HomeMy WebLinkAboutBLD1989-00555 BIDDING , TRMIT APPLICATION At ,
Jefferson County Building DepartmenteP .O . Box 12201MITrt Townsend, WA 93368
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LOCATION
SPECIFIC LOCATION SITE ADDRESS , 1) ',/ i-.,44-,i
POSTAI.. DISTRICT /SUBDI V I S ION '-.I.:::'0-. , ..`
LEGAL DESCRIPTION LOT I BLOCK_ DIVISION TAX NUMBER
' , t
PARCEL. NU ER -T/TLO
Cl. — e'M C) 3 1 / 4 SECTION
PL W ,
ANNING AREA SECTION TO NSHIP f9-7,1 NORTH RANGE kE , WM
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BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 6 NEW BUILDING MAIN, FLOOR 4' / -
.:7
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
ppqTAtigp/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT iGARAGE
O WOODSTOVE 0 wRECG/DEMOLITION ' COMMERCIAL
V-1 } 0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
Yill NUMBER OF UNITS____
MOBILE HOMES
kr.) 0 COMMERCIAL
O INDUSTRIAL SIZE a $35
----0
YEAR.. P.
@ $ 16
O HOTEL/MOTEL/DORMITORY
HAKE 172- 0
NUMBER OF UNITS _
O OTHER - SPECIFY ---_,
$6 5 37
ESTIMATED COST OF 41 a
i I MPROVEMENy.S „, , TOTA FAIR MARKET VALUE
KY- UBC OCCUPANCY GROU p,/,' i $ /6, '7 -(_ $
cr SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
k WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
Z0 MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
1
-......) 0 STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL n OTHER - SPECIFY
. 1
0 MASONRY ( WALL BEARING ) DIMENSIONS --.
O OTHER - - NUR OF STORIES L- 4 -i)
TOTAL LATH) AREA4' 'c.:
DEPARTMENTAL REVIEW
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HEAL 1, EpARTMENT TYPE OF S E VI i'', b: D I S P OS A L I NUMBER OF PROPOSED BEDROOMS
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS __
0 INDIVIDUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
0 INDIVIDUAL WELL 1,11...VBER OF EXISTING BATHRCCM
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 'PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . W HIM SHORELINE JURISDICTION
YES NAME OF ADJACENT WATEkk BODY
0 NO
APPROVED DATE BARK HEIGHT SETBACK _
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRrn 0 YES 0 NO
IDENTIFICATION
—...
-........... NAME MAILING A,DORESS ZIP TEL NO
OWNER . i .
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CONT 'r;, . •; :: A ( • '. -.
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ARCH .. t," 11 ? li,'.r. ' ; 'J ._. 4
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
SIGNATUFIE OF APPICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMPER OR CASH
-a_. AL2369'
APPRO1 . BY
1
/
allik PERMIT FEES
2-6
C s+
BASE FEE INSPECTION
A p p ,,: ra . . .ct.
---- BLDG SURCHARGE PLAN CHECK
EP
mg ENERGY SURCHARGE $ TOTAL
JEFFERSON COUNTY 9 I I NUMBER REFUND DATE 1 DATE ISSUED
PLANIW&BLQG BUILDING OFT-_riga-
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