HomeMy WebLinkAboutBLD1989-00489 f3U DING a 'ERMIT APPLICATION IN
Jefferson County Building Department®P .O . Box 1220®Pig. Townsend. WA 98368
•
LOCATION �'-\ 1
SPECIFIC LOCATION SITE ADDRESS 2—tr' 14.Le c_ — 1-P.--.e._.
_ Ike
POSTAL DISTRICT i— /SUBDIVISION L—
LEGAL DESCRIPTION LOT V BLOCK
. E�/at ,3 2DIVISION a TAX NUMBER
PARCEL NUMBER �IcjC�fn�Y�� )c<1 1 pp 1 / 4 SECTION
PLANNING AREA SECTION q TOWNSHIP n2 (? NORTH RANGE ) �.- WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR /VW
MOBILE HOME KADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES ,_,//''
❑ COMMERCIAL SIZE LJ a $35
❑ INDUSTRIAL YEAR 0 r(a $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKES @ $8
NUMBER OF UNITS
❑ OTHER SPECIFY •
ESTIMATED COST OF 0 @ $8
IMPROVEMENTS ,.o - TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ 2 °C, ' $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
'74 WOOD FRAME ❑ ELECTRICITY ❑ COLLECT' AR
\ ? 0 MANUFACTURED ❑ WOODSTOVE VE SOLAR
�� ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OTHER - SPECIFY
Y ❑ MASONRY ( WALL BEARING ) DIMENSIONS
�*,
r"
,~, '( ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
\ DEPARTMEN AL REVIEW
HEALTH D PARTMENT T PE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
PUBL C OR PRIVATE NUMBER OF EXISTING BEDROOMS
---, h/ P"..
I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
�j APPROVE DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD / TYPE OF WATER SUPPLY
7 ////
/P- ❑ PUBLIC ( NAME OF WATER SUPPLY1__Z__/--
APPROVEDDATE ❑ PRIVATE ( NAME OF WATER SUPPLY L"IrleIRrrprlArRr If��
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ 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 ❑ YES ❑ NO
IDENTIFICATION
— NAME MAILING ADDRESS ZIP TEL NO
a
OWNER
/mo LA"w b.(Et. kl, Y- e. LL....s... 1���- 1/3/7
CONT (.i',UPcI 6 :- L DbEa p/_'- 9&-63- '32
y1AT IC N IQ�L1lC t 70 M Y/3.3,
ARCH 14 n 3�-3
4 75—
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGNATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APPROVE B PERM T F ES
A P P U'E BASE FEE INSPECTION
f
-- BLDG SURCHARGE PLAN CHECK
1 1989 ENERGY SURCHARGE 5��7 s`4
TOTAL
JEFFERSON COUNTY REFUND DATE DATE SSUE
PLANNING St BLDG DEPT 9 1 1 NUMBER
BUILDING OFFICIAL 0:<1... 17
APPROVED
FEB 1,689 .....zZO-D -/-*? saevitt
JEFFERSON COUNTY
PIAMINR 8$81.06 OEPT
A
3k ,
3 3 ,
IA 4-
-L
i /(70
C.7