HomeMy WebLinkAboutBLD1989-00585 GIVING 4,:-)ERMIT APPLICATION . .
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Jefferson County Building DepartmentA,P .0 - Box 1220T, ort Townsend. WA 98368
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SPECIFIC LOCATION SITE ADDRESS aatk/i ibmAy a
POSTAL DISTRICT -?7-77 /SUBDIVISION
LEGAL DESCRIPTION LOT r7___BLOCK DIVISION TAX NUMBER
PARCEL 77Rc140_, / SECTION
PLANNING AREA SECTION TOWNSHIP (A) NORTH RANGE . WM
BUIL ING INFORMATION
sU DING TYPE Tyr_ OF IMPROVEMENT SQUAREOFOOTAGW5,6
SINGLE FAMILY NEW BUILDING MAIN FLOOR
O MOBILE HOME
0 ADDITION
0
O MODULAR HOME 0 ALTERATION BASEMENT
--1.
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT , GARAGE
O wOODSTOVE 0 WRECKING/DEMOLITION / COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES I. A--
O COMMERCIAL
SIZE I ' I @ $35 , .
D INDUSTRIAL
O HOTEL/MOTEL/DORMITORY
MAKE , 0 2 $6
NUMBER OF UNITS . _ -__ —
--
-
O OTHER - SPECIFY ---- -0 @ $8
ESTIMATEI COST CE7 -
_A IMPROV - 4ENTS
V-) UBC OCCUPANCY GROUP
- $ TO...L. , 41KET VALUE
IS ........-
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CND
SELECTED CHARACTERISTIC OF RUIEDI7As
; 2 PRINCIPLE TYPE OF HEATING FUEL
Fr„JACIPLE TYPE OF FRAME
WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED 0 WOO TOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL 0 CJC.., 0 COAL
Cr- 0 REINFORCED CONCRETE OIL 0 OTHER - SPECIFY
O MASONRY ( WALL BEARING )
‘ 0 DIMENSIONS
O OTHER - NUMBER OF STORIES1,--..../ TOTAL LAND AREA
Cr-
DEPARTMENTAL REVIEW
HEALTH) DE T ENT TYPE OF SEWAGE D I srosAL TmBER OF FROFOSED REDRookts3
0 P IC OR PRIVATE NUMBER OF EXISTING BEDROOMS .
APPROVED DATA46, D INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHRt7-.
',ME„) ,
...
0 INIVIDUAL WELL
- NuuTraOF isTING FATIARoom
...._....... ,
PUB TYPE OF WATER SUPPLY
,...„..
O 17y,BLic ( r1,-mc OF WATER SUPPLY)
APPROVED DATE PrPRIVATE ( NAME OF WATER
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
O YES NAME OF ADJACENT WATER BODY
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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 U YES 0 NO
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IDENTIFICATION
NAME MAILING ADDRESS Z I P TEL NO
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UWNER ' .---
)(3.0\:lior4T MIPIINIF
_ iii _,_ ==2, 7O i , 7-•- •--S
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40 ARCH
THE OWNER OF THIS BUILDING AND THE UNDSIGNED AGREE TO CONFORM TO ALL APPLICARLE LAWS.
. .-......... ..-..... .....- ,,..,-........,,.........-.„..........
X :;I: TR E. OF P__,, Aw APFLICATI )t '1 7 RECEIPT MUMS. R CHECK NUMRER OR PAqH
A ,,,'... 00, U ior - NT.
i S-- S 703
APPROVED BY P MIT