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HomeMy WebLinkAboutBLD1989-00117 RUING or'ERMIT APPLICATION Jefferson County Building- Department P .© . .Sox 1.220*Po Townsend. WA 98368- , LOCATION _ . SPECIFIC LOCATION SITE ADDRESS POSTAL DISTRICT' ,. ./SUBDIVISION LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER PARCEL NyyMBERL.cy/� /r/ 6 1 / a SECTION PLANNING AREA SECT I ON A- TOWNSHIP 30 NORTH RANGE o76--( ) WM BUILDING INFORMATION BUJ DING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGc I NGLE FAMILY ❑ NE -EU I LD I NG MAIN FLOOR (( / ❑ MOBILE HOME DDITION 2ND FLOOR ❑ MODULAR HOME ❑ ALTERATION BASEMENT ❑ DETACHED/ATTACHED ❑ REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER or UNITS OR I LE HOMES ❑ COMMERCIAL S[ � � ���'^ S J $3 5 % AVD ❑ 1 NC"USTR 1 ALYEAR �f ❑ HOTEL/MOTEL/DORMITORY MAKE__- -- �J ,� $B6 NUMBER OF UN1TSB_ OTHER - SPECIFY < 0 @ $8 ❑ ES T I MAT , COS OF I mrno rMENTS TOTAL F R- MARKET VALUE UBC OCCUPANCY GROUP $ $_ EZ ' SELECTED CHARACTERISTICS OF BUILDING PR 1 G/I PLE TYPE OF FRAMEPR I Nx 6 PLF_ TYPE OF HEATING FUEL, WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR ❑ MANUFACTURED ❑ 3':'OOD3TOVE ❑ PASSIVE SOLAR O STRUCTURAL STEEL ❑ GAS 0 COAL O REINFORCED CONCRETE I 0 OILT 0 OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS ^ ❑ OTHER - NU ,WER OF STOR I ESc72 TOTAL LAND AREA- ,J0 DEPARTMENTAL REVIEW _ __ _ HEA TH D yPARTMENT TYPE OF `SEWAGE DISPOSAL NUMBER OF PROFOSED BE TIOOMS, i JI r// L/ P B IC OR I VATEve .NIUMBER OF EXISTING BEDROOMS J I11����� 4 ( DIV I DUAL ( SEPT 1 r NUMBER OF PROPOSED BATHROOM APPROVED DATE I ND 1 V I DUAL ' ELL NUMBER OF EXISTING BATHROOM , PUD 4 TYPE OF WATER SUPPLY /'J - ❑ PUBLIC ( NAMEOr WATER SUPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY) �a: � PLANNING DEPT . WIT I'd SHORELINE JURISDICTION YES NAME OF ADJ - GENT1QER BODY 0 NO /_ i I APPROVED DATE BANK FIE I GHTI(67,� SETBACK cX PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO IDENTIFICATION _ �..,-....,,.- _. _.NAME M .- G ADDRESS ZIP T E L NO . -..._,,,.... ....•..,•... OWNER a ' CONT .I _ IIIIII ARCH 1 THE OW R OF THIS BUILD NG AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS SIG UJ'IE 0 P L CAS .. ..PPE t '�T f O nE2(7IB R CkiECK-�BER R CASH AP i)PW'd0 i®M. BY Bd _C� BASE: jI T FEEZ IC'' / L FEE INSPECTION CT I I ------ BL D G SURCGE PLAN CHECK 1 _ I-L^..R eG J, ERSnN COUNTY _ , ENERGY SURCHARGE PLANNING&BLDG DEPT - .‘ n' TOTAL _„ ,.,� ���91 I NUMBER REFUND DATE D BUILDING OFFICIAL _ _ __� i VeCi ;1 4 \40Asotte Z'Nlipa.- &BLDG DEM r ,,--..?„ / -e/.5,4, - 7r.;--- itz-----/A-/-01 1 et., "4""it i 4 I '17 1\ ecli $ .. . , - )--1;k.„( 0 _ Ate) _..... ._ , 41- cs--- . . 5/64f 6'... .' -'''''' -``'".".......".....r-.....r. .---a. ........."" " • L. ) %__ -- tar-.. , -.4,_ - •CA0....)4.- - c$, 410 ------ . cfr: ..1 '\\ Ail P-i NO 1---331,4-1--- , Z._ iia % I 16) led4//v a) 41/517 )74-