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HomeMy WebLinkAboutBLD1989-00411 filILDING , >ERNIT APPLICATION Jefferson County Building Department^P .O : Box 122O ort Townsend. WA 98368 LOCATJ ON ' SPECIFIC LOCATION SITE ADDRESS 0, 0. () Yc-LA-r O S1- POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK L� DIVISION TAX NUMBER PARCEL NUMBER /62-' O//Z 1 / a SECTION PLANNING AREA SECTION 7 TOWNSHIP _NORTH RANGE /�= WM BUILDING INFORMATION B ILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR MODILE HOME ❑ ADDITION 2ND FLOOR ❑ MODULAR HOME 4 ALTERATION BASEMENT O DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE 0 REPLACEMENT GARAGE f\J ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL O ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS � � 0 COMMERCIAL MOBILEIZHOMES ` J a_� @ $3 5 l_� � (�� ❑ INDUSTRIAL YEAR l a.r @ $ 16 e 4 / C3 0 HOTEL/MOTEL/DORMITORY MAKE 0 `q� $8 NUMBER OF UNITS OTHER - SPECIFY a] $8 l� Asc �� v ' ESTIMATED COST OF I TOT I./0 MARKET VALUE UBC OCCUPANCY GROUP i ;MPROVEMENTS $'' j y SELECTED CHARACTERISTICS OF BUILDING cOn1vT "I(y�ne1� � � PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR ❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL 0 GAS ❑ COAL ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY O MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER NUMBER OF STORIES TOTAL" LAND AREA DEPARTMENTAL REVIEW Peg Sy rrea. //! 18 ___ HEALTH DEPAR P4ENT TYPE OF SEWAGE DISPOSAL NUMBER OF PRoroSED BEDROOMS ?... �` \ 0 PUBL I C OR PR I VAT£ NUMBER OF EXISTING BEDROOMS �l I ND I V 1 DUAL ( SEPT'I G ) NUMBER OF PROPOSED BATHROOM APPROVED DATE0Y--- 0 I ND 1 V I DUAL WELL NUMBER OF EXISTING BATHROOM 41/4 4 PUD TYPE OF WATER SUPPLY °�" ❑ PUBLIC ( NAME OF WATER SUPPLY) t ROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY V PLANNING DEPT . WITHIN SHORELINE JURISDICTION 0 YES NAME OF ADJACENT WATER BODY ❑ NO APPROVED DATE BANK HEIGHT SETBACK PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH --- C‹ NAME OF PUBLIC ROAD -m- NAME OF PRIVATE ROAD APPR ED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO IDENTIFICATION NAME l� /h�/� MAILING ADDRESS �y-y�(ZZIPS TEL NO OWNER /!y/� �C_iL !" V x _&�� -0 co Cic, / " 3/ J(8.s--„ CONT - CMj;LQrL - �[> SLATE LT H L NO T ARCH r THE OWNER OF HIS ILD AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; 1G79.7 ARP CA AP LI ATION DATE RE PT�UM CHF UMBER OR CASH ROVED BY P E R M I T Fle.S CI D !�Il�, ° (V7C/J BASE FEE INSPECTION APPROVED .-.15D BLDG SURCHARGE PLAN CHECK AUG 7 igii ENERGY SURCHARGE c; TOTAL JEFFERSON COUNTY •- 9 1 I NUMBER REFUND DATE D E /UED PLANNING 5:10C DEPT /y BUILDING OFFICIAL APPROVED AUG l i999 J€FFE S©N COUNTY PLANNING&BLDG DEPT //:° Z L C� •