HomeMy WebLinkAboutBLD1989-00551r BUILDING ,'ERMIT APPLICATION
Jefferson County Building artment®P .O . Box 1220+Por�Tawnsend. WA 98368
•LOCATION /"!%
SPECIFIC LOCATION SITE ADDRESS 6 M `L M-12-0i , )C.,
POSTAL DISTRICT7bjFLut1LD I)SUBDIVISIONP .ALT_449bf 1L .
LEGAL DESCRIPTION LOT 1.30 BLOCK / DIVISION TAX NUMBER
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PARCEL NUMBER ! ei —6,03 /J0 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MO[.l I LE HOME ADDITION 2ND FLOOR
O MODULAR HOME "' 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 MOBILE HOMES
❑ COMMERCIAL
0 INDUSTRIAL SIZE �� $35
❑ HOTEL/MOTEL/DORMITORY YEAR ( $ 18
NUMBER OF UNITS MAKE $8
❑ OTHER - SPECIFY ESTIMATED COST OF @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU7 '7 $ /l Q el �t $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
XF WOOD FRAME EfELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREA /JJ 02 '94r
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 7n—
S_PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS .-.?
• INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM,
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM 2—
sror
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE )4. PRIVATE ( NAME OF WATER SUPPLY) L .&. L,tt/J i fie Ctj.
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
NO
APPROVED DATE ANK 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
0
NAME MAILING ADDRESS ZIP TEL NO
OWNER �i F2�,1csh 2d ���' i,� Ro� �Q h e— c�.??-as93
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ARCH
THE •WNER OF THIS BUILDING AND' THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SI ATURE OF APPLICANT APPLI ATION DATE I RECEIP MBER I CHECK NUM ER OR CASH
/APPR• -1., - PERMIT FEES
A P .. III : D I V 642 BASE FEE INSPECTION
ilk G-
f' .; 7 p- BLDG SURCHARGE PLAN CHECK
U U ENERGY SURCHARGE $ `V2 -7
JEFFERSOn COIOM° TOTAL
KlAA1M$SLOG DEPT
811 NUMBER REFUND DATE i,
BUILDING OFFICIAL
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JErFERSCN COUNTY
PLANNING&8LDG DEPT
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