HomeMy WebLinkAboutBLD1989-00434 4..,.
LDING ;, 'ERMIT APPLICATION
Jefferson County Building DepartmentqP .O . Box 12200ort Townsend . WA 98368
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SPECIFIC LOCATION SITE ADDRESS_ -A___ e ) tVeA at__
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POSTAL D I STR I CT _JSUBDIVISIONc ----
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LEGAL DESCRIPTION LOT V(5'Cq(63, LOC DIVIS ON TAX NUMBER ,
PARCEL NUMB :R 1 / 4 SECTION
PLANNING AREA. SECTION . TOWNSH I P NORTH RANGE WM
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BUILDING INFORMATION
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BUALDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE y-
cLie5s2
',. ' SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
CY,) MOBILE HOME 4-dc KADITION 12-,e( 3,7/ 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
,--. 0 DETACHED/ATTACHED 0 P.EPAIR CARPORT
-'-' GARAGE 0 REPLACEMENT kGARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ' COMMERCIAL
D MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE MOVES ,
O COMMERCIAL -11.- A $35 /
SIZE Yc:Do
O INDUSTRIAL
YEAR 0 9 $ 16
O HOTEL/MOTEL/DORMITORY
MAKE
NUMBER OF UNITS ---
----
.Z.- 0 OTHER - SPECIFY ESTIMATED COST OF . _JA @ $8
IMPROVEMENTS TC:/pp.. . ARKET VALUE
cf; UBC OCCUPANCY GROU//71-3, . $
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SELECTED CHARACTERISTICS OF BUILDING
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P INCIPLE TYPE OF FRAME PRINC7PLE TYPE OF HEATING FUEL
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2OD FRAME LECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING )
DIMENSIONS
0 /OTHER - NUMBER OF STORIES TOTAL LAND AREA
0
—4 DEPARTMENTAL REVIEW I iP, OAL --
7
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) H E L T H D E P AR TM 11 T TYPED BO OF c SEWAGE OR PR I V ' — t)NUMBER OF EXISTING ,
iAPPROVED ATE l D I S P(. ,,.p35 NUMBER OF PROPOSED BEDROOMS --7-• ,3=(1.3)1!.r..„t 1
0 INDIVIDUAL (1111110001. NUMBER OF PROPOSED BATHROOM 0 c 3}
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..i." 0 INDIVIDUAL W . NUMBER OF EX I,ST I NG BATHROOM
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PUB TYPE r'''' WATER SUPPLY
PUBL. I C ( NAME OF WATER SUPPLY
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APPROVED DATE El PRIVATE ( NAME or WATER SUPPLY
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PLANN I//G DEPT . WITHIN SW1771, 114E. JURISDICTION
0 YES NAME OF A7)JACENT WATER BODY
DUO o .
APPROVED DATE BANK HEIGHT SETBACK
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pupLI WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
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42± NAME OF PUBLIC ROAD --
NAME OF PRIVATE ROAD - ---- _ ---
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APPROVED DATE POAD ACCESS PERMIT REQUIRED 0 YES 0 NO
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IDENTIFICATION
HAME MAILING ADDRESS ZI7 TEL NO
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ARCH
THE OWNER OF THIS BUILDING AND THE urtomusicHro AGREE TO CONFORM TO ALL APPLICABLE LAWS:
."5,4,GN Tyne orArTLICA I\ri't )c Arrci ATI 1 RE EIPT NUMB7 CHECK HumeEn OR CASH
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APPROVED<BY PERMIT FEES
A P t9 V e p H - .L2,..Q.., BASE: FEE _ INSPECTION
.1ter IrT.:k:)-- ---____ . (.14 SD
FJLDC suncylARGE PLAN CHECK
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ENERGY SURCHARGE iz...c, ;_o
JEFFOD1 COUNTY TOTAL
PLANNING&ROO DEPT
9 1 i NUMBER REFUND DATE DAT 17,ial
BUILDING OFFICIAL /6 5A1P7
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ARRROVED\
\AYFEVoti.earATY \
PLANNING&BM DEPT
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