HomeMy WebLinkAboutBLD1989-00446 L!!ILDING 'ERMIT APPLICATION
Jefferson County Build Departm: nt®t' .O . Box 1220•ort Townsend, WA 98368
LOCATION , / ''
SPECIFIC LOCATION SITE ADDRESS &. / � l W t/"l� a f
POSTAL DISTRICT /SUBDIVISICA /1-cirC-CG9rod t1(e
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LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER /362 (d}0 Ci( � 1 / 4 SECTION
SECTION l? TOWNSHIP V NORTH RANGE rt i WM
1
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOI.? I LE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
RAGE 0 REPLACEMENT GARAGE
( OODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
ULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL
0 INDUSTRIAL SIZE �' @. $35
❑ HOTEL/MOTEL/DORMITORY YEAR 7 r $ 16
NUMBER OF UNITS MAKE $8
O OTHER SPECIFY ESTIMATED COST OF p� $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOVAI
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
t (1 0 STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER. NUMBER OF STORIES TOTAL LAND AREA
am..,y
.._..
DEPARTMENTAL REVIEW _..
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY ,/
❑ PUBLIC ( NAME OF,,.WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY)
f) PLANNING DEPT . WITHIN SHORELINE JURISDICTION
,� 0 YES-'" NAME OF ADJACENT WATER BODY
l O
❑ NO
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 0 YES 0 NO
IDENTIFICATION
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,� l/ NAMEP. 1/ MAILING/ ADDRESS ZIP TEL NO
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OWNER V I f f(, LOY c/ 7, ci
TAT7= L I CFNSt NO 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
1 TURE���PLICANT C� APPLI�ATIpN,�DATE � RECEIPT���-! ��ER I CHECK �� Ec�R OR CASH
APPROVED BY PERMIT FEES
a-, ,do BASE FEE INSPECTION
�/BLDG SURCHARGE PLAN CHECK
�i--�l ai 19 ENERGY SURCHARGE
1 , •• $ S t TOTAL
PI a� ''$13106 L1FPT 8 1 1 NUMBER REFUND DATE I DALE I S, tlEt�
BUILDING OFFICIAL j 1/1),/(,�)`/ `JY
♦ I
APPROVED
J AN 1 0 1989 ( S f r J
JEFFERSON(O1JNTY
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