HomeMy WebLinkAboutBLD1989-00374 IFUILDING i'ERMIT APPLICATIO* ,.
Jefferson County Building DepartmentrT .O . Box 11,17Tort Townsend. WA 98368
r . . .
SPECIFIC LOCATION7 SITE ADDRESS 4 ,, a_.1,.e/t_) aWei__ d •
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISIO1 TAX NUMBER
PARCEL NUMBER 877 ac ,2, - 1 / 4 SECTION
PLANNING AREAL_ SECTION Ce TOWNSHIP NORTH RANGE / WM
BUILDING INFORMATION
BUILDING TYPE TYP OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY [ NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULA-R__,HOME 0 ALTERATION BASEMENT
0---DICIACHg114ATTACHED 0 REPAIR CARPORT
,-. ----
GARAGE 0 REPLACEMENT GARAGE C9-4Z)0-7t
D WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
... . NUMBER OF UNITS -——
\.)
-• 4DBILE HOMES
\„) 0 COMMERCIAL
SIZ,4
O INDUSTRIAL
0 @ $35
YEAR 0 @ $ 16
0 HOTEL/MOTEL/DORMITORY __.
MAKE //S-, 0 @ $a
NUMBER OF UNITS Nov
a--- 0 OTHER - SPECIFY r .•.
ESTIMATr'd COS OF 0 @ $8
‘.>0 IMP e EMENTS - TOTAL„_n MARKET VALUE
sC3' UBC OCCUPANCY GROUP ...404 $ (--/--,"
i4 - ' aid -----
SELECTED CHARACTERISTICS OF BUILDING
- —
-Z.) PRI LE TYPE FUEL
PR CIPLE TYPE OF FRAME OF HEATING
WOOD FRAME 0 ELECTRICITY COL IVE SOLAR
0 MANUFACTURED 0 WOODSTOVE AS SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 0 0 OTHER - SPECIFY
--- _ __ -------c-
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - , NUMBER OF STORIES TOTAL LAND AREA
-------
DEPARTMENTAL REVIEW .
HEALTH DEPARTMENT TYPE Or SEWAGE DISFOSAL NUmBER or pRorOsED BEDROOMS _.--4-
27DL 'C OR PRIVATE
I IVIDUAL ( SEPTC ) NUMBER OF EXISTI
kiii4 NG OOMS
NUMBER or P',' :-. ED BATHROOM
APPROVED DATE
L INDIVIDUAL 7!ELI, NU : OF EXIEMNG BATH
PUD YEE OF WATER SUPPLY
O PUB , C ( NAME OF WATER SUPPLY
APPROV D DATE 0 PRIVATE AME' OF WATER SUPP
PLANN NG DEPT . WITHIN SMORELIr- JURISDI ON
/11//
1:-.7)I
O YES NAME CF ADJA AT WATER BODY
DUO
APPROVED DATE BAN EIGHT SETBAC1 ---....
—-----
. .
PUBLIC WORKS DEPT OAD RIGHT-OF -WAY WIDTH
NAME Or PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED n yES 0 NO
. -----
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
--........ --...
OWNER LL --c,2--Y7-ze -422--.)6
, -----
CONT
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-g-TATZ LiLi, 7T0 I
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—-- --------
ARCH
----
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
7
SI A RE OF PPL ANT APPLICA I ATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVED BY PERMIT FEES
APPAQVED 111_,_ BABE FEE INSPECTION
0 C JgF ; ., ilei•, I -- 64) BLDG SURCHARGE PLAN CHECK
50 ERtAMINTY- ---- ENERGY SURCHARGE $ ) al
. TOTAL
Rwmr,1810GDEP7 l
911 NUMBER REFUND DATE DAT ISS ED
...... .,-*-.,..,-*
BUILDING OFFICIAL 10 V ? 4
# PP Vika)\i.
17
COUNT'V
411ANNING &Si%We
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