HomeMy WebLinkAboutBLD1989-00581 BULL NG ERMIT APPLICATION
Jefferson County Building Department'P .O . Box 1220'Por0Townsend . WA 98368�
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LOCATION f f�
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SPECIFIC LOCATION SITE ADDRESS POSTAL nISTRICT /SUBDIVISION S7I9''I /
LEGAL DESCRIPTION LOT r
BLOCK DIVIS �+N TAX NUMBER
PARCEL NUMBER _ 1 / 4 SECTIONus
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PLANNING AREA
SECTION l TOWNSHIP t �,I NORTH RANGE �.t WM
BUILDING INFORMATION
BUILDING TYPE TY E OF IMPROVEMENT SQUARE FOOTAGE
0 SINGLE FAMILY / NEW BUILDING MAIN FLOOR
` iOnILE HOME ' ❑ A DITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
0 DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
WRECKING/DEMOLITION ( COMMERCIAL
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v� 0 WOODSTOVE 0 0 MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILEHOMES
S
O COMMERCIAL SIZE ? 0 hl $3 5
O INDUSTRIAL YEAR // q@ $ 16
O HOTEL/MOTEL/DORMITORY MAKE FA @ $6
NUMBER OF UNITS
O OTHER - SPECIFY ESTIMATED COST OF 0@ $8
IMPROVEMENTS TOTAL FAIR MARKET VALUE
UBC OCCUPANCY GROUP,"/, $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PR CIPLE TYPE OF HEATING FUEL
❑ . .OD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
NUFACTURED 0 WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
0 REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
\ ❑ MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW
`�.
HEALTH DEPARTMENT TYPE OF SEWAGE D 1 SPOSAL NUMBER OF PROPOSED BEDROOMS
J ❑ PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
{� INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
,� APPROVED DAT 0 I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM
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PUD TYPE OF WATER SUPPLY �_(�
PUBLIC ( NAME OF WATER SUPPLY.) 0-4 k
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
A0 YES NAME OF ADJACENT WATER BODY
❑ NO
APPROVED DATE BANK HEIGHT SETBACK
PUB I WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
1- NAME OF PUBLIC ROAD
�JI NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION —•
NA E
MAILING ADDRESS ZIP TEL NO
OWNER ) ( 2 �/ ^- le
CONT
—VTATE Li CEASE ALI T
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V THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
\\( tan TUBE OF,APPLICANT AP 1 AT ATE R E PT NU DER C CSC ifMBER OR CASH
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f• / APPROV D For -., PERMIT FEES
✓ f A P R, V j. ) ?Cj.,(Jl )BASE FEE INSPECTION
3.' ) BLDG SURCHARGE PLAN CHECK
P 1( 1989 &i."------,,....
J€FFI:Y n ENERGY SURCHARGE y TOTAL
S i �� �` mil✓
PIIINPl�N11 LD OFwY REFUND DATE D T I S U D
911 NUMBER / /y lb. ---b Yi b " /
BUILDING OFFICIAL /�
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