HomeMy WebLinkAboutBLD1989-00402 •ILDING )ERMIT APP!ICATION
Jefferson County Building DepartmenteP .O . Box 122• ort Townsend, WA 983 8
LocAT o A , r if . Pc. ��@@ 2 i&/J w J
SPECIFIC LOCATION SITE ADDRESS C44JC'4De IA )/E
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT zo. BLOC CIE 1S` DIVISION, .TAX NUMBER
PARCEL NUMJpER 9q® 7 oa 4 a 1 / 4 SECTION "
PLANNING AREA SECTION /( TOWNSHIP NORTH RANGE J� J, +NM
BUILDING INFORMATION
-. .. e
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
NI SINGLE FAMILY ® NEW, BUILDING MAIN FLOOR /331.
❑ MODILE HOME ❑ ADDITION ZND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT `i-S —
❑ DETACHED/ATTACHED 0 REPAIR CARPORT .----
GARAGE 0 REPLACEMENT GARAGE 4/90 _,
O WOODSTOVE ❑ WRECKING/DEMOLITION I COMMERCIAL 4--
❑ MULTI - FAMILY 0 RELOCATION/MOVING ' INDUSTRIAL - .
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES ,-f M ,51:1
SIZE �'U CLl $3�
0 INDUSTRIAL
❑ HOTEL/MOTEL/DORMITORY YEAR .( q� 16
NUMBER OF UNITS MAKE l T0 p� 8 �-rJ
❑ OTHER - SPECIFY ! rl 8
ESTIMATED COST O. _- l�j a
IMPROVEMENTS TOT FA {L iATET VALUI
UBC OCCUPANCY GROUP $ 1�
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
A WOOD FRAME X ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 50 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY _,:„__,
, %6 0 MASONRY ( WALL BEARING ) DIMENSIONS ..... _� /�
❑ OTHER - NUMBER OF STORIES r TOTAL LAND AREA2 G e) STET.
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BE{77OC:.K.9S
\. PUBL I C OR PR 1 VATE NUMBER OF EXISTING BEDROOMS
❑ I ND 1 V I DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
T-- PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE PRIVATE ( NAME OF WATER SUPPLY '
--- PLANNING DEPT , WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
- ❑ NO
CO APPROVED DATE BANK HEIGHT - SETBACK fmm
� PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH ----
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD ...m._..- —
—,
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
.-.—.2
NAME MAILING ADDRESS .., Z P� TEL NO
OWNER
DI11 4,9n rIP�f ton A Pry rad is P .32_
CONT , P(-p
STATE Li CEINO I
ARCH
. .. a -- ,
i _
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS
a IGNATU E 0 P_PL ANT APPLICATION DATE RECEIPT NUMBER ( CHECK NUMBER OR CASH
. ti- � 0 2
7
Y M 1 T FEE''
e "i l c?c vY BASE FEE INSPECTION
JEFf 9 V 3 t55 BLDG SURCHARGE PLAN CHECK
p(44 Iy�gSON c,,,
&8 g,P,Nr T I 5 c ENERGY SURCHARGE 1....L� 51 `l-)O TOTAL
9 I I NUMBER REFUND DATE DAT IS
BUILDING OFFICIAL '�j� 7 7
APYED
1980
ERSON CORY
PUNNING&SLOG OPT
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