HomeMy WebLinkAboutBLD1989-00439 *DING , 'ERMIT APPLICATION
Jefferson County Building Department.P .O . Box 1220• ,rt Townsend. WA 98368
LOCATION 1 �+'s� _
SPECIFIC LOCATION SITE ADDRESS jl ' O riu ' ,) L""!`
POSTAL DISTRICT -- /SUBDIVISION
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LEGAL DESCRIPTION LOT_ BLOCK DIVISION TAX NUMBER _
PARCEL NUMBER /n f--:5 O 1 / 4 SECTION
PLANNING AREA SECTION 1"/ TOWNSHIP . 9,2) NORTH RANGE M/ WM
BUILDING INFORMATION
BU LDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY 0/NEW BUILDING MAIN FLOOR ,i::
❑ MOLIILE HOME ❑ ADDITION 2ND FLOOR (a/-
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE (/J)?)
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❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
' , ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL _
I NUMBER OF UNITS ( MOBILE HOMES / �/
O COMMERCIAL ��7 @ $3 5 '-T�� ,
V SIZE ��� (�j W
❑ INDUSTRIAL /YEAR � -/ '-''_" $ 1 6 �c�
❑ HOTEL/MOTEL/DORMITORY MAKE (47,O VI a@ $8 T!a
NUMBER OF UNITS
❑ OTHER SPECIFY ' ESTIMATED COST OF _JA @ $8
IMPROVEMENTS TOTAL FA MARKET VALUE
UBC OCCUPANCY GROU $ $ /„/� '�
Y JA
SELECTED CHARACTERISTICS OF BUILDING
PRI CIPLE TYPE OF FRAME PR CI PLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) ��
DIMENSIONS ,,
Ll OTHER i
NUMBER OF STOR I ES`_ -----' TOTAL LAND ARE BOG
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOSAL NUMBER OF PROPOSED BEDROOMS-
� /1 7t Cci'- -� 0 PU L I C OR PR I VAT E NUMBER OF EXIST"ING BEDROOMS
1�i�dJJ l SI 311$�,2, i f�1D I V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM J,.�-,...
APPROVED DATE ^ _ ❑`"I ND I V I DUAL WELL NUMBER OFEXISTING BATHROOM
CTO PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES :,NAME OF ADJACENT WATER BODY
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APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER IIIIIIIIMMIN
WNERR" I -1111111
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CONT illIMIR EIN />dii, i' a wflt. .+J- W ,9040, 4
ARCH ��,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF APPLICANT. APP ICATION DATE RECEIPT NUMBER CHECK NUM ER OR CASH
?-74&1_,- ,5 c)-a
APPRO BY \ PERMIT FE,E.R.
A P R 1 C� BASE FEE INSPECTION
50
1989 BLDG SURCHARGE PLAN CHECK
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-- YfFFER$QN COUNTY ! ENERGY SURCHARGE $ LL TOTAL
PLANNING&BLDG DEPT /
9 I I NUMBER REFUND DATE DAT )SS
BUILDING OFFICIAL ,/!/
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