HomeMy WebLinkAboutBLD1989-00567 BUIII,NG ERMIT APPLICATION
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Jefferson County Building DepartmentmP .O . Box 1220,PorL Townsend . WA 98368
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SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK
DLIVISION.1 _NUMBER
PARCEL NLIMB R 7(4 cf° 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP i NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 )* w BUILDING MAIN FLOOR
O monILE HOME ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED [I REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
I
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE P.07,177,S
O COMMERCIAL 0 2 $35
SIZE
O INDUSTRIAL
YEAR 0 @ $ 16
O HOTEL/MOTEL/DORMITORY
MAKE
UMBER OF UNITS
OTHER - SPECIFY' _,
47/
ESTIMATED COST OF 4400 0 2 $8 7- 2erpe-j)
,
f)_] 2 $8
8017 Ft°7' IMPROVEMENTS
TOI (.1...7kiR MARKET VALUE
UBC OCCUPANC GROW $ $ ..7
SELECTED CHARACTERISTICS OF BUILDING
PRI IPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE S
0 MANUFACTURED 0 WOODSTOVE 0 PASSIV ..› LAR
O STRUCTURAL STEEL 0 GAS 0 C
O REINFORCED CONCRETE 0 OIL OTHER - SPECIFY
El MASONRY ( WALL BEARING ) DIrMENSl1S
L] OTHER - LI UT, R OF sTorn ES TOTAL LAND AREA
DEPARTMENTAL REVIEW .
HEALTH D E P R TM E N T TYPE OF SEWAGE D I S P OS A L NumeEn OF PROPOSED BE DROOn
/
0 P BL I C oR PR I vATE
I ND I V I DUAL ( SEPT I C ) NUMBER OF EX I ST I Rooms
Num B ER 0- OPOS ED BATHROOM
.....2 APPROVED DA E '
0 INDIVIDUAL WELL N . . R OF EXISTING ELATHR<XA1
CC) PUD TYPE OF WATER SUrPLy
O PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
O 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
( NAME
MAILING ADDRESS ZIP TEL NO/
•-•
OWNER 1
-- 37_i4t
CONT
ff T7CT rr. --ETTiEl S ETM I --
AR cH
IHE OWNER OF TI!IS BUILDING AND THE UNDERSIGPED AGREE TO CONFORM TO ALL APPLICABLE LAWS;
SIGNA4WE OF A PLICANT
14--
LC MENUR CASH .,
APPRAI51, RMIT &TES
BASE FEE INSPECTION
LAMA ' ig LC/4-6-r"5—
BLDG S URCI-LARGE PLAN CHECK
JEFFERSON COUNTY •--,,,, ..... ENERGY SURCHARGE $ ( .7-7 '
PLANNING&SLOG OEPT TOTAL
, 911 NUMBER REFUND DATE i ;1-,E yy E
•••*"*."'"
BUILDING OFFICIAL 47
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AP R E
JEFFERSON COUNTY
PLANNING&BLOC DEPT
C lC44 /al r>e C J