HomeMy WebLinkAboutBLD1989-00527 BU: ING ERMIT APPLICATION
BuildingDepartment'P .'� . Box 1220IPo.
Jefferson County t Townsend . WA 98368
SITE TE ADDRESS J ��i���'
LOCATION
SPECIFIC LOCATION I
POSTAL DISTRICT/SUBDIVISION
a't LGoi, 4
LEGAL DESCRIPTION LOT "'� d BLOCK crDIVISION TAX NUMBER
PARCEL N ER - I 1� )`�(�� SECTION �� �� WM
L NORTH RANGE
PLANNING AREA SECTION TOWNSHIP ,`
BUILDING INFORMATION
BUILDING TYPE PE OF IMPROVEMENT SQUARE FOOTAGE .
ci.,_!INGLE FAMILY tNEW BUILDING MAIN FLOOR
2ND FLOOR
\- ❑ MOBILE HOME ❑ ADDITION
❑ MODULAR HOME 0 ALTERATION BASEMENT
I 0 DETACHED/ATTACHED 0 REPAIR CARPORT
c"
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
1 ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL�
NUMBER OF UNITS MOBILE HOMES iJ^ /C�
❑ COMMERCIAL SIZE ( @ $35 q �//
C, s-:),
❑ 1 NDUSTR 1 AL YEAR �j+� @ $ 1 6 C/ 0 (0
❑ HOTEL/MOTEL/DORMITORY MAKE $B
k' NUMBER OF UNITS
c": 0 OTHER - SPECIFY ESTIMATED COST OF 0 2 $8
IMPROVEMENTS TOIA F IR MARKET VALUE
UBC OCCUPANCY GROUPS $ $ ' ----
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
P,.tINCIPLE TYPE OF FRAME
WOOD FRAME LECTRICITY 0 COLLECTIVE SOLAR
1- 0 MANUFACTURED 1 WOODSTOVE 0 PASSIVE SOLAR
L 0 STRUCTURAL STEEL AS ❑ COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
+ 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEAL H DEPARTM T TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
+ q ❑ PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
S 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM A
APPROVED DATE - 1 J❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
a PUD TYPE OF WATER SUPPLY n
..,PUBLIC ( NAME OF WATER SUPPLY) DA
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
f� PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
) l
R.-
❑ 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
_ ZIP T E L NO
NAME / MAILING ADDRESS , A
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CONT y� - a
J — H-
ARCH
A
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED// AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGN TUNE OF APPLICANT AP7 FICA e'clirTE ' RECEIPT NUMBER ' CHECK IUMB*O?�CASH
/ P ROV BY PERMIT FEES
/ 3,L J ASE FEE INSPECTION
5 LDG SURCHARGE PLAN CHECK
MA 1 J 18 ! z^, ENERGY SURCHARGE ` / r TOTAL
--f L/C
JEFFERSON COUNTY // -------
PI_AA'IAW&3LOG DEP, 9 1 1 NUMBER REFUND DATE DATE IS UE•
BUILDING OFFICIAL r-•°" IL) 8
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