HomeMy WebLinkAboutBLD1989-00401 t,''TLDINO PERMIT APPLICATION
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Jefferson County Building Department•P .O . Box 1220+ jrt Townsend. WA 98368
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LOCATION
SPECIFIC LOCATION' SITE ADDRESS ()72.7 �I�PE GEcf2CC Rb ,
POSTAL DISTRICT (2 1 /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIV ION TAX NUMBE
PARCEL NU ER l.)® `- 1 / 4 SECTION
Pi, SECT I ON3_ TOWNSHIP ZO NORTH RANGE ! w' WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY i• NEW BUILDING MAIN FLOOR 14
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR ( LS '2.V
❑ MODULAR HOME ❑ ALTERATION BASEMENT --
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT --
GARAGE ❑ REPLACEMENT , GARAGE Lt40
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
q466
❑ COMMERCIAL MOBILE HOMES
❑ INDUSTRIAL SIZE $35 �1
•
YEAR @ $ 16 ' / C
❑ HOTEL/MOTEL/DORMITORY
NJ NUMBER OF UNITS MAKE-"_ 0 @ $8 35: -C�
\°' ❑ OTHER - SPECIFY 0 @ $g
ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MA KET VALUE
UBC OCCUPANCY GROUP 5
$ $
V s
NI SELECTED CHARACT ISTICS OF BUILDING
`�... PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
74, WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED OODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - _ NUMBER OF STORIES 2, TOTAL LAND AREA Sf1L„
1 DEPARTMENTAL REVIEW
1
/LTH TMENT TYPE OF SEWAGE D I SPOSA I, ' BER OF PROPOSED BEDROOMS 3
) O ❑ PUBL I C OR PR I VATE `� " MBER OF EXISTING BEDROOMS
l ((( gi I ND I V I DUAL ( S E P T I C 91 NUMBER OF PROPOSED BATHROOM).i
APPROVED DATE
- ,7 ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
v"' PUD TYPE OF WATER SUPPLY '\ - _,_,r
CT- (isi, PUBLIC ( NAME OF WATER SUPPLY) (t A..
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY) (
Q) PLANNING DEPT . WITHIN SHORELINE JURISDICTION
1 A [1 YES NAME OF ADJACENT WATER BODY
C bl---- [, NO
APPROVED DATE
BANK HEIGHT SETBACK
PU L C 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 mow_ MAILING ADDRESS I ZIP TEL NO
tk` � � 0 P is kk;at�Cp�F 0, SOK !C4 Pc RT i..QDL Cc,) r tA.)P 92.3c3 tt3`7-z.L3?
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CONT .6gp.1,
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HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
-IGNATURE OF APPLIJ:ANT APPLICATION DATE RECEIPT NUMBER CHEC NU OR CASH
APPRO ;QED BY , PERMIT T -' ES
A P P D W —' BASE FEE INSPECTION
AUG 2 1989 ( f BLDG SURCHARGE PL CHECK
v ENERGY SURCHARGE
TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEPT 9 I I NUMBER I REOUND DATE 4T I SSI/FrD„_.`
BUILDING OFFICIAL. P
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