HomeMy WebLinkAboutBLD1989-00388 l'iLDING , 'ERMIT APPLICATION
Jefferson County Building Department'P .O . Box 12201Fort Townsend. WA 98368
LOCATION 44117/.00K: . r
1 °
SPECIFIC LOCATION SITE ADDRESS
POSTAL D STRICT ../SUBDIVISION
LEGAL DESCRIPTION LOT 4° BLOCK / DIVISION TAX NUMBER
( / PARCEL MBER 1'73 M 00 1 / 4 SECTION
PLANNING AREA -7 SECTION - TOWNSHIP „._:zetNi NORTH RANGE , ,_.. WM
BUILDING INFORMATION
BUILDING TYPE TTYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 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 I COMMERCIAL
O MULTI - FAMILY J RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL SIZE Q X 40 0 @ $35
O INDUSTRIAL
YEA ' 16140 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
mAKEg11.1,CIZCS-1 0 @ $8
NUMBER OF UNITS
O OTHER - SPECIFY 0 @ ro
! ESTIMATED COST OF
i IMPROVEMENTS
TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROl 1
1,
SELECTED CHARACTERISTICS OF BUILDING
Cr"), PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME M ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
L--- 0 STRUCTURAL STEEL 0 GAS 0 COAL
Cr0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
! 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPAFTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS k
OPUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
a,-IND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM 1 .
APPROVED DATE
0 INDIVIDUAL WELL Z fumoKrz OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY .
-a,PUBLIC ( NAME OF WATER SUPPLY
,.., -
APPROVED DATE Li PRIVATE ( NAME OF WATER SUPPELL
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
60 0 YES NAME OF ADJACENT WATER BODY
eti
?Z(NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
I NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
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)'9 IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO .
C7 OWNER _Th, 9$339 -091'7 Qcoa., 9 fAct_nch c .A ve_. H
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THE/ ER OF IS BUliLDIAG AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,N/(9
SIG TURE OF AVM. APPLICATIO DATE RECEIPT NUMBER CHECK NUMBER OR CASH
iii"1-'.0 • _ 08/2,39 41,, 3_I 5 70
APOR VED 13 ' PERMIT FEE
A P V 75 .CO BASE FEE I NSPECT I ON
G2 b 0 BLDG SURCHARGE PLAN CHECK
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- ,-/ cr (-4)JEFFERSON COUNTY ENERGY SURCHARGE $ TOTAL
PLANNING&BLDG DEPT 9 1 1 NUMBER REFUND DATE DATE ISS
BUILDING OFFICIAL
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AU 25199
JEFFE'SON COUNTY
PLANNING&BLDG DEPT
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