HomeMy WebLinkAboutBLD1989-00566 BUDDING .:'ERMIT APPLICATION
Jefferson County Building Departmerit'P .O. Box 1220* t Townsend. WA 98368
j,OCAT 1 ON �y�oo r�e_
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT( , /SUBDIVISION rCYI O
A
LEGAL DESCRIPTION LOT (I`L .12 BLOCK DIVISION TAX NUMBER
PARCEL NUMBER 1 / 4 SECTION JJ
PLANNING AREA-( SECTION TOWNSHIP NORTH RANGE I� WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOPILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
RAGE ❑ REPLACEMENT GARAGE
OODSTOVE ❑ WRECKING/DEMOLITION ICOMM CIAL
-14-ULT 1 - FAM I LY [] RELOCATION/MOVING I USTR I AL
NUMBER OF UNITS
MOBILE HOMES
❑ COMMERCIAL a $35
SIZE
❑ INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY
MAKE 0 a $8
NUMRF_R OF UNITS
0 OTHER - SPECIFY EST I r"AT COST OF 0 @ $8
IMPRO MENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP2((}}��3 $ „--TT $
tSELECTED CHARACTrn IST YCS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAME ❑ ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
i 0 STRUCTURAL STEEL 0 GAS ❑ COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SP - IFY
❑ MASONRY ( WALL BEARING )
DIMENSIONS
0 OTHER - NUMBER or STORIES TOTAL LAND AREA
\r- DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE D I SPOS NUMBER OF PROPOSED BEDROOMS
❑ PUBLIC OR PR I VAT NUMBER OF EXISTING BEDROOMS
..+. ❑ INDIVIDUAL ( S E: ' IC ) NUMBER or rROr'OSED BATHROOM
i. APPROVED DATE ❑ INDIVIDUAL EL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WA _R SUPPLY
❑ PUBLI ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PR 'ATE ( NAME: OF WATER SUPPLY
PLANNING DEPT . W HIN SHORELINE JURISDICTION
■ YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED D E BANK HEIGHT SETBACK
PUBLIC YORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MA LI G ADDRESS ZIP TEL NO
OWNER
CONT
j
£I l 6 4-A � iNSk NO
IL} _
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO �C-7ONFORM TO ALL APPLICABLE LAWS.
�'S///{�URE 0 L 1 CANT- APPLI A� /1e7 DATE .�J("j f L ER I CE SMBEg OR CASH
AO D BY \ PERMIT FEES// ��/Cf Cr�/y
v �,�, r� BASE FEE INSPECTION
S BLDG SURCHARGE PLAN CHECK
JEFFERSQNCQUNTY ENERGY SURCHARGE C5 6
TOTAL
PLANNING&DWG DEPT
911 NUMBER REFUND DATE DATE ISSU
BUILDING OFFICIAL I
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