HomeMy WebLinkAboutBLD1989-00430 BUIING 'ERMIT APPLICATION
Jefferson County Building' Department•P .O . Box 1220403101 Townsend. WA 98368
rLOCATION - .. 1
SPECIFIC LOCATION SITE ADDRESS 251 Sc-'K& R g P ` ` 1�''''` xS �'
POSTAL DISTRICT 1) 4 /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER On% .2O 1bo -- 1 / 4 SECTION
PLANNING AREA` SECTION 4.-.C; TOWNSHIP 3(-,)/h 4 NORTH RANGE 1 L- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
W. SINGLE FAMILY [ NEW BUILDING MAIN FLOOR I l:)
❑ MOF.IILE HOME ❑ ADDITION 2ND FLOOR
"�
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
`� GARAGE 0 REPLACEMENT GARAGE
't,; 0 WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
cc, 0 MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL SIZE j '�' ' 0 @ $35 5 qiTO0.6y
O INDUSTRIAL $ 16 0 q�YEAR
0 HOTEL/MOTEL/DORMITORY MAKE $8 ---y
NUMBER OF UNITS
❑ OTHER SPECIFY ESTIMATED COST OF 0 @ $$ —
IMPROVEMENTS TOTALFAIR MARKET VALUE
UBC OCCUPANCY GROUP /Z3 $ $ 3( ) 'ss-(::cf `' '
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
la WOOD FRAME ®. ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
l 0 MASONRY ( WALL BEARING ) ^' DIMENSIONS54
❑ OTHER - NUMBER OF STORIES 1 TOTAL LAND AREA
DEPARTMENTAL REVIEW
aHEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS j -
CN R I , �l� I ®(,3% W� -^�tC5 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS -"
n INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM ,a
APPROVED DATE
C S. 1 ND I V 1 DUAL WELL NUMBER OF EXISTING BATH
Cr...' PUD ^TYPE OF WATER SUPPLY
tCr 0 PUBLIC ( NAME OF WATER SUPPLY)
c3 , APPROVED DATE Li PRIVATE ( NAME OF WATER SUPPLY
Bern ,
..--
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
L NO
APPROVED DATE BANK HEIGHT - _' SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD R f l 41*
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION fS t.41T�
NAME ,,s� t MAILING ADDRESS ZIP I P TELL' NO
OWNER
C"'S l\ \\ 44 J Y1; \\e,, R.:& � 'k,t �� ,-
-` , , o v& `I (.),`_t9 J' 1 Q 1 ,.. l3 i . q GCS? S 3 .i as ' G�`!
to rn100..A10 LU -YYt 6 - (:;LC/-- :1 F R.T
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE APPL C10/il DATE RECEIPT NUMBER CHECK NUMB R OR CASH
�,'
APPRED BY PERMIT FEES 1
A P8.7 7. Ems® `7'.�S,(7t.,BASE FEE I NSPECT ION
3,3D BLDG SURCHARGE PLAN CHECK
'' ` ' 1989 V l.��ild ENERGY SURCHARGE $ q7L- 5 ) TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEFT 9 1 1 NUMBER REFUND DATE DATE I$SUED
4. BUILDING OFFICIAL
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