HomeMy WebLinkAboutBLD1989-00498 [3 ,LDING ,r 'ERMIT APPLICATION
Jefferson County Building Department.P .O,. Box 1220 in Townsend. WA 98368
LOCATION
SPECIFIC LOCATION SITE ADDRESS (ID61 1.0 () r F' I C% -
POSTAL DISTRICT "il /SUBDIVISION`
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER ,2(-)
PARCEL. NUMBER ctp�l O(,� 3 [��(`)��', 1 / 4 SECTION
PLANNING AREA SECTION il,, TOWNSHIP ry_9 NORTH RANGE 1 . WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
NEW
MA I
0 MODIDLE HOMELY ❑ ADD I T ION
BUILDING 2ND F LOOR N FLOOR
eit�, '
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT l �
GARAGE 0 REPLACEMENT GARAGE Li7G�
O WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL �— MOBILE HOMES
❑ INDUSTRIAL SIZE
1��� �/I/�, a $ 1 6 )NQC)
YEAR
❑ HOTEL/MOTEL/DORMITORY �,r,
NUMBER OF UNITS MAKE g2.Li �1 @ $8 7J c`.9Z
❑ OTHER - SPECIFY ESTIMATED COST OF W7(p 0 @ $8 3� • (*i l
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GRC1Uy
P, $ $ (c, '•)k 4tic L
SELECTED CHARACTE ISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME _ PRINCIPLE TYPE OF HEATING FUEL
yC, WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
4 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW -�--
V HIAL/TH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS �} M,_.
to 07//l/8? /2,2A_, ❑ PUBL I C OR PR I VAT E NUMBER OF EXISTING BEDROOMS /
(y- LLB.-•` ( /(� O tU INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM- 1.Z
�✓ PPROVJED �)��T 0 INDIVIDUAL WELL — NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
I
' XPUBI. IC ( NAME OF WATER SUPPLY) 0 d^1
APPROVED DATE LI PRIVATE ( NAME OF WATER SUPPLY '
`C ' PLANNING DEPT . WITHIN SHORELINE JURISDICTION
1 I,.. X YES NAME OF ADJACENT WATER,BODY
7ilt_Rb , P�r;-III
❑ NO \i %
APPROVED DATE BANK HEIGHTVII SETBACK 1�
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
NAME MAILING ADDRESS ZIP TEL NO
� '� •
'� OWNER
� j . NOr►Y� A n L , P CB k ( I LI F5 } t-- q',3. � -C)!`>.`i I
CONT I �. iJ , I Cry(-e.. L 93-
I A7 .- rTRCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI NATURI OF APP IC T • APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
- ' eri-te.-0.) 0-77(5(0/(T9I \.9 n) 1-2- (__ 31--(
-
APPR i V-.. BY PERMIT rFEfE1S
APpI '116, �I 'l10 BASE FEE INSPECTION
,1:in SLOG SURCHARGE PLAN CHECK
Jet 17 1 1 FS 00 ENERGY SURCHARGE /./ (`)
1 ( ! ' ,c)-C TOTAL
484l 911 NUMBER REFUND DATE DAT IS' UED
•
BUILDING OFFICIAL .
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