HomeMy WebLinkAboutBLD1989-00561 BFTI_DING 'ERMIT APPLICATION A/ L c 3 ./
Jefferson County Buildi Department'P .O . Box 1220'01-t Townsend. WA 98368
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LOCATION /VW ,�/
SPECIFIC LOCATION SITE ADDRESS i 3 �o(1eL I ( �/n� 1 m e_
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOTJ 3 BLOCK DIVIJS_I/ON TAX NUMBER
PARCEL NUMBER 9r)• Sc .9Ua°) 1 / 4 SECTION
PLANNING AREA SECTION /7 TOWNSHIP - R NORTH RANGE `'"' WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
A SINGLE FAMILY /0 NEW BUILDING MAIN FLOOR /a 9
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE /7 3
❑ WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL SIZE / @ $35 -�1/�
❑ INDUSTRIAL YEAR Q] a1 $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE y
N ! 73 0 @ $8 , `3 7S
UMBER OF UNITS
❑ - SPECIFY 0 @ $8
OTHER ESTIMATED COST OF _
IMPROVEMENTS TOT pJ��FQ,I` �RK T- VALUE
UBC OCCUPANCY GROUP` $
$
fir.; SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
X WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL ❑ GAS 0 COAL
fey_-" 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY 0 MASONRY ( WALL BEARING ) DIMENSIONS
� 0 ❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREA
.." ✓ DEPARTMENTAL REVIEW
j HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
'____J aPUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
`,."�.�!} 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM 07
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOMS
PUD TYPE OF WATER SUPPLY �/1�
t-" PUBLIC '( NAME OF WATER SUPPLY) L-ttDL.pW (J�/(77�/ileS
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY w..rw,w+r
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
X NO
APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
J l NAME OF PUBLIC ROAD
` - ( NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME .a- MAILING ADDRESS ZIP TEL NO
OWNER
pa, eSO(IV C ( Ir'? in Pc07,ariis.y loci,
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CONT 50vi/)e _
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGN LE OF/eP! IF2' 12?/c7/
APPLIC frION E k3sf2
R CEIPT NUMBER I CHECKj OR CASH
APP�•%0 BBBY// PEIjMIT FEES ,,(•,[
i
4 L BASE FEE INSPECTION
C, BLDG SURCHARGE PLAN CHECK
II 21 ' \ � ENERGY SURCHARGE
r fL� ��i TOTAL
$EIE�SO tr�Y Y / Q O( REFUND DATE I DATE I SSUED
P!A DI G F�FI i 1 911 NUMBER I /a���8
BUILDING OFFICIAL
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