HomeMy WebLinkAboutBLD1989-00520 (3U?'' DING „ 'ERMIT APPLICATION
Jefferson County BuildiniDepartmentoP .O . Box 1220*P•t Townsend. WA 98368
LOCATION
in
I SPECIFIC LOCATION SITE ADDRESS
/0 ,__- ,,
POSTAL D I STR I CX 1 /S.LI BD I\-iS ION (JC,i,Qr/T- F' :5 t'0 jt<�.w.-1j
LEGAL DESCRIPTION LOT BLOCK DIVISION�� W TAX NUMBER
PARCEL NUMBER 95 I IO I �a�J0•5✓Y/yI / 4 SECTION
PLANNING AREA SECTION •.;,( _ TOWNSHIP NORTH RANGE ' WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMrROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0N-EW BUILDING MAIN FLOOR
❑ MOn I LE HOME (� AoD I T ION 2ND FLOOR
❑ M ULAR HOME ❑ ALTERATION BASEMENT
ETACHED/ATTACHED ❑ REPAIR CARPORT .
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEPMOLITIONCOMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL ' / a@ $35
SIZE
❑ INDUSTRIAL
YEAR -�- @ $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $8 c :5! °
NUmPr-R OF UNITS
❑ OTHER - SPECIFY $8
ESTImi) D COST OF G�
I MP¢ SV EMENTS TOTAL, FA 17' MARKET VALUE
UBC OCCUPANCY GROUP $ - $ }-2 2L I
SELECTED CHARACTERISTICS OF BUILDING
PRI IPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME 0 ELECTRICITY 0 COLLEC SOLAR
O MANUFACTURED ❑ WOODSTOVE SIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
O REINFORCED CONCRETE ❑ O ❑ OTHER - SPECIFY
i ❑ MASONRY ( WALL BEARING ) DIMENSIONS
�
❑ OTHER - NUMBER OF STORIES_ TOTAL LAND AREA
" DEPARTMENT AL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM
❑ P LIC OR PRIVATE NUMBER OF EXISTING : z •• S
I I V I DUAL ( SEPTIC ) NUMBER OF rA• .zED BATHROOM
APPROVED DATE 1 ND I V I DUAL WELL i = - OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLYL�
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES N E OF ADJACENT WATER BODY
NO
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 0 YES 0 NO
IDENTIFICATION
NAME MAILING A I-V E S S ZIP T E L NO
y
0WNER l J .~/•' /� �/d �! �/ .r}l .�/' x r �
_
GOUT
�-----: STAI E L 1 C.rRT���
ARCH
r ,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S P{A*URE OF APP CAN'S .. APPL CATION DATE RECEIPT NUMBER CHEC}C NUMBER OR CASH
I
/I 9/&7 5°173 ICD(.00
A VED BY P RMIT FEES
AP 5 G,
y' BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE Q ._j TOTAL
JEFFERSON COUNTY P
PI.,MtNINi;&DWG DEPT
911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
M
•
_
•
_I,
!/
r `
//
__ 1
A Ov ED
3
EFF +COU
P!.ai, IN &8LDG DEP
7/2 L7(///,
/JJ </_-