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HomeMy WebLinkAboutBLD1989-00413 (3UILDI G _ 'ERMIT APPLICATION Jefferson County Building G artnintVP .O . Box 1220.PorSownsend. WA 98368 LOCATION SPECIFIC LOCATION SITE ADDRESS 'AO G C e V 6C_0-t4,0 S7� POSTAL DISTRICT /SUBDIVISION - 4-1-,,a ot_e 'rD'r A LEGAL DESCRIPTION LOT 7�j BLOCK DIVISION TAX NUMBER "a PARCEL NUMBER 96LL70C ©V ( ga 1 / 4 SECTION 1 JPLANNING AREA SECTION 7 TOWNSHIP CJ NORTH RANGE 0,,, ! WM U BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR 7 0 MOTILE HOME 0 ADDITION 2ND FLOOR ❑ MODULAR HOME 0 ALTERATION BASEMENT DETACHED/ATTACHED ❑ REPAIR CARPORT �ci0,., ,- i:1- GARAGE 03j�-tX( ❑ REPLACEMENT GARAGE ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS U ❑ COMMERCIAL MOBILE HOMES �y SIZE 0 a $35 �/ ❑ INDUSTRIAL 6 a $ 1 ,� YEAR 0 HOTEL/MOTEL/DORMITORY MAKEE 0a $ 8 NUMBER OF UNITS ❑ OTHE SP CIFY �r a� $8 � EST I T�ATED COST OF w /� 1Jrl� IMPROVEMENTS TOTAL FAIR MARKET VALUE -.,j UBC OCCUPANCY GROU $ $� '�.` i jj SELECTED CHARACTERISTICS OF BUILDING l P I NC I PLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL ( WOOD FRAME RjLe ❑ ELECTRICITY ❑ COLLECTIVE SOLAR MANUFACTURED ❑ WOoDSTOVE ❑ PASSIVE SOLAR ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL 0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY 7 0 MASONRY ( WALL BEARING ) DIMENSIONS ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA ' DEPARTMENTAL REVIEW HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL - NUMBER OF FROPOsED BEDROOMS f,� ❑ ,PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS 140111 ( \ I ND I V I DUAL ( SEPT I C )iuo10,+6 NUMBER OF PROPOSED BATHROOM APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM iJD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SUPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY PLANNING DEPT . WITHIN SHORELINE JURISDICTION YES NAME OF ADJACENT WATER BODY C7P,`c- la::;,--\! ❑ NO k APPROVED DATE BANK HEIGHT SETBACK YOC$ L-74 PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH NAME OF PUBLIC ROAD NAME OF PRIVATE ROAD APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO IDENTIFICATION NAME n MAILING AD RESS ZIP P TEL NO T 2C3t(ca_. S IA . L LIL1VE, NC) 1 )WNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS; URE OFv PLI T APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH \.. A P D B PERMIT FEES A V D BASE FEE ?9t ---5, INSPECTION BLDG SURCHARGE PLAN CHECK l 71ng \ ENERGY SURCHARGE $ TOTAL 'PtANl4IN ACIUMU PT 911 NUMBERREFUND DATE DATE ISSUED \ 3UILDING OFFICIAL: ' D j lL -2fl Mt� .--c O.� /� L1 C' 4 n\ 'TL' i 7 G I 66 4 BUILDI 'ERMIT APPLICATION Jefferson County Building Department'P .O . Box 1220.Port `wnsend . WA 98368 r r---- IL ? 