HomeMy WebLinkAboutBLD1989-00525I , 111LDING iERMIT APPLICATION di .
Jefferson County Building Departmentl7P .O . Box 9836 .
12207ort Townsend. , WA
LocATIpTi
4Wr SPECIFIC LOCATION LOCATION SITE ADDRESS —
POSTAL DISTRICT /SUBDIVISION
__ - __9 s-5?t_f_
LEGAL DESCRIPTION LOT 45nULOCK DIVISION TAX NUMBER
_
(-) PARCEL NUMBER 06/14-4,-/-oo- .--- 1 / 4 SECTION
PLANNING AREA SECTION ___TO H WNSIP —?.0 NORTH RANGE /64i WM
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BUILDING INFORMATION —
....--
FILDING TYPE T pg OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY NEW BUILDING MAIN FLOOR
0-1 MOBILE HOME 0 ADDITION 2 ND FLOOR 8 70
,-
,-- . 0 MODULAR HOME 0 ALTERATION BASEMENT S—2,
0 DETACHED/ATTACHED 0 REPAIR CARPORT
---
GARAGE 0 REPLACEMENT IGARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
4.:
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
— .
NUMBER OF UNITS
(„1 0 COMMERCIAL ---- TBILE HOMES
Of 3 tfC
YEAR 6)2 0 VIJ @ $ 1
O HoTEL/moTEL/DoRmiTony, _ ,
NUMBER OF UNITS
O OTHER - SPECIFY
EST1M ED CO, OF
------ IMP VEMENTS TOT L FAIR MARKET VALUE
use OCCUPANCY GROUP _
...- '
r"----
SELECTED CHARACTERISTICS OF BUILDING
- _
PRINOIPLT TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
ii1)6.1
WOOD FRAME ELECTACITY 0 COLLECTIVE SOLAR
MANUFACTURED _ 'WOoDSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL ;KOTHER - SPECIFY
O MASONRY ( WALL BEARING ) DimuN, /or;s
0 OTHER - _—_ NUMBER OF STORIES 2-( TOTAL LAND AREA5;241
V—) .
DEPARTMENTAL REV I EW Atcrr ..X.Iri•Aett >
N, _.....__
HEA T H DEPARTMENT
TYPEv'.h.•.)
, OF
SEWAGE DISPOSAL._ NUMBER OF PROPOSED BEDROOMS 3
I120PURL OR PRIVATE NUMBER OF EXISTING BEDROOMS
- 3 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 3
APPROVED DATE . INDIVIDUAL WELL NUMBER
OF EXISTING BATHROOM
arielarr
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME C! 'V:ATER SUPPLY)
APPROVED DATE
1110(i 0 PRIVATE ( NAME OF WATER SUPPLY) ,„=„Imm=mmommmm c-s — PLANNING DEPT .
_, WITHIN SHORELINE JURISDICTION
0 (c p ut c\,r1 )XYES NAME OF ADJACENT WATER BODY
.,/
--......*
-, /(t6 t tl 0 NO
APPROVED DATE 44— BANK HEIGHT SETBACK
.-„. PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
4,) NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES 0 NO
---__ --_—_
IDENTIFICATION
4
NAME PIAILIVG ADDRESS ZIP TEL NO
-
OWNER 1
W-
............ „ N - 6 (/8
BEAMS -
. .
CONT - C.i 38.r_viyi
---- --g-TwiL LF7-7=-7
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO cowrowl TO ALL AprLic,v3LE LAWS,
GNATURE APPLI ANT
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- APPLIC TIOI DATE RE El PT NumEmn CHECK NUMSERXT CASH
2
A R BY PERMIT rEas
BASE FEE A P P E , _-- INSPECTION
----- _ _- _ _Y
515 BLaG SURCHARGE PLAN CHECK
1
. ENERGY SURCHARGE
—_-- TOTAL
JUFEWMCOMY
MANYNG&MGDEPT /° ---
9 1 I NUMBER REFUND DATE pik E IS D
BUILDING OFFICIAL )1 C(
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