HomeMy WebLinkAboutBLD1989-00563 BUIL[ tNG PERMIT APPLICATION
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Jefferson County Building , partment*P .O . Box 1220•Pollownsend, WA 98368
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LocATIoN
SPECIFIC LOCATION SITE ADDRESS 0 INP7-7d,EY Cr1-4.-.4-,
POSTAL DISTRIC' LUI4SUBDIVISION ?Ore-- i--1-4-klacEED“),
LEGAL DESCRIPTION LOT a BLOCK DIVI5,' ION TAX NUMBER
PARCEL NU Ergl 0 gob 0/66 1 / 4 SECTION ,
Y'•, __ SECTION TOWNSHIP (4 ,49 NORTH RANGE jr5:- AWM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
A4 SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME ) ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT _
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS 1
---- MOBILE HOMES
0 COMMERCIAL
SIZE 0 @ $35
O INDUSTRIAL I
YEAR 0 @ $ 16
"c> 0 HOTEL/MOTEL/DORMITORY
0 @
N•3 NUMBER OF UNITS MAKE $8
irm 0 OTHER - SPECIFY 0 @ $8
.41 ESTIMATED COST OF
IMPROVEMENTS TOTAL FAIR MARKET VALUE
-, UBC OCCUPANCY GROUP $ 0, n n 0 Q:--r--
-A
IS
a SELECTED CHARACTERISTICS OF BUILDING
Eo PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
CXI 0 WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
(7— D MANUFACTURED 0 WOODSTOVE n PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
_/fr) 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
—E. 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
CO
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS (E)
4-PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
O I ND I v I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
EI INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE '1-.. PRIVATE ( NAME OF WATER SUPPLY) ..at,t-
4
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
D YES NAME OF ADJACENT WATER BODY
[7] NO
APPROVED DATE BANK 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
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NAME MAILING ADDRESS ZIP TEL NO
OWNER
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CONT
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ARCH
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THE WNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS:
SIG ATURE OF NT APPLI ATION DATE RECE T N 'ER CHECK NUFWER OR CASH
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APPRO E BY PERMIT FEES
IW S-6 BASE FEE INSPECTION
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BLDG SURCHARGE PLAN CHECK
JUN 7 99
- ENERGY SURCHARGE $ t 0 ° TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEPT 911 NUMBER REFUND DATE DATE ISSUED
BUILDING OFFICIAL
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