HomeMy WebLinkAboutBLD1989-00564 V A.i...V317V 0, L. iIA1'1 I ri I- LJ. PA{ i iVI s-�
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Jefferson County BuiLdi Department+P .O . Box 1220'1rt Townsend. WA 98368
LOCATION ` .
SPECIFIC LOCATION SITE ADDRESS / 0 Dyl D7Jt/.i ett__/-a-
POSTAL
D I STR I CT r-
- /SUB ON ?j9- '.7J6r, �1_LLcJLo -- a�SI
LEGAL DESCRIPTION LOT // S- BLOCK DIVISION TAX NUMBER
PARCEL N1/BER C `" 0 --C..) 1 / 4 SECT I ONi
PLANNING AREA SECTION / TOWNSHIP NORTH RANGE ` S WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME ALTERATION BASEMENT /
❑ DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS .
❑ COMMERCIAL ~�� MOBILE HOMES
❑ INDUSTRIAL SIZE @ $35
❑ HOTEL/MOTEL/DORMITORY YEAR 4t q'� $ 16
NUMBER OF UNITS MAKE W� $8
❑ OTHER - SPECIFY ESTIMATED COST OF �u a $8
T! IMPROV MENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROU $ U b ® er L� $e
SELECTED CHARACTERISTICS OF BUILDING
P INCIPLE TYPE OF FRAME PRI IPLE YPE OF HEATING FUEL
WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
CI ❑ REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING )
DIMENSIONS
C!� ♦ 0 OTHER - NUMBER OF STORIES // TOTAL LAND AREA
._.
— DE ARTMENTAL REVIEW
H J� (\LTH DEPATMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
;,' ', PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
( 3�R 0 INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
A PRO D DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM��
PUD TYPE OF WATER SUPPLY
PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ,(PRIVATE ( NAME OF WATER SUPPLY)/J-rlL-vt.-) G'f/i)/7e,S
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
❑ 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 ❑ NO
IDENTIFICATION
NAME x MAILING ADDRESS ZIP TEL NNOJ
OWNER ( 0,111?) ._�%�,./V - ,36 x ;/
3 7 (7 (l/.'-dOO V
C°NT (&02._a_uti--e_(1 , 0 . leo .5( 6-6 , F-6/-E7-1,(4_0/4m0 4t32-,)-2-67
' Ei74Q 4 3—
r
ARCH „ /��
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THE •WNER OF THIS BUILDING ANDTHE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
'SI • .IATURE OF I ANT APPLI ATION DATE RECEIPT NUMBER CHECK NUMBEROR CASH 1
/d7 7 915 7 I 7,s
P PERMIT T FEES
A (C-315 Q BASE FEE INSPECTION
UV
BLDG SURCHARGE PLAN CHECK
pry SOO"
t G:GG P P1' :// ENERGY SURCHARGE 6 7,
40,4 '" ` $ TOTAL
911 NUMBER REFUND DATE DATE 1SS
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