1 LOCATION JJ /q���/j� SPECIFIC LOCATION SITE ADDRESS ( iinvC.,u1 POSTAL DISTRICT H /SUBDIVISION LEGAL DESCRIPTION LOT BLOCK uf�DIVISION TAX NUMBER Yoll/L/co PARCEL NUM ER / U l//� 7 Vo 1 / a SECTION PLANNING AREA Li SECTION TOWNSHIP NORTH RANGE / /4_) WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE ❑ SINGLE FAMILY 117f�NEW BUILDING MAIN FLOOR O MOBILE HOME 0 ADDITION 2ND FLOOR O MODULA _HOME 0 ALTERATION BASEMENT GDETACHE ATTAC Dn 0 REPAIR CARPORT ARAGE' 61e— ❑ REPLACEMENT GARAGE Y U t D O WOODSTOVE ( \ ❑ WRECKING/DEMOLITION COMMERCIAL ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNITS MOBILE HOMES ❑ COMMERCIAL SIZE & $35 ❑ INDUSTRIAL YEAR �f� -...,0q@ $ 1 6 O HOTEL/MOTEL/DORMITORY MAKE r7�1-/A @ $8 NUMBER OF UNITS ❑ OTHER SPECIFY ESTIMATED COST OF $8 IMPROVEMENTS TO[ 6I1DMARKET VALUE UBC OCCUPANCY GROUP+h $ $ L SELECTED CHARACTERISTICS OF BUILDING ` P NCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL �YOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR '777❑"" MANUFACTURED 0 WOODSTOVE 0 PASSIVE .-SOLAR O STRUCTURAL STEEL 0 GAS 0 COALS O REINFORCED CONCRETE 0 01L O---OTHER - SPECIFY ❑ MASONRY ( WALL BEARING ) DIMENSIONS 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA DEPARTMENTAL REVIEW H LT DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS / 2 (2 C 0 P U B L I C OR PRIVATE NUMBER OF EXISTING BEDROOMS O I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM APPROVED DATE 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM_�r PUD TYPE OF WATER SUPPLY ❑ PUBLIC ( NAME OF WATER SliPPLY) APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY) PLANNING DEPT . WITHIN SHORELINE- JURISDICTION • YES NAME--OF ADJACENT WATER BODY ❑ 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 ❑ YES ❑ NO IDENTIFICATION —! NAME , fv MAILING j ADDRESS ZIPI P TEL NO OWNER l �0 e,s l' 1 D-vS1 3 9 i C? 3P.r- CONT (NW � ,(, ( a)7 cd'IW1 !p �. v 7l �]/`(� T Al L i t N U i (31797'm 77 9 11 /f 4,4...fwl_ ARCH S THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS. 5SI_. 'UR;E OF A PICA T APPL CATI N DATE RECEIPT NUMBER CHECK NUMBER OR CASH II APiROVED BY P RMIT FEES A ; •i E , 7, IJBASE FEE INSPECTION SLDG SURCHARGE PLAN CHECK J �� JI ENERGY SURCHARGE di. I s? ) TOTAL 4Efati GOUN7 P 1M'WNW a 8.f$Kr 9 1 1 NUMBER I REFUND DATE DAT IS ED BUILDING OFFICIAL I `���� TO . W'o 7\foR 7-64 ' -�j( Si Soa i 1 300 Noo• tb# N 1 ca C o r 7 9 20A/04 ' i7L�cTS q62, 7°°08/ NT IN 50 v /1/77-; • 1-7unc. r, 6,0 ------ 00/ ilat '11 aN, 4#1,41 , 0 / . FEB 3 1989 JEFFERSON COMFY ---.�� � j s*fD'.'1"JG&BLOC UPI jils/G7 AAllh 7/://6; . ---21-7 ‘e)ritue...._ Rsi-32:7, ...._ D4-1 e_ ''+''' .4. , CO,,,......eL.4„........ ci,. 1 - rbG1/4wLC1 40,1/4,1' 40 LCt C-42..c,0 is"T' AO4,.cct -1/1:11---------4-- jhica / titi► iv- a., 'r- iteice ____ ... Al., 7 • V,* art PLR & LOG OEPT _ A P R v fit 17 JEFFERSON COUNTY PLANNING&BLDG D PT 7/74;— /./50.-e _ _,,,`S.,fir V. 0; w..“ C)' 0 P.I.W g.,ots S49 f( 0 / \ Sl` Cie 0f, ( /U.!-7 7/112(i � (---t-o-c—`