HomeMy WebLinkAboutBLD1989-00526 I3UILG 'ERMIT APPLICATION A��
Jefferson County Building Department0P.O . B-ox 1220•Por rnsend . WA 98368
LOCATION �a
SPECIFIC LOCATION SITE ADDRESS F / Acr.C,i-fo/lr L, ] R ,1
A POSTAL DISTRICT �y7 /SUBDIVISION h
LOT 2 YYY ••, TAX NUMBER 1-
LEGAL DESCRIPTION d___ PARCEL NUMBER5/ ! Sn��DIVISION J 1/0 / a SECTION
PLANNING AREAja SECTION /� • TOWNSHIPc.2 NORTH RANGE V WM
•
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR !
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENTI
gl/DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE WRECKING/DEMOLITION -1E-
❑ WOODSTOVE 0 ®•
c—
ECKING/DEMOLITION ' COMMERCIAL .❑ MULTI - FAMILY REs OCAT ION/MOVING INDUSTRIAL "'— 4 (:)4� �r J '- -��
NUMBER OF UNITS i 1
MOBILE HOMES $35
❑ COMMERCIAL SIZE
❑ INDUSTRIAL YEAR / @ $ 16 _ )
O HOTEL/MOTEL/DORMITORY MAKE 3�t @ $8 1
NUMBER OF UNITS /
❑ OTHER - SPECIFY ESTIMATED COST OF LJ @ $a
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP f ? �;"5 $ c�f "4 .4 D
SELECTED CHARACTERISTICS OF BUILDING
`"'Y
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
WOOD FRAME ❑ ELECTRICITY ❑ COL E SOLAR
O MANUFACTURED 0 WOODSTOVE ASSIVE SOLAR c'. :•
❑ STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 O -L ❑L OTHER SPECIFY C\
O MASONRY ( WALL BEARING ) j DIMENSIONS 24-,X 2.$ A�
t 0 OTHER - NUMBER OF STORIES 2 {,
TOTAL LAND AREA' `'
N.
Z.
DEPARTMENTAL REVIEW N
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS Z
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS ` .e
El INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
)43
APPROVED DATE ❑ I NO 1 V I DUAL WELL NUMBER OF EXIS'TiE J BATHROOM `p'
PUD TYPE OF WATER SUPPLY 4
O PUBLIC ( NAME OF WATER SUPPLY) li,o1 ‘
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY NJ
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY kev 4
z
❑ NO (�I
APPROVED DATE BANK HEIGHT SETBACK \I
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD I
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑, NO 4
IDENTIFICATION NI
MAILING ADDRESS ZIP TEL NO
NAME i
OWNER 51701JNE S I SNE:p c e /,o. 80•>e e 2's. .cif 4.4,e rd s=:4 4,- (A)A , I ",3— 957-g
CONT ,e,eff Nest-'--
r 'STATE LICENSE NO I
r,.
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. y
SIGATUREfOF A.V.1pL III CANTK APPL I AT►ON DATEI REC I,+/P^/(��/TJy//y/�JN UM/BBB EAR CHECj/1K
C-/^NUMBER R CASH
4s A Z. �..d Cf'Fj rif.Y + '/ // / i" (! LJ I ! Gam/t� �I
AP ROVED BY PERMIT FEES��''}}
iv * , 00 BASE FEE INSPECTION
A P R Y E �� BLDG SURCHARGE
PLAN CHECK
3 9
ENERGY SURCHARGE /-2 JF � TOTAL
JEFFERSON COUNTY 9 II NUMBER REFUND DATE6 f DATE IS uED
PLANNING &BLOCG_ T
BUILDING //jam /ICIAL ' 1 t / •
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