HomeMy WebLinkAboutBLD1989-00550 . ..
IIILDING f.'ERMIT APPLICATION a
Jefferson County Building Departmnt"P .O . Box 122g rort Townsend. WA 98368
LOCATION__ . ,
1 ,
SPECIFIC LOCATION SITE ADDRESS ry
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER (10
PARCEL taumpER ,,,, 4 1 C)0,_. 1 / 4 SECTION
PLANNING AREA SECTION r211 TOWNSHIP 31 NORTH RANGE ,;L , ) WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME % ADDITIOT1 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
ARAGE
WOODSTOVE
0 REPLACEMENT GARAGE
O WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY
O RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS__
- '
MOBILE HOMES
O COMMERCIAL VI @ $35
SIZE ____
O INDUSTRIAL
YEAR_ _ 0 @ $ 16
O HOTEL/MOTEL/DORMITORY --._
MAKE 0 @ $8
NUMBER OF UNITS
---
i - 0 OTHER - SPECIFY ESTIMATED COST OF 0 @ $8
i4- ) IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
. --
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
, rm
0 WOOD FRAME 0 ELCTRICITY 0 COLLECTIVE SOLAR
0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
(7 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL. 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DImENsIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
, —
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
O PUB L I C OP PR I VATE NUMBER OF EXISTING BEDROOMS
e
0 I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 I ND I V 1 DUAL WELL NUMBER OF EX I ST I T K; BATHROOM
PUB TYPE OF WATER SUPPLY
O PUBLIC ( MAME OF WATER SUPPLY)
APPROVED DATE , f-1 PRIVATE ( NAME OF WATER SUPPLY),
....** 7
PLANNING DEPT . WITHIN SH077:LINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
O NO
APPROVED DATE BANK HEIGHT SETBACK
----
.
PUBLIC WORKS DEPT ROAD RIGHT- -WAY WIDTH
NAME OF PUBLIC ROAD
• NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCES PERMIT REQUIRED 0 YES 0 NO
_ -- ---
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
...* •
OWNER - (9O-B
-
CONT
, -SIAIE 1. 11:_ ,-N:.;2- i iii
ARCH
THE 0 ER OF THIS BUILDING AND THE UNDERSIGNED AGrE TO CONFORM TO ALL APPLICABLE LAWS:
IG TURE APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
I OA j8c1„ -1-3I P) . 1 9-2
APPROVED BY PERMIT FEES
. ' E C : ! 1 E ID .J-27,00, BASE F.E. INSPECTION
OCT 24 i: ) ____22 (5-Q. BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ c :7i C5-0
JEFFEV'' TOTAL
911 NUMBER REFUND DATE DAT I SS ED
*
BUILDING OFFICIAL I
. .,.., .
EC.,' .71 '/ E0
OCT 2 4 19
JEFFERS'IN C, Y
// .-- e. C-r
0 /7/24 J-r / ''.' "I-1,- I
,irse.
// 2/2/87 P-e,Ley E'• -Lp,< /1. -esti>4 .,_-1\3 ,
44 c cyc.