HomeMy WebLinkAboutBLD1989-00391 BUIL TNG ; 'ERMIT APPLICATION
Jefferson County Building partment.P .O . Box 1220•Por Townsend. WA 98368
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LOCATION / r� � ✓✓� � �
SPECIFIC LOCATION SITE ADDRESS / 3r�� ( v 4C , /,70C )(2,( .4.-e.
POSTAL DISTRICT /Y) 1_ /SUBDIVISIONVVIQtt�,
LEGAL DESCRIPTION LOTT /3 BLOCK L DIVISION TAX NUMBER
PARCEL NUMBRY 9,$/00d.5"/3 1 / 4 SECTION
PLANNING AREA, 5 SECTION 27/ 9? TOWNSHIP "Z 't/ NORTH RANGE_/. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
0 MOBILE HOME s ADDITION 2ND FLOOR
0 MODULAR HOME ❑ ALTERATION BASEMENT
;", DETACHED/ATTACHE.D 0 REPAIR CARPORT .51
ram- e.a...9ack.41-/,511ap ❑ REPLACEMENT GARAGE
❑ WOODSTOVE VX_31 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES
0 INDUSTRIAL SIZE fZ] q`) $35
YEAR 0 &l $ 16
0 HOTEL/MOTEL/DORMITORY MAKE ;a/ $8 50e�
NUMBER OF UNITS
❑ OTHER - SPECIFY 0 @ $8
ESTIMATED COST OF
IMPROVEMENTS TOT `I)F2 MARKET VALUE
UBC OCCUPANCY GROU�}J $ $ Q
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
(-- WOOD FRAME 0 ELECTRICITY 0 COLLECTI„V£"-OLAR
0 MANUFACTURED 0 WOODSTOVE ❑ _F A&ST✓VE SOLAR
---' ❑ STRUCTURAL STEEL 0 GAS �---"J COAL
�J 0 REINFORCED CONCRETE ❑ Off.-Lr 0 OTHER - SPECIFY
O0 MASONRY ( WALL BEARING )
�.,DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
,,.V HgA TH D PARTME T TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
`y ,J� �i.4,1 T Q IL_ :, 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
u;
INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVE' DATE
❑ INDIVIDUAL WELL_.�o..`._® NUMBER OF EXISTING BATHROOM
PUJ� TYPE OF WATER SUPPLY
At �r 0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLYI—
W) PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
^3 ,
XNO
APPROVED DATE ) BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
4 174)-- NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
—• NAME MAILING ADDRESS ZIP TEL NO
OWNER +— a`
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STA T . LICENSE NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE{ O/fF APPLICANT 76,APPLICATION ���l 0_1 ON DATE I R�Ej,.PT N1,IMBER I CHECKOR CASH
OP.:',,,:‘
APPROVED BY PERMrI T ,FEES
A Ilf BASE FEE INSPECTION
p0 I. 3 ,cs� ,) BLDG SURCHARGE PLAN CHECK
Y T
' P 40/? ENERGY SURCHARGE d [�� J TOTAL
't4IV NG Jk COr 1 9 1 1 NUMBER REFUND PVDAJTE D?7i
�NNG I TICIAL � �f
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APP QED
JEFFERSON COUNTY
PLANNING&SLOG DEPT
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