HomeMy WebLinkAboutBLD1989-00547 ['Ail,"D'G ;'ERMIT APPLICATION -
Jefferson County Builds „ Department'P .O . Box 12204Wr•ownsend. WA 98368
LOCATION J
SPECIFIC LOCATION SITE ADDRESS G / 6 CJ , .i:'l-at
POSTAL DISTRICT 4-1 /SUBDIVISION
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LEGAL DESCRIPTION LOT SLOCK / 4-` DIVISION TAX NUMBER
PARCEL NUMBER y(..,/ EO7 2I'1 1 / 4 SECTION SECTION 1317 TOWNSHIP -AFIV NORTH RANGE 1 J WM
3/[cBUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME ADDITION 2ND FLOOR
0 MODULAR HOME ❑ ALTERATION BASEMENT
DETACHED/ATTACHED 0 REPAIR CARPORT //
GARAGE 0 REPLACEMENT GARAGE (e
❑ WOODSTOVE 0 WRECKING/DEMOLITION ICOMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
NITS
COMMERCIALF , MOBILE HOMES { $35
...* ,❑ INDUSTRIAL SIZE ---0
" 0 HOTEL/MOTEL/DORMITORY YEAR @ $ 16
NUMBER OF UNITS MAKE @ $8 (c-:///CY
❑ OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
IMPROVEMENTS TOTAL/FA-II/ MARKET VALUE
UBC OCCUPANCY GROUP $ $ J7
SELECTED CHARACTERISTICS OF BUILDING l a
c PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
R . WOOD FRAME 0 ELECTRICITY 0 CO ECTIVE SOLAR
c `" 0 MANUFACTURED 0 WOODSTOV ___. PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS.- 0 COAL
❑ REINFORCED CONCRETE LT OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
' ° 0 OTHER NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEALT DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
l , _
O PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
- ROVED DATE 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPL)
PLANNING DEPT . WITHIN SHORELINE JURISDICTION y_
❑ 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 0 YES 0 NO
IDENTIFICATION
,
NAME MAILING ADDRESS ZIP TEL NO
OWNER 3b
2 7 o 0/, ,.///G eio e. `S3J9 , a 7
CONT
S 17CTE-L I ..ENI E NO 1
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIGNATURE
'/OF APPLICANT APPL/I C�/T`I/ON DATE `R jCE I PT BER CHECI .UMBER °`OR CASH
APPR V BY PERMIT FEES
AP R V,E c BASE FEE INSPECTION
�9$9 : S U'BLDG SURCHARGE � PLAN CHECK
JEFFERSON COUNTY $ --ENERGY SURCHARGE ?3, l
PI 4kNINI3&SLOG K - �-� TOTAL
911 NUMBER REFUND DATE I DA E S UED
BUILDING OFFICIAL /A q P
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APPPOVED
JAM 0 g /S./tic_ 19-c12-144.
JEFFERSON COUNTY
PLANING&6100 OUT
37 777
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