HomeMy WebLinkAboutBLD1989-00535 (3 DING ,'ERMIT APPLICATION
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Jefferson County Buildio DepartmentsP .O . Box 122000W Townsend. WA 98368
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LOCATION •
SPECIFIC LOCATION SITE ADDRESS _4 / i IA) , a ( A •
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POSTAL DISTRICT /SUBDIVISIO ' Q/{U � ,�j tK 1r�s`J
LEGAL DESCR I PT. ON LOT ' I BLOCK �j y� ID VI I ON TAX NUMBER
PARCEL NOI�[)BF�� 7 �jul 1 / 4 SECTION
PLANNING AREA SECTION �� TOWNSHIP cZ 'NORTH RANGE i {� WM
BUILDING INFORMATION
BUILDING TYPE T- PE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY NEW BUILDING MAIN FLOOR
On I LE HOME 0 DI T ION 2ND FLOOR j'
❑ MODULAR HOME 0 ALTERATION BASEMENT /
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❑ DETACHED/ATTACHED 0 REPAIR CARPORT ,
GARAGE 0 REPLACEMENT GARAGE f
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL /
NUMBER OF UNITS
MOBILE H ES /
❑ COMMERCIAL SIZE _ c/ 5- U� 5
0 INDUSTRIAL YEAR / ��� $ 1 6
❑ HOTEL/MOTEL/DORMITORY �'fl' �
NUMBER OF UN 1 TS MAKE 7.:4pJy1'(L M @ $8
❑ OTHER - SPECIFY ESTIMATE
((/D COST OF $8
IMPROVEMENTS TO,'tA"L FAIR MARKET VALUE
UBC OCCUPANCY GROU �, $ ��s
1
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ OOD FRAME ,_. =" ECTRICITY 0 COLLECTIVE SOLAR
" "`1
MANUFACTURED ~WOODSTOVE ❑ PASSIVE SOLAR
'[) RUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
+ a 0 MASONRY ( WALL BEARING )
' 0 OTHER - DIMENSIONS
NUMBER OF STORIES TOTAL LAND AREA
p1 DEPARTMENTAL REVIEW
`V HEALTH 'EPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
1 /30 tCI ❑ PURLIC OR PRIVAT O1NU B OF EXISTING BEDROOMS
�} I N D I V I D U ( S E P T I 0-60 TN( R OF PROPOSED BATHROOM
C APPROVED DATE ❑ INSIVIDUA�4
NUMBER OF EXISTING BATHROOM
PUS TYPE OF WATER SUPPLY � 1�
PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
,. PLANNING DEPT . WITHIN SHORELINE JURISDICTION
`- ❑ YES NAME OF ADJACENT WATER BODY
7 1. ❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD
i):41 NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME ry,'y/`/ ^ `MAILING ADDRESS �y ZIP
y-.,��..f TEL(./�NO
OWNER f)
�� `Cf l l W �..Ji �� "`. ( C.�4C f) /
cx v .5 c� 9 �5
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CONT
$T-AT.E=M h a b t, NO 1
ARCH
T E W ER T IS BUILDING 4ND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
1 'RE LICANT APP ICATI N DATE RECEIPT NUMBS CHECK NUMBER OR CASH
AP RO ED BY PERMIT
(F� S
A P D 75. BASE FEE INSPECTION
FEB 6 t9_ 3,S�BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ St
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JEFFERSON COUNTY ,P / TOTAL
PLANNING&BLDG DEPT
81 1 NUMBER REFUND DATE { DATE 17)
BUILDING OFFICIAL C" )/� /�J\1(,/'?'
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APPROVED
FEB 6 1989
JEFFERSON COUNTY
PLANNING&BLDG DEPT
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