HomeMy WebLinkAboutBLD1989-00577 BIDDING „ 'ERMIT APPLICATION
Jefferson County Building Department*P .O . Box 1220At Townsend, WA 98368
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LOCATION � 'A y� j� ��
SPECIFIC LOCATION SITE ADDRESS i ""ll ��
POSTAL DISTRICT r /SUBDIVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER c11 -I� t r 1 / 4 SECTION
PLANNING AREA SECTION 3 TOWNSHIP R...-1-
7•gf I) NORTH RANGE (.F , WM
BUILDING INFORMATION ✓✓✓✓ I
BUI ING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 AJ..TERATION `� BASEMENT
❑ DETACHED/ATTACHED Cl/REPAIR f_( IJp,,v,r, S CARPORT
GARAGE ❑ REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
❑ COMMERCIAL $35
SIZE ' '@
❑ INDUSTRIAL YEAR W @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 0 @ $S
NUMBER OF UNITS
O OTHER SPECIFY ESTIMATED COST OF a $8
IMPROVEMENTS t,-- TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP R-3 $ $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PI,”"NCIPLE TYPE OF FRAME
WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
.., HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
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-- s 0 PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ I ND I V I DUAL ( SEPT I C ) NUMBER OF PROPOSED BATHROOM
APPROVEB``fDATE ❑ 1 ND 1 V 1 DUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
1 APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
DEPT . WITHIN SHORELINE JURISDICTION
(\C}n L A N NING
(7:5-`-�/' / 0 YES NAME OF ADJACENT WATER BODY
Qi., � ❑ N O
- APPROVED DATE BANK HEIGHT SETBACK
/
* PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
`l APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
MAILING ADDRESS ^ 1 ZIP TEL NO.
NAME _
OWNER �V �Q,•, , _`� - iq�_ ` . a'C..'_ r^
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ARCH
' ''HE OW OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
S reNAT PP' 1 CANT APPL CAT ON_ TE 13 -
R�EtP NU ER I CHEC��MBE OR CASH
AP O Ea\ Y PE MIT FEES
(l BASE FEE INSPECTION
A P S U BLDG SURCHARGE
PLAN CHECK
. B 2 1 1989 �`` �+t/ENERGY SURCHARGE 2J/�`�
e TOTAL
JEfFERSGN GQUNTY PLANNING&BLDG DEPT 8 1 1 NUMBER ! REFUND DATE DAY 1 SI � '
BUILDING OFFICIAL
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