"T I ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
❑ I ND I V I DUAL WEL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATE. SUPPLY
0 PUBLIC ( ME OF WATER SUPPLY) _
APPROVED DATE ❑ PRIV ( NAME OF WATER SUPPLY A
PLANNING DEPT . W I TI SHORELINE JURISDICTION - `/7 - 7 /S'3
ES NAME OF ADJACENT WATER BODY '
Soso
0 NO ,,,N.(Ji
APPROVED DAT '` BANK HEIGHT SETBACK ace ( _
PUBLIC W KS DEPT ROAD RIGHT-OF -WAY WIDTH
-'` NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
PPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
L� C T) G �1� C1fEf F1tcQF
NAME IC / /^'�� M A/�'I LJ/1TG ADDRESS /,',�' J'�'''"' ZIP(j T E L NO
OWNER (±1,22;44 /�C� / L/-✓— L C; .. \_?7 i! ' �1 0 '-
CONT K-U 14-60I (._ Dnsgr r 17 7 -_.{
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i i E L t ti I`i7 1 Nu �� �\
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ARCH a S3
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
4NFRE OF APPLICANT APP CA ,27E qEIPTNUER CHECK ow=Adet fZR CASH
APPROVED BY f PERMIT F-
r-- BASE FEE INSPECTION
/ i V BLDG SURCHARGE PLAN CHECK
SEP 1 1 1989 ' ENERGY SURCHARGE 17c ,S7D
TOTAL
JEFFNS& WGCOU O 9 1 1 NUMBER REFUND DATE DATR 1 SS ,��ss��BUILDING
�GLaGFFPT 1 / D)
BUILDING OFFICIAL ,-„
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