HomeMy WebLinkAboutBLD1989-00540 BODING '`'ERMST APPLICATION � 1F (�
Jefferson County BuildingDe a "' �_
p �menteP .U . E3ox 1220fPort Town end. WA 98.3b,8)
LOCAT 1 0 -- __� .,,_._ . X,�-•.� _.-�.�.- y
- t-��7r�Pam....•
SPECIFIC �. ,
LOCATION SITE ADDRESS
POSTAL DISTRIC V UBDIVISION _
T
LEGALQ DESCRIPTION LOT__, — BLOCK DIVISION
( 5 I YUO U/.3 PARCEL NUMBEW 1- TAX NUMBER
PLANNING AREA SECTION 4�d�� 1 / 4 SECTION llp
,� TOWNSHIP T ? N NORTH RANGE P,Z -, WM
BUILDING INFORMATION
ti BUILDING TYPE
TYPE OF IMPROVEMENT SQUARE FOOTAGE
<, SINGLE FAMILY �/NEW BUILDING MAIN FLOOR /7.36,
Id"
❑ MOniLE HOME ❑ ADDITION
❑ MODULAR HOME 2ND FLOOR „S3 3
❑ ALTERATION BASEMENT
C
tX
0 DETACHED/ATTACHED ❑ REPAIR
GARAGE CARPORT ��?
❑ REPLACEMENT GARAGE „4--40/11 0 WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION MOVING
Y) NUMBER OF UNITS / INDUSTRIAL
❑ COMMERCIAL MOBILE HOMES �z
r( ❑ INDUSTRIAL SIZE @, $3 5 07(e O
��/ 0 YEAR L HOTEL/MOTEL/DORMITORY �—,� $16 � r^v Ci
NUMBER OF UNITS MAKE ^ =_ ,,S _ / �C(
❑ OTHER - SPECIFY
ESTIMATED COST OF _-r i jii a $8 i,q
UBC OCCUPANCY GROUT $MPROVER9 IMPROVEMENTS j(G+ �%0 o o �'" TQT .4—F 1,13� MARKET VALUE
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
(WOOD FRAME VELECTR I C I TY
❑ MANUFACTURED ❑ COLLECTIVE SOLAR
0 AUCRAL STEEL ❑ WOODSTOVE ❑ PASSIVE SOLAR
0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL
❑ MASONRY ( WALL BEARING ) ❑ OTHER SPECIFY
❑ OTHER - DIMENSIONS
NUMBER OF STORIES
TOTAL LAND AF1EA.IS J
DEPARTMENTAL 'REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISP
A L NUMBER OF PROPOSED BEDROOMS
4' ` ''DLPUBL I C OF; PRIVATE NUMBER OF EXISTING BEDROOMS
APPROOVED DATE ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED
❑ INDIVIDUAL WELL BATHROOM ._
P U D NUMBER OF EXISTING BA71 ff?OC�Rq
TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY / i
APPROVED DATE �ftFr N.... ,
❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
k) (-f)-
❑ NO
APPROVED DATE BANK HEIGHT
SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH
NAME OF PUBLIC ROAD 3 � /
NAME OF PRIVATE ROAD I
APPROVED DATE ROAD ACCESS PERMIT REQUIRED
D NTIFICATIGN ❑ YES ❑ NO
NAME
� R MAILING A D D R E S S
ZIP F' TEL NO
,ALL;;�`
4 d ) 44.... 3-- /I /
•
CONT
•
ARCH
1
ME OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
3IGNAT OF P T
APPLI A'TION 'ATE RECEIPT NUMBE CHECK NUMBER OR CASH
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APPR V BY
' ERMI FEES
BASE FEE INSPECTION
1
M 1 1 BLDG SURCHARGE
/� 1 PLAN CHECK
JEFFERSON COUNTY / ENERGY SURCHARGE a 0/� s
pi AN Ujf &i?inG D9PT \ �/ TOTAL
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