HomeMy WebLinkAboutBLD1989-00375 LAILDING ''ERMIT APPLICATION . '
Jefferson County Building Department P .O .� Box 122O Vort Townsend, WA 98368
L.00AT 1 ON l
SPECIFIC LOCATION SITE ADDRESS }'✓A`-'`D �L�?
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIV1 ION
TAX NUMBER
L'
1 1 4 SECTION
PARCEL NUMBER D( /" � /
G ,TOWUSH 1 P c%� NORTH RANGE WM
f�.. PLANNING AREA SECT I ON 7
'1
,.
BUILDING INFORMATION _ _
BUILDING TYPE T -E OF IMPROVEMENT SQUARE FOOTAGE
❑ INGLE FAMILY Wi EW BUILDING MAIN FLOOR
w' MOBILE HOME / ❑ ADDITION ZND FLOOR
3 ❑ • • r HOME ❑ ALTERATION BASEMENT
! . ATTACHED 0 REPAIR CARPORT
�.d GARAGE 0 REPLACEMENT GARAGEX
tKD WOODSTOVE 0 WRECKING/DEMOLITION ! COMMERCIAL
(-, ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
�.. NUMBER OF UNITS BILE HOMES �{
0 COMMERCIAL ; a $35
0 INDUSTRIAL❑ HOTEL/MOTEL/DOnMITORY MAKE YEAR _ T- q� $ 16
7� @ $ 8 /�t1tJi
NUMBER OF UNITS
0
OTHER - SPECIFY EST I l7AT ,D CO OF
$8
1ldFI' Ef7E;PITS TO7 FA1- MARKET VALUE
UBC OCCUPANCY GROUIjj ,./ $ $ /L/����
SELECTED CHARACTERISTICS OF BUILDING /
PRINCIPLE TYPE OF FRAME
P I PLE TYPE or HEATING FUE, -"
[/WOOD FRAME 0 ELECTRIC 0 COLL 1VE SOLAR
❑ MANUFACTURED 0 WOODSTOV ' S I VE SOLAR
❑ STRUCTURAL STEEL 0 GAS ,/-- ❑ COAL
❑ REINFORCED CONCRETE 1----;)-..--g4 ' 0 OTHER - SPEC FY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREAS L
DEPARTMENTAL REVIEW
— HEALTH DEPARTMENT TYPE OF SEWAGE D t ;POSAL NUMCE - PROPOSED BE
0 PUBL I C OR PR I VATE /id• NUMBER OF EX I - EDROOMS
�N D I V I DU^�,L ( S E P"r I C ) NUMBER OF POSED THROOM
APPROVED DATE ( t{D 1 V 1 DUAL WELL )14-BEErF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
V) ❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE L.i PRIVATE ( NAME OF WATER SUPPLY �.
-
PLANNING DEPT . WITHIN SHOF LINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
cl.-‘' --
APPROVED DATE BANK HEIGHT _ SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-or - Ay WIDTH
NAME of PUBLIC ROAD
NAME OF PRIVATE ROAD „
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
NAME
MAILING ADDRESS ZIP T E L NO
OWNER , R q8 �
CONT 1
STA !=i ' L 1 tl'd 'IUD
ARCH --
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED nCREE TO CONFORM TO ALL APPLICABLE LAWS,
/ SIZRPPLIcAN
APPLICATI I ATE ,. REC,E�IPT ER I jCHECKUUMD E OR CASH
APPR V D BY
P I T FE°E
A �, BASE FEE INSPECTION
Gov
QC ' �. BLDG G SURCHARGE / PLAN CHECK
tENERGY SURCHARGE $ 1L6v TOTAL
PUNNING& TaUNTy� g�
SLOG OEpT 9 1 I NUMBER REFUND DATE /Vjf6� /
BUILDING OFFICIAL
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ON COUNTY
PLANNING&BLDG DEPT
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