HomeMy WebLinkAboutBLD1989-00412 ' -
110LDING v 'ERMIT APPLICATION . ....
Jefferson County Building DepartmentivP .O . Box 1220401ort Townsend' WA 98368
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LOCATIOR,
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SPECIFIC LOCATION SITE ADDRESS e- , ,
POSTAL DISTRICT_ /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION ,_TAX NUMBER
PARCEL NUMBER 7 , ) <2, 1 / 4 SECTION
PLANNING AREA SECTION /7_ TOWNSHIP NORTH RANGE 7F-----WM
BUIL ING INFORMATION
BU LDING TYPE TYP OF IMPROVEMENT SQUARE FOOTAG
SINGLE FAMILY NEW BUILDING MAIN FLOOR _LC=
O MOBILE HOME 0 ADDITION ND T
O MODULAR HOME 0 ALTERATION Aar
0 DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT iGARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
c.7'.
EN: NUMBER OF UNITS -
77
MOBILE HOMES
0 COMMERCIAL a $38 C- t - - -
O INDUSTRIAL
“E ' 0 HOTEL/MOTEL/DORMITORY
MAKE YEAR Ald= /170 @ $ 16 fiTEW
0 a $8
'r.E.7S NUMBER OF UNITS ,
O OTHER - SPECIFY 0 iii $8
ESTIMAT- o COST OF -----
IMPR0 EMENTS TOT FA FA ARKET VALUE
UBC OCCUPANCY GROU 1E3, ___- $-451 0 tln:
SELECTED CHARACTERISTICS OF BUILDING
,
PRIIPLE TYPE OF FRAME
PRINE PLE TYPE OF HEATING FUEL
100D FRAME LECTRICITY 0 COLLECTIVE SOLAR
:
0 MANUFACTURED 0 wooDsTovn 0 PASSIVE SOLAR
.!' 0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
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0 MASONRY ( WALL BEARING ) . _
DIMENSIONS
O OTHER - NUMBER OF STORIES (,e%_ TOTAL LAND AREA
DEPARTMENTAL REVIEW '
HEALTH DEPARTMENT I TYPE OF SEWAGE D 1 rzrOSAL r‘iurzez OF Frio poSED0EPROO IV
I , ,8 81 a 076T-73LIC OR PRIVATE NUMBER OF EXISTING BEDROOMS .,
APPROVED DATE R4 INDIVIDUAL ( SEPT I C )
0 INr !V' DUAL WELL NUMBCF? OF PROPOSED BATHROOMr--2,
NUMBER OF EX I sT I NG BATHROOM
6(0; PUD TY OF WAlER SUPPLY
C --- PUBLIC ( NAME or WATER SUPPLY.,..
...„ APPROVED DATE n PRIVATE ( NAME OF WATER SUPPLY)
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PLANNING DEPT . WIT IN SHORELINE JURISDICTION
NAME OF ADJACENT WATER BODY
----
0 NO . --- ,
-..1.3 ,*
,,Q.,.. APPROVED DATE BANK HEIGHT SETBACK
-----------
PUBLIC WORKS DEPT ROAD 71GHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD _
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
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NAME MAILING ADORES r TETEL. NO
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. . .
CONT
7AE LIEEN'g.7 71
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
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RAI, I CANT ArP5r I CAT I ON ATrz nacr.CPT NUMBEit 4. CHE1
N B OR CASH
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APPROVE BY PE II :ES A P P ., aisif :Fik.„)
r,-,sc FEE
ALDG SURCHARGE INSPECTION
EI CHECK ir/20 9ifi - 4tY
ENERGY SURCHARGE ..4...a. 1*.....‘- TOTAL
.0:FERSON COUNTY
PLANoiING N H_DG DFPT
911 NUMBER rEFUND DATE I D TE I St
BUILDING OFFICIAL
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JEFFERSON COUNTY
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