HomeMy WebLinkAboutBLD1989-00537 Fa rp��ry
BUI ING ERMIT APPLICATION
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. Jetferson County Building uepartment•P.O . ,Box 1220• ort Townsend. WA 98368
LOCATION i(a-,►- -1 yt2�-- K2-- -2
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SPECIFIC LOCATION' SITE ADDRESS V/ ,Q �y� / L / '
POSTAL DISTRICT /SUBDIVISION
9LEGAL DESCRIPTION LOT A I(OBLOCK DIVISION TAX NUMBER
3 1 '/OQ o/& PARCEL NUMBER ' - 1 / 4 SECTION
PLANNING AREA SECTION i0: TOWNSHIP �c' NORTH RANGE / WM
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BUILDING INFORMATION
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BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
'.,..) d SINGLE FAMILY i NEW BUILDING MAIN FLOOR /%
' ❑ MOBILE HOME 0 ADDITION
� 2ND FLOOR
�.�p
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT \_"v``
o
GARAGE ❑ REPLACEMENT GARAGE//Z
0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
_. 0 COMMERCIAL MOBILE HOMES /
} ❑ INDUSTRIAL SIZE ;�721.0 @ $35 60 CiOn
❑ HOTEL/MOTEL/DORMITORY YEAR 0 @ $ 16
NUMBER OF UNITS MAKE ijr1oCO $8 � r/
0 OTHER - SPECIFY �1O/(G W $8 vQ J�tf�,'/j
ESTIMATED COST OF
UBC OCCUPANCY GROUP IMPROVEMENTS TOTAL„ FAA Iy1AR 1 KET VALUE
/'� $ $ (p Crj
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑' WOOD FRAME ' ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
0 STRUCTURAL STEEL 0 GAS ❑ COAL �� /fit
❑ REINFORCED CONCRETE 0 OIL ❑-OTHER - SPECIFY ! i -
❑ MASONRY ( WALL BEARING ) R
0 ❑ OTHER DIMENSIONS
NUMBER OF STORIES TOTAL LAND AREA+<
DEPARTMENTAL REVIEW
HEALTH D PARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ,
/I ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
APPROVED ATE 0 INDIVIDUAL ( SEPTIC )
NUMBER OF PROPOSED BATHROOM
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
milow
PUD TYPE OF WATER SUPPLY // �
❑' PUBLIC ( NAME OF WATER SUPPLY /4 7)[� V�'l_,.) U/a�/
APPROVED DATE [] PRIVATE ( NAME OF WATER SUPPLY , \
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 3C "
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED
0 YES 0 NO
IDENTIFICATION
NAME 1� r /}M /�MAILING ADDRESS/ ry/
OWNER poi...),
c,) . 1�es UIrii bV P Kce's /, Aid-- S _,(.L Z 1 P TEL NO
______._ P�-.L k o En J / f 4>/9- F3 9 sf"3 5 V37 -/t/
coNT DQ Resccuc
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA •F APPLICANT ,. IAPPL C ON DATE IRECEI T NUMBER CHECK NUMBER OR CASH
PPcAil
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9 7 O ( 1..,
o �-V'E �. PERMIT FEES
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`-' �� /i(1 BASE FEE INSPECTION
JU , ;9 . 2(J BLDG SURCHARGE PLAN CHECK
JEF R)IN GIiNiY
P!..ANF!!NG&BLDG DEYT (c.(JL) ENERGY SURCHARGE $ .1q
( CCa
l-''`� 1 TOTAL
811 NUMBER REFUND DATE 1 qAT 1Sy
BUILDING OFFICIAL / 1 lv Y
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F:ROM: PLANNING AND BU•I NG DEPARTMENT
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ADDRESS REQUEST
FLAGGED:
:
1 . ' X NEW ADDRESS ADDRESS CHANGE
2 . NAME: POPE RESOURCES
3 . MAILING ADDRESS: 60M Paradise Bay Rd. Suite $4 Pt. Ludlow, WA 98365
4 . TELEPHONE: 437-2101
5 . LOCATION: Please attach map.
LEGAL DESCRIPTION:
SECTION /( TOWNSHIP T28N RANGE R1E
LOT ` BLOCK PLAT
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6. ROAD NAME: YV O r0\e;v --Cp[C(-C .— •
BETWEEN ST. & -S T. ..
MILES/FEET FROM
7 . NEIGHBORS: :-
NAME: NSEW _ -
ADDRESS:
NAME: N S E W
ADDRESS :
NAME:
NSEW �;
ADDRESS:
8 . FEE PAID CASH CHECK NO.
NEW ADDRESS
STREET:
CITY: -
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date entered •
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