HomeMy WebLinkAboutBLD1989-00432 I3UI G , 'ERMIT AP►LICATION
� 0 . Box 1220�Po Townsend . WA 98368
Jefferson County Building Department P .
•ocAT O► p1.7
SPECIFIC LOCATION SITE ADDRESS10116111
/SUBDIV . ION
POSTAL DISTRICT 60 TAX NUMBER .► -
BLOCK
� D I V S LON
LEGAL DESCRIPTION LOT_______ • r -- - 6 n 1 / 4 SECTION
PARCEL NUM R
SECTION
, � 1 TOWNSHIP P / r+ORTH RANGE
(� WM
PLANNING AREA
BUILDING INFORMATION
BUILDING TYPE T PE OF IMPROVEMENT SQUARE FOOTA
MAIN FLOOR
NEW BUILDING MAD FLOOR
SINGLE FAMILY ❑ ADDITION
O MOBILE H HOOME BASEMENT
0ALTERATION CARPORT
❑ REPLACEMENT
❑ MODULAR HOME REPAIR
O DETACHED/ATTACHED 0❑ WRECKING/DEMOLITION GARAGE
( COMMERCIAL
O MULTI
GARAGE• WOODSTOVE MULTI - FAMILY
❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES raj $3 5
❑ COMMERCIAL SIZE �..1r��i 1 6
❑ INDUSTRIAL YEAR �r�J a $8
❑ HOTEL/MOTEL/DORMITORY MAKE —
NUMBER OF UNITS rIl $8
[] OTHER - SPECIFY ESTIMATED COST OF
IMPROVEMENTS TOTO.L2 F ).L.A.jR MARKET VALUE
UBC OCCUPANCY GROUP,_ ._, $
SELECTED CHARACTERISTICS OF BUILDING
PR NCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME COLLECTIVE SOLAR
ELECTRICITY ❑
�` 0 M MANUFACTUREDFRAME WOODSTOVE ❑ PASSIVE SOLAR
� �❑ ❑ GAS []
❑ STRUCTURAL STEEL ❑ COALALR SPECIFY
[] OIL
❑ REINFORCED CONCRETE
0 MASONRY ( WALL BEARING ) DIMENSIONS TOTAL LAND AREA
` ❑ OTHER NUMBER OF STORIES --ram^
DEPARTMENTAL REVIEW NUh ER OF PROPOSED BEDROOMS
d{Y�IJER OF EXISTING BEDROOMS
Hi
L H DEPARTMENT TYPE OF SEWAGE DISPOSA
❑ PUBLIC OR PRIVATE
/7 �J C�J �- t-
"ti7 I 2 I ND I V I DUAL ( SEPTIC F ' NUMBER OF PROPOSED BATHROOM{
i NUMBER OFFEXISTING BATHROOM
APPROVED DATE LiINDIVIDUAL WELL
P U D TYPE OF WATER SUPPLY• /� � ��
(- UBLIC ' ( NAME OF WATER SUPPLY l
APPROVED DATE
❑ PRIVATE ( NAME OF WATER SUPPLY
OMIW
N. PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
t()
( _/ SETBACK
APPROVED ATE
BANK HEIGHT
PUBLIC WORKS DEPT NAME OFGPUBOL I CWAY ROAD WIDTH
NAME OF PRIVATE ROAD"—__ ____-----------------_
OAD YES ❑ NO
Cr APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑
�. Z I P T E L N O
IDENTIFICATION
r
.ir MAILING ADDRESS ��^
'NAME 1 ei * t7`)-
CZQ OWNER ( .0 ��.
• /
----- --
ARCH
C
f11 OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO CIE +Ut CABLE LAW OR S
tj .
DATE RECE I PT NUM ER 4
/
/' APP 1 C A .� C/_-1 1
1 GNATU r� AP�if I�
PERMIT FEES
w- - -OWED, a INSPECTION
,R \ �J� � BASE FEE
w) PLAN CHECK
\\- 1 7 BLDG SURCHARGE
p • • R�oVE ® \ ` _
` C 1 L� ENERGY SURCHARGE _ 2,_ c7 �( ) TOTAL
MAR z a 198� -�� r%�
, ` ) REFUND DATE DATE
/(,/� 9 1 i NUMBER 3 t
JEEfER�GNgCGnUNT��Ypp , r
PI.1 � �i�iGGO�FICIAL t _`.. C3 ;:
,. .
APP110460
,s-s- c_.
tim A 7 10% ,---5 7
AffERSON C1119111
PLANNING&9106 OM
\ \ /
.\,
err.,A.,.....
0 Ic_--k-b c. , _ G'r----zi--
9 2 ti trt --A--,A-.),A-. ----1-4s? ,--- G5 c.A_L.5 Ars....- ,.. 0
(-7(jb Rli2-4-1 Lo, P3A-Losts t•-• I\
-
"(-1-kaicb-t4.-3L, to.-
6•"44"- CIA-k-- jat.us v o-vte.A.4
/il/e7
4Ar-- -Pv44---- /2--3 c...‘,.......-
ety---
e1C-41:61---
ssix_ c/zii