HomeMy WebLinkAboutBLD1989-00571 Bll,DING c 'ERMIT APPLICATION
Jefferson County Building DepartmentV .O . Box 122064=urt Townsend. WA 98368
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l !SPECIFIC LOCATION SITE ADDRESS7 � 0 44; ( /22fire02-4)--riee're?
POSTAL DISTRICT , /SUBDIVISION
LEGAL DESCRIPTION LOT BLOC, / yv IVIS-IION TAX NUMBER
!PARCEL NUMBER 7GO o26‹.) /// d---)1 / 4 SECTION
PLANNING AREA SECTION, 3 TOWNSHIP,-V"J NORTH RANGE / WM
BUILDING INFORMATION
BUILDING� TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
o S�I'NiGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
L1-d/MODILE HOME 0 ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS '
M❑ COMMERCIAL S I Z LE HOMES �� Ifl @ $35
E
❑ INDUSTRIAL YEAR D
❑ HOTEL/MOTEL/DORMITORY MAKE 49 )17�'e II, . $ 168
NUMBER OF UNITS
.
❑ OTHER - SPECIFY - "� 0 @ $8
ESTIMATED COST OF
IMPROVEMEN T• AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP 4,7 $
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1-'- SELECTED CHARACTERISTICS OF BUILDING
.' PRINCI E TYPE OF FRAME PRI PLE TYPE OF HEATING FUEL
❑ W D FRAME ELECTRICITY 0 COLLECTIVE SOLAR
MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
O 0 STRUCTURAL STEEL ❑ GAS 0 COAL
C ❑ REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY ,
) 0 MASONRY ( WALL BEARING ) ~
( DIMENSIONS �`7(�Tj(a 70
�`� 0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
'�.J
V' DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS .--.y
1 4 iC
❑ P L I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
�j ) INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOS ED BATHROOM
APPROVED ATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
/3 PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
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 }jam. 1{�/�]S MAILING�(� ADDRESS
DD�D�)RISE S�SJ/ OW
ZIP TEL NO
OWNER j V 1 ' v 1l/�./7 t ) r5../'.� �C`K/V 5
CONT
ST/0'E LICENSE-NO I..
1
ARCH
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SI NATURE OF APPLICANT APPLICATIO D TE RECEIPT NUMBER CHECK NUMBER OR CASH
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APPR VE Y-,, PERMIT
A �; / �.. BASE FEE INSPECTION
St) BLDG SURCHARGE PLAN CHECK
89 'l
UL ENERGY SURCHARGE /8 ,
se)
JE'FFERSON COUNTY TOTAL
PLANNING$ BLDG DEFT 9 I I NUMBER REFUND DATE DAT I SSUED
BUILDING OFFICIAL
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