HomeMy WebLinkAboutBLD1989-003971
LIDDING 6..'ERMIT APPLICATION it . \
eP :O .° LJX 1220' 'ort Townsend . WA 98368
Jefferson County Bu � ld � ng Departrne. rr t
1
0 LOCATION
SPECIFIC LOCATION SITE ADDRESS a 7 )(- -----.
POSTAL DISTRICT��VV , /SUBDIVISION
LEGAL DESCR I PT I O LOT CC BLOCK �� D 1 v F I OF TAX NUMBER
6 / % `E'°° Qc- PARCEL NUMBER1 in : / 4 SECTION
PLANNING -AREA SECTION ci TOWNSHIP NORTH RANGE K WM
BUI DING INFORMATION
BU LDING TYPE TYPE IMPROVEMENT SQUARE FOOTAGE /�
SINGLE FAMILY 0 N BUILDING
j;/� /MAIN FLOOR � l`
,� ❑ MOB I LE HOME ADDITION b-t7LI Y,/ / 2ND FLOOR
❑ MODULAR HOME 0 ALTERATIOP (/ BASEMENT
a ❑ DETACHED/ATTACHED ❑ REPAIR /101 I,,y., CARPORT
GARAGE ❑ REPLACEMEUT LJ ` GARAGE
<Th ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS f
c' lqr n ➢ LR: HOMES
O COMMERCIAL SIZE 0�V, @ $3 /5 .c
❑ INDUSTRIAL YEAR , 0 `a $ 1 6
❑ HOTEL/MOTEL/DORMITORY [�t $B
CY- NUMBER OF UNITS MAKEJ
❑ OTHER - SPECIFY ESTIMAT . . COST OF 0 @ $6
( 1MPR EMENTS TOT F I .MARKET VALUE
UBC OCCUPANCY GROUP; R $ / S
SELECTED CHARACTERISTICS OF BUIL NG
PRI CIPLE TYPE OF FRAME
PR1 C➢'PLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
O REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
•
❑ OTHER OF STORIES TOTAL LAND AREA
NUMBEi�, '
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYP F SEWA07 DISPOSAL NUMBER OF PROPOSED BEDR
r ) PUBLIC OR PRIVATE NUMBER OF EXIST! DROOMS
,� � \- 'd ❑ I NU 1 V➢ uAL. ( EEP7 1 G ) NifJ[+tBER 0➢�- ��ED BATHROOM
APPROVED ATE ❑ INDIVIDUAL I-I.,..._„� . P R OF EXISTING BATHROOM
1
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLYa
APPROVED DATE 0PRIVATE ( NAME OF WATER SUPPLY
t' 1 PLANNING DEPT . WITHIN SHORELINE JURISDICTION
(�"` ❑ YES NAME OF ADJACENT WATER BODY
��11 NO
pv.
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD --
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER r �A -
r1 J
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)1e. '� e43
C:ONT 1 LJ� L K
u ► vz• v\ & r51 6
0
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGN OFAPPLICANT -er I CAT I OI A' FRE P N JMB R NECCS( !C EF2 ,OR CASH_~
AP O •7Ga.'F BY PEF IT F II
' 8a:SE FEE I NSF'ECT I ON
a
•` 17179 41 BLDG SURCI IARGE PLAN CHECK -
C-VJEFFERSON COUNTY ENERGY SURCHARGE $ _,/ TOTAL
C
PLANNING&BLDG DEPT
REFUND DATE D(2
911 NumBER I { T
BUILDING OFFICIAL /1 S
11
pROVE kNNING&BLDG DEP I
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