HomeMy WebLinkAboutBLD1989-00544 (3UI ING ; 'ERMIT APPLICATIONiii
Jefferson County Building epartment®P .O . Box 12200P t Townsend. WA 98368
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SPECIFIC LOCATION SITE ADDRESS lif`--
POSTAL DISTRICT.�� /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK
// �OIIVI ION TAX NUMBER
,(PARCEL NUMBER gfp -? /rX J / 4 SECTION
PLANNING AREA SECTIOIkt 5 TOWNSHIP 5en NORTH RANGE WM
BUILDING INFORMATION
BU ''L.DING TYPE TYPE/OF IMPROVEMENT SQUARE FOOTAGE
0/SINGLE FAMILY ❑ W BUILDING MAIN FLOOR j
❑ MOBILE HOME ADDITION 2ND FLOOR �_-✓r
❑ MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
za "" MOBILE HOMES ,/�,�) �{ C/
"".,../ SIZE
• COMMERCIAL SIZE 1i1 ,, as $3 6 y ) .Jr)
r ❑ INDUSTRIAL
�' YEAR ,/r is() 0 @ $ 16 / C3
0 HOTEL/MOTEL/DORMITORY
NUMBER OF UNITS MAKE a $g
❑ OTHER SPECIFY ESTIMATED COST OF a $8
IMPROVEMENTS TOTAL FAJR MARKET VALUE
UBC OCCUPANCY GROU $ $ �G /'1
SELECTED CHARACTER STICS OF BUILDING r l�
PR fICIPLE TYPE OF FRAME PRI CIPLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - j NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW ,
HEALTH DEPARTMENT TYPE SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOM 1 .
O P BL I C on PRIVATE NUMBER OF EX 1 ST 1 NG BEDROOMS / 4 -,
_. INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM /
APPROVED DATE {p/`ND 1 V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES----
.,NAME OF ADJACENT WATER BODY
NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES 0 NO
IDENTIFICATION
NAME y(,�� MAILING ADDRESS�-yt�c, i�g ZIP T E L NO
OWNER 1)L. I ' M Ps � IW S .. , 9"_,
CONT
TrA'IE LIC'NSE NU J
ARCH
A A
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LA S
S I�+(JATUC APPLICANT A'PJPL 1 CAT 1/Q ATE IRE.5_,WMBER CHECK NUMBER 0 CASH
APPROVE Y PERMIT F�,ES
rJj/
AP -- -. 9 BASE FEE INSPECTION
6 ¶90 45v
BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE $ //`1.
PLANNING&SLOG OEPT ((�/ TOTAL
911 NUMBER REFUND DATE DJISSUED
BUILDING OFFICIAL
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JEFFERSui,COUNTY
PLANNING&BLDG DEPT
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