HomeMy WebLinkAboutBLD1989-00523 .f
•LDING, 'ERMIT APPLICATION
Jefferson County Building Department"'P .O . Box 122•ort Townsend. WA 98368
LOCATION . a `�
SPECIFIC LOCATION SITE ADDRESS /� ���/ � `� � .' I
POSTAL D :STRICT__? /S�JBa 1SION
--,
LEGAL DESCRIPTION LOT � ,BLOCK tDIVIS ON TAX NUMBER__
PARCEL NUMBER � 16 59/ (b 1 / 4 SECTION
PLANNING AREA SECTION c,, TOWNSHIP '",la NORTH RANGE WM
„....2)--
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
V\-1 ❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ❑ ADDITION 2ND FLOOR
,+ 0 MODULAR HOME- 0 ALTERATION BASEMENT
_,. 0 DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
�/ ❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL"
tc) 0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
�-„ NUMBER OF UNITS MOBILE HOMES �1
t 5, ❑ COMMERCIAL S 17.E ,, $3 5
Q 0 INDUSTRIAL 0 HOTEL/MOTEL/DORMITORY YEAR N@ $ 16
MAKE fI @ $g
NUMBER OF UNITS OTHEf - SPECIFY EST I M ED COST OF 0 @ $°
LL0 IMPF VEMENTS OTAL FAIR MARKET VALUE
UBC OdICUPANCY +C UP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - 4 NUMBER OF STORIES TOTAL LAND AREA ,
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED flFDR
❑ PUBLIC OR PRIVATE NUMBER OF EXIST DROOMS
A ❑ INDIVIDUAL ( SEPTIC ) NUMBER OPOSED BATHROOM
APPROVED DATE illIP" ❑ INDIVIDUAL WELL R OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
t. ❑ PUBLIC ( NAME OF WATER SUPPLY)
kh- PR VED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
Q � 110
❑ YES NAME OF ADJACENT WATER BODY
„� ;: Ifs ).' V ❑ NO
S
APPROVED DATE BANK HEIGHT SETBACK
PUB 1 ' 'ORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
-- NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
C IDENTIFICATION
NAME e-. MAILING ADDRESS ZIP TEL NO `
OWNER —�'/J�1//\ 1 { r ..± may. '^`� R.:
�....-,1.. _
CONT - _
<s� / J SIXILL I L c i3"`a -
•
ARCH 6 .
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THE0R OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
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A1,j''LICATiOF -DATE RECEIPT NUMBER CHECK NUMBER OR CASH
d ,.P D BY PERMIT FEES
BASE FEE INSPECTION
D r BLDG SURCHARGE PLAN CHECK
�I
r AU ENERGY SURCHARGE ' .
i ,• TOTAL
JEFFERSON COUNTY ,
PLANNING &tIDG DEPT 9 I 1 NUMBER REFUND DATE 1TV7721
BUILDING OFFICIAL
I
APPROVED
AUG 8 1989
JEFFERSON COUNTY
p!AN:N1Ni &BLDG DE7I
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