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HomeMy WebLinkAboutBLD1989-00493 [3UkING 'ERMIT. APPLICATION Jefferson County Building DepartmentbP .O . Box 1220.Pt Townsend. WA 98368 r �� L--u 0 LC -!_=ee/ l ciA LOCATION SPECIFIC LOCATION SITE ADDRESS �/ POSTAL DISTRICT /SUBDIVISION LEGAL DESCRIPTION LOT ( ' BLOCK tt DIVISION TAX NUMBER PARCEL NUMBER 1 C /t 1 / 4 SECTION PLANNING AREA SECTION /7 TOWNSHIP � p NORTH RANGE / C` WM BUILDING INFORMATION BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE,yy�� 2 ❑ SINGLE FAMILY Q NEW BUILDING MAIN FLOOR ,7V[./. ' (P- ❑ MO17I LE HOME ❑ ADDITION 2ND FLOOR 29/ 7/-7b ❑ MODULAR HOME 0 ALTERATION BASEMENT .-49'•� ❑ DETACHED/ATTACHED 0 REPAIR CARPORT GARAGE ❑ REPLACEMENT GARAGE / /c cz . .0.2..., ❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL K MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL NUMBER OF UNIT COMMERCIAL MOBILE HOMES { / / ❑ SIZE @ $3 5 d o l 77$ ': ❑ INDUSTRIAL /�� Q/ ❑ HOTEL/MOTEL/DORMITORY YEAR $ 16 `7 �7 .3IJ' NUMBER OF UNITS MAKE [ $8 ` -7 (` ,,' ❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8 /// 3/ 47/b vimS- �r^1I UBC OCCUPANCY GROUP / IMPROVEMENTS $OTAL„/Fq,IR ¢ E SELECTED CHARACTERISTICS OF BUILDING PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL WOOD FRAME ( ELECTRICITY 0 COLLECTIVE SOLAR rC, ❑ MANUFACTURED '❑ WOODSTOVE ❑ PASSIVE SOLAR 1,t❑ STRUCTURAL STEEL ❑ GAS ❑ COAL Z C�,��} L�`�`._ ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY QCP-4.) ❑ MASONRY ( WALL BEARING ) DIMENSIONS / ❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA ---3 DEPARTMENTAL REVIEW f`a'r� HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS e +•� N % 0 PUBLIC OR PRIVATE ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF EXISTING BEDROOMS -6/"- APPROVED /DATE NUMBER OF PROPOSED BATHROOM 7 ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM PUD TYPE OF WATER SUPPLY ��// ` /' �, ��`� f PUBLIC ' ( NAME OF WATER SUPPLY) L-< i)t O ) a.,)e e,--- APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY PL NNI/ DEPT . WI HIN SHORELINE JURISDICTION CA \ YES NAM OF ADJACENT WATER aODY �� afJ ���y J1 A `0 f Q ,..-• 'k) 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 rrr---��� NAME /��Q t1 /�) MAILING ADDRESSSS ,p���•-}}}yn {\` ZIP TEL NO O W N E R ' )G , /`--[..,0 Z.kts4) 3X,© I! ! PaAactis ____, !� - A SJ _ -kg �'-f-- L1,01 qk L/37 rWn/ CONT Pflie leS IA)Tr-K c7Iss , 1 ARCH THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.SIGE - ., L( CAT 1��p?��'••p ATE Rel00BER CHECN B OR�CASH '\ cDQ, 3 , *N E ® PERMIT FEES e(03 . 0 BASE FEE INSPECTION C>C1 J I 3 5-6BLDG SURCHARGE PLAN CHECK JEFFERS°'COU PLANNING&BLDG DEPT L® a� ENERGY SURCHARGE �, �7 `J s 1, _C1 ! , )�� TOTAL /U.CA.) 9 1 1 NUMBER REFUND DATE DAT J SUED ' BUILDING OFFICIAL 7 ✓ FROM: PLANNING AND B•DING DEPARTMENT S ADDRESS REQUEST FLAGCMD: 1 . ' X NEW ADDRESS ADDRESS CHANGE 2 . NAME : POPE RESOURCES 3 . MAILING ADDRESS • 601,4 Paradise Bay Rd. Suite $4 Pt. Ludlow, WA 98365 4 . TELEPHONE: 437-2101 5 . LOCATION: Please attach map. • LEGAL DESCRIPTION: SECTION/ TOWNSHIP T28N RANGE R1ECI:1Y?ii- ',64j21678 LOT / BLOCK PLAT ' 6. ROAD NAME: \'' "E-e1 Vv00-A - BETWEEN ST. & '-ST. MILES/FEET FROM ST. T . NEIGHBORS : .. NAME. N S E W _ ADDRESS: - .. NAME: N S E W I �- -ADDRESS : -. Y � 4 xr, NAME. N SEW {ADDRESS : c 8 . FEE PAID CASH CHECK NO. NEW ADDRESS • . STREET: - - CITY: - date entered • • s;4141WllitarY P9 WY --‘-' P[ANDING&SLOG DEPT YAsk - ‘-. c-s-lc_ •=.C.._ --c)..„. .. tztlor 1/411,--ei re,...c...1 'g 1 1.3 A 1c._ 14... .I .r...-_,..s,/ ,,7 z<2)2 / / ,,s4..... ii-Z)L1/ i \ zit- --,* - L/) pibeA- cu.m.„.. , 124 r__ y 4 ,--,7„:--- kv(--,,-,---- yai z„,.- ,--) „.,,,, t, o) i-„,,....., , ,,i, ut24,,,_ 12,10. :), 73,,.." ,,,4,-,.._,,s_.--7 'fi --ottl,c,z /( cc_ _ ---1 k_ 25 7/ /4,.) ,,,--- 12-4-1 La•-e tcr- (I tc_ 0/7 etA._ 12 ht - pfi,4.3 atit- 744 c 4c-Jo r d I\ PA' -PS Dr104-4,- i( t/