HomeMy WebLinkAboutBLD1989-00570 .c•
B DING k'ER11IT APPLICATION.
Jefferson County Building Department*P . ) . Box 122O9 rt Townsend. WA 98368
LOCATION / f'�/)
SPECIFIC LOCATION SITE ADDRESS /7� ,7/ < C.�09r1P fr '
POSTAL DISTRICT 173, /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK ) o DIVISION TAX NUMBER
PARCEL NUMBER 9601 10 1 &174 /. / a SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYP/Fy- F IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY [J/I�EW BUILDING MAIN FLOOR
jy 0 MOBILE HOME ❑ ADDITION 2ND FLOOR
0 MODULAR HOME ❑ ALTERATION BASEMENT
O DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT ( GARAGE
O WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL i
❑ MULTI -FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES �/
(.4- 0 COMMERCIAL SIZE UJ a $3 5
❑ INDUSTRIAL
1."' ❑ HOTEL/MOTEL/DORMITORY MAKE �,► p� $gs p�30 /
UMBER OF UN 1 TS --
1/[
air OTHE - SPECIFY" + EST 1 MAT COST OF 0 a7 $8
oft......- V � L / f, 1MPR EMENTS TOT FAI MARKET VALUE
UBC OGCUPA Y GROUP $ $ j /
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME
PRINCIPLE TYPE OF HEATING FUEL
O WOOD FRAME ❑ ELECTRICITY ❑ COLLECT! L R
❑ NUFACTURED 0 WOODSTOVE VE SOLAR
STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING ) ` DIMENSIONS
❑ OTHER - - NUMBER OF STORIES TOTAL LAND AREA
DEP RTMENTAL REVIEW
H TH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF FROPOSED BEDROOMSY..--"'�
JF O'C j P L I C OR PRIVATE NUMUFR OF EX1STI _DROOMS
I MD I V! DUAL ( SEPTIC ) NUMBER OF SED BATHROOM
APPROVED DATE
❑ INDIVIDUAL WELL I` OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
O PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES AME OF ADJACENT WATER BODY
O
j�.�� APPROVED DATE BANK HEIGHT SETBACK
.1. 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
Oa
4"' IDENTIFICATION
C:r'
NAME'/y-B' `l� / MAILING ADDRESS �^ZIP,,a� TEL
NO
® OWNER ..( [ ' 1 "' ' l 1s.;' �0 )C^ `5 / F +� r
'„J CONT l ,, rti C- _Q ,=)1 4, E r fit L
. , STA 1'E L I CE:NNSE ND Crf)/M CV
ARCH
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S GNATURE OF AP IC PCHECKLICPTIOpFODATE RECEIT NUM ER OR CASH
APPROVED BY PERM! FEES
A P P ! O V E D BASE FEE INSPECTION
AUG 14 t989 �0 BLDG SURCHARGE PLAN CHECK
,,
JEFFERSON COUNT ENERGY SURCHARGE "*' TOTAL
PL NP;!NG :�t UG DEPT H
Z25 - /177
911 NUMBER REIFUND DATE I ,D'lyT/
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APPROVED
AUG i lgeg
JEFFERSON COUNTY
PLANNING&BLDG DM
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