HomeMy WebLinkAboutBLD1989-00584 •LDING 'ERMIT APPLICATION dik
Jefferson County Building DepartmentsP .O . Box 1220erort Townsend . WA 98368
LOCATION l
SPEC I F I C LOCAT I ON S I TE ADDRESS *a - _lc k, �P Vrr Plc/ C/EP.
POSTAL DISTRICT /SURDIVISIO c e C2C- )f/
LEGAL DESCRIPTION LOT BLOCK
c� f DIVISION ) TA X NUMBER
JJ
PARCEL NUMBER 1�{1 �t�7O0()_� 1 / a SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
❑ MOBILE HOME g.ADDITION 2ND FLOOR
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
• WOODSTOVE 0 WRECKING/DEMOLITION ( COMMERCIAL
O MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ MOBILE HOMES
COMMERCIAL
SIZE q`) $35
O INDUSTRIAL
YEAR 4 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE
NUMBER OF UNITS �"®�" — $II --_e
❑ OTHER - SPECIFY ESTIMATED COST OF i @ $8
}- IMPROVEMENTS TOTAL FAIR MARKET VALUE
taw UBC OCCUPANCY GROUP $ $
.r SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
0 WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW •
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE ❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O 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 ❑ YES 0 NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP
`_ TEL NO rr
OWNER .9 r(I irk_ n(k P )to <3((- -70 (k)
• (()
GOUT
R-S"EM -T413-
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1
HE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
I ;NATURE OF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
Bp rt,-----A ,, ‘__„..1-__ ar, 1.23/89' -41 00,3e5 I 0-r(i '
APPROVED BY PERMIT FEES�,/�
APPROVED ,(/,l ) BASE FEE INSPECTION
J U N 231 1989 ,,L)r) BLDG SURCHARGE PLAN CHECK
ENERGY SURCHARGE $ TOTAL
JEFFER$ON COUNTY
PLANNINf&BLDG DEPT
91I NUMBER REFUND DATE ' AT ISSU
BUILDING OFFICIAL �
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