HomeMy WebLinkAboutBLD1989-00414 BUILDING ,'ERMIT APPLICATION
Jefferson County Builcllg Department®P .O . Box 1224Ikort Townsend. WA 98368
f LOCATION -
SPECIFIC LOCATION SITE ADDRESS JED C_ 4.4p,p t'PL—,1,4 n e. /�l�
POSTAL D I STR I CT,,jL—�o/2-7l /SUBDIVISION Pope_ i- 74_%/Jc/ he 0is d!-Oc-v
LEGAL DESCRIPTION LOT B-L--0-CK -3 DIVISION TAX NUMBER
PARCEL NUMBER /?O ?OD Uc3- t 1 / 4 SECTION
PLANNING AREA SECTION r7 TOWNSHIP—?? NORTH RANGE % WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME yf ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS ( MOBILE HOMES
❑ COMMERCIAL
❑ INDUSTRIAL SIZE q� $ �
❑ HOTEL/MOTEL/DORMITORY YEAR $ 16
NUMBER OF UNITS MAKE $8
O OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
I IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ 3 -7� SJ _ $
1
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
4 WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
, :,,, ❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
1 0 STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING )
,,c, , DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS C)
) :,,PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
r 1 3 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM CD
APPROVED DATE
r ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY
'.. APPROVED DATE PRIVATE ( NAME OF WATER SUPPLY ?z... 1.L. e•J-G�
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
)KNO
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
NAME MAILING ADDRESS ZIP TEL NO
OWNER
T}I
C O N T cL r�EC:l.-�LPL; /U. f JL) )C G.7` t�4 0 Cl.„t e' p e_i),_.) 1----g tik Q___, 932-ay73
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a TE CyI CT1VSE
ARCH /t`
THE OWNER OF THIS BUILDING AND` THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
r
SIG T 6 F APPLICANT APPLICATION DATE RECEIPT NU 'R CHECK NUMBER OR CASH
I
APPROVED BY PERMIT FEES
APPROVED
l� 3, L 0 BASE FEE INSPECTION
BLDG SURCHARGE PLAN CHECK
DEC 1 9 1989
JEFFL SON COUNTY l ��) ENERGY SURCHARGE $ G 2 r TOTAL
PLANNING&BLDG DEPT 9 1 I NUMBER REFUND DATE }DA'TE/ IyS`SUED
BUILDING OFFICIAL
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APPROVED
DEC I 9 190
JEFFERSON COUNTY
PLANNING&SLOG DEPT
112 /41:7 0