HomeMy WebLinkAboutBLD1989-00501I
f3UVING 'ERMIT APPLICATION
Building De artment�Y,P .O , Box 1220*P•t Townsend, WA 98368
Jefferson County g P
J„OCATip IL L1i r 3 1— ._ -/e-/N ,if-I' l ilf 714 ae `/�l J/ ,1 _
O SITE TE ADDRESS / 1 �J" / / t /'
SPECIFIC LOCATION 7 t�
POSTAL DISTRICT 7 /SUBDIVISION
LEGAL DESCRIPTION LOTS BLOCK DIVISI9N TAX NUMBER
x PARCEL NUMBER �/78 , (''C c---d�j ' . 1 / 4 SECTION
PLANNING AREA SECTION / TOWNSHIP c ,O NORTH RANGE /it WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
////
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
MOBILE HOME ❑ ADDITION 2ND FLOOR _
g MODULAR HOME ❑ ALTERATION BASEMENT
gi DET HED/ATTACHED ❑ REPAIR CARPORT /
AGE [] REPLACEMENT GARAGE '
WOODSTOVE 0 WRECKING/D AOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATIO, /MOVING INDUSTRIAL
NUMBER OF UNITS I MOBILE HO ES
O COMMERCIAL SIZE 0 @ $35
O INDUSTRIAL
YEAR 0 '6 $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE :1;2:/2
$8
NUMBER OF UNITS -
O OTHER SPECIFY EST MATED COST OF a7 $8
I , PROVEMENTS TOTAL FAIR MARKET VALUE
C°' UBC OCCUPANCY GROUP
r- SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
• WOOD FRAME Q EL TRICITY 0 COLLECTIVE SOLAR
M MANUFACTURED OODSTOVE 0 PASSIVE SOLAR
i44" ❑ STRUCTURAL STEEL ❑ GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
1 0 MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES. TOTAL LAND AREA
DEPARTMENTAL REVIEW .,,r'''
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDR...• •=
❑ PUBLIC OR PRIVATE NUMBER OF EXISTING t •ROOMS
0 INDIVIDUAL ( SEPTIC )
NUMBER OF F'I +•-� ED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER -XISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WAT SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME • - WATER SUPPLY
PLANNING DEPT . WITHIN SHOR NE JURISDICTION
O YES 00E OF ADJACENT WATER BODY
• 0
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORE DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
PPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION _
NAME MAILING ADDRESS ZIP TEL NO
OWNER • ' 'Cj
a
CONT
S'i ATE LTLvvrTrT.Tr7�F7€3
ARCH 1 1
1 ) ,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF APPLICANT APPL I,CAT O .ATE RECEIPT NUMBER ( CH N�JMUER OR CASH
APPROVED BY PERMIT FEES
'1)
APPROVED BASE FEE INSPECTION
9en BLDG SURCHARGE _ PLAN CHECK
0' ENERGY SURCHARGE $moo,//"'" (�
c S C Y
�✓ TOTAL
1!'•'d°.!l;; 2 utIC DEPT
911 NUMBER REFUND DATE DAT EA!!.
BUILDING OFFICIAL. 9 7/1 v '/
APPROVED
SEP 1 Sag 1 S,S Piqt,zA
JEFFERSON COUNTY
FitOG flicPT
nit.)
Cfilfri3/8q itC1) 42