HomeMy WebLinkAboutBLD1989-00548 BIDDING ''ERMIT APPLICATION • .
Jefferson County Building DepartmenttT .0% E3o; 1220Akt Townsend. WA 98368
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,I,OCATION
SPECIFIC LOCATION SITE ADDRESS_ ' i(-2
POSTAL DISTRICT /SUB VISION
LEGAL DESCRIPTION LOT, P) BLOCK DIVISION TAX NUMBER
PARCEL NUMBER . it 1 / 4 SECTION
PLANNING AREA SECTION 0 TOWNSHIP NORTH RANGE //Aki WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOMILE HOME 0 ADDITION 2ND FLOOR 7- ,
O MODULAR HOME 0 ALTERATION BASEMENT
O DE ACHED/ATTACHED 0 REPAIR CARPORT —
RAGE 0 REPLACEMENT iGAR
WOODSTOVE 0 WRECKING/DEMOLITION IC , MERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
O COMMERCIAL MOBILE HOMES --A a $33
SIZE_
Cf.' 0 INDUSTRIAL
YEAR
O HOTEL/mOTEL/DORMITORY _ 0 @ $ 16
0 a
.. -- NUMBER OF UNITS MAKE $8
VK-2 0 OTHER - SPECIFY ESTIMAT COST OF 0 @ $8
I MPR EMENTS TOTAL FAIR MARKET VALUE
43 UBC OCCUPANCY GROUP__ ,.,7 $
C) .
SELECTED CHARACTERISTICS OF BUILDING
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PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
Cr.'
tY9 0 WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
CT- 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPE Y
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - _ NUMBER Or7 STORIES ...--- L LAND AREA
-,) •e-- _
CO ' DEPARTMENTAL REVIEW
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HEALTH DEPARTMENT TYPE OF SEAGE v ; sros NUMBER OF PROPOSED BEDROOMS
O PUBLIC OR PRIVAT - NUMBER OF EXISTING BEDROOMS
O INDIVIDUAL ( S",' -TIC ) NUMBER OF PROPOSED rammcom ,
APPROVED DATE
O INDIVIDUALLL NUMBER OF EXISTING BATHROOM
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PUD TYPE OF WkfER SUPPLY
Li PUB>LC ( NAME OF WATER SUPPLY)
APPROVED DATE 0J'IJ,I' _ _VATE ( NA,77T: OFWATER SUPPLY
PLANNING DEPT . W THIN SHORELINE JURISDICTION
/70 YES NAME OF ADJACENT WATER BODY
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O NO
,6 .
APPROVED 5ytE BANK HEIGHT SETBACK
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PUBLIC ORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
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NAME OF PRIVATE ROAD
PPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
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IDENTIFICATION
AME
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HAILING ADDRESS zip TEL NO .42
OWNER )27-- 7-7FITVL--7 E).-
CONT
' SIA ;17-LiCT=, J75-T
ARCH
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TIHE WNER Or THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
4N, SI TuRE,._OF AprLICANT , AppLICAT 07
TE riE 'EAR ' NV5DER CHECK NJMDE OR CASH
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Ap/pROVE(3 BY ERMIT E4-Es
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EASE FEE INSPECTION
, , 1
DLLG SURCHARGE PLAN CHECK
_
ENERGY SURCHARGE
----------- TOTAL
pli NUMBER REFUND DATE DAT S
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BUILDING OFFICIAL J
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