HomeMy WebLinkAboutBLD1989-00437 B DING W'ERMIT APPLICATION
Jefferson County Building Department0P .O • Box 1220*PTrt Townsend. WA 98368
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J,,OCAT)ON
SPECIFIC LOCATION SITE ADDRESS f r�'7V'
S DISTRICT SUBD I V I S ‹ULc a >'
POSTAL I � I /
LEGAL DESCRIPTION LOT ✓ ( BLOCK DIVISION CO TAX NUMBER
^ PARCEL NUMBER( 7 OCO O 7 1 / a SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
c3 BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
`t SINGLE FAMILY 0 NEW BUILDING
LL//,b7C10 MAIN FLOOR
'. 0 MOBILE HOME i-.! ADDITION �l � ZND FLOOR
U CC)'1 f e r( cf�C1
❑ MODULAR HOME ❑ ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT _
GARAGE ❑ REPLACEMENT GARAGE ��^
1 •-- 0 WOODSTOVE , 0 WRECKING/DEMOLITION I COMMERCIAL
1
Q1 ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL �y//�
NUMBER OF UNITS '? L L�/')haus.
MOBILE HOMES �I
❑ COMMERCIAL ._._.�... U a $a 5
SIZE
❑ INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORYrfi $8 / �/J�l
MAKE WW [ `/ l
NUMBER OF UNITS
0 OTHER - SPECIFY ESTIMATED COST OF ) 0 @ $8
IMPROVEMENTS TO7M7
IJ R MARKET VALUE
UBC OCCUPANCY GROUP $ $ t/S_`
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
X.� 0 WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
' • 0 MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIE,
a0 MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TO. AL LAND AREA
i DEPARTMENTAL REVIEW /-��
i
HEALTH f]EPARTMEr{T TYPE aF caE'JdAGE p 1 SPOSAL p1UMsF_R OF PROPOSED BEDROOMS
r
0 PUBLIC OR PRIVATE -'' NUMBER OF EXISTING BEDROOMS
Y ❑ INDIVIDUAL ( SEPT I C,1 NUMBER OF PROPOSED BATHROOM
�' APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
a
f1 MIRMEIPOr
PUD TYPE OF WATER S-U PLY
-c
❑ PUBLIC ( NAM-6 OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE "(NAME OF WATER SUPPLY
PLANNING DEPT . WITHII",ImSHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE ,. BANK HEIGHT SETBACK
t PUBLIC WORK‘ DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
AP: -OVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
D I F I CAT I ON
101 NAME 1 t{AI L1 NG ADDRESS ZIP TEL. NO
• HER Ift,
� ! - E
W
GONT 7110
•.
ARCH
1li_______
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
.I'NATUR Off' APPLICANT -.. APP IC . 1 DATE PT RECTA'I PT NUMBER CHECK NUMBER OR CASH
• I ' ,&-Jce V Alo I cfc/ce,
APPROVED BY PERMIT FEES
APPROVED '
BASE FEE INSPECTION
AUG 1 6 198 BLDG SURCHARGE PLAN CHECK
JEFFERSON C _ ENERGY SURCHARGE 1�'" l / TOTAL
PLANNING h BLDG DEPT
9 I I NUMBER REFUND DATE cgTr ISS
BUILDING OFFICIAL ,
AMINFO.....031.61•Onam
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1.> '0\CV 0 Lb$
/ 16°
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Legend
Contour Lines—_ . 0 Water Tap
Property Lines.... S7 Phone Tap 1
Roadway 0 Electrical Tap
AREA: lq,n3to S . FT Drainage --- 0 3/4" Iron Pipe jj
. Loy 266 :i
li KARA no , DIM IM00-6
......
,,,,,,
APPROVED
AUG 1 6 1,89
JEFFERSON COUNTY
PLANNINi &3LOG'DEPT
FOB S 1C 1076/7z—/97
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