HomeMy WebLinkAboutBLD1989-00574 (311ILDING , 'ERMI'e
:PPLICATION
Jefferson County Buildl, Departmer':, a0 . Box 1220 ort Townsend, WA 98368
LOCATION •
SPECIFIC LOCATION SITE ADDRESS 3 Cf ) U/ a,,, 1-c)Z.
POSTAL DISTRICT /SUBDIVISION e J S f
LEGAL DESCRIPTION LOT/ / ( BLOCK 1 DIVISION TAX NUMBER
PARCEL NUMBER `?y.2 ?Y)/ CgO 1 / a SECTION
SECTION_ �.', -'.1 TOWNSHIP . / NORTH RANGE ( (_. WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOLIILE HOME ❑ ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
0 DETACHED/ATTACHED ❑ REPAIR CARPORT ,'' '
GARAGE ❑ REPLACEMENT GARAGE
WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
��--�/❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES
0 INDUSTRIAL SIZE p�. $35
0 HOTEL/MOTEL/DORMITORY YEAR 0 $ I6
MAKE i' 0 @ $8
NUMBER OF UNITS ,'"
❑ OTHER SPECIFY ESTIMATF,.b COST OF 0 @ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $ $
SELECTED CHARACTERISTJ.GS OF BUILDING
Jr
PRINCIPLE TYPE OFzFRAME
PRINCIPLE TYPE OF HEATING FUEL
0 WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTUR 0 WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURrAI STEEL 0 GAS ❑ COAL
0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 O,'P'-IER - NUMBER OF STORIES TOTAL LAND AREA
,/DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PPOSED . R BE G
RO OOMS
0 PUBL I C OR PRIVATE NUMBER OF EXIST-i 4 BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF.-PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER-'OF EXISTING BATHROOM
-1 .;
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF-'"WATER SUPPLY 1
PLANNING DEPT . WITHIN SHOREL.,1- 4E JURISDICTION
0 YES NAME` OF ADJACENT WATER BODY
V ❑u00-----'
APPROVED DATE / BANK HEIGHT SETBACK
0.. PUBLIC WORKS DEPT ROAD RIGHT-OF-WAY WIDTH
r, NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
--S-77"' 'I NTIFICATION
NAME , MAILING ADDRESS ZIP TEL NO
OWNER - 1, t; t_ v (P
lA
IS ji. c`tvardt SUS
CONT
' STATE, LICENSE NO
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
` S 1 URE �A PL;C� 'A PL(1 CA,T O 'f'E RECE L 1L�f'7�-IPT NUMBER CHECK UR OR CASH
APPROVED BY PERMIT FEES
APPROVED 'El: /
BASE FEE INSPECTION
JAN 0 4 1989 3, S?_ I.DG SURCHARGE PLAN CHECK
JEFFERSON ,OUNTY ENERGY SURCHARGE
P�"+"'`r' 3 G UFPT' f ` TOTAL
,`�,�//,�/�///) �i / 91 1 NUMBER REFUND DATE D E 1 S •
BUIL ING OFFICIAL I I. T.1
APPROVED
JAM 0 4 1989 I S d
4EFFIRS44 EMMY
PtAlsZti4c 4 ROG OEPT
— s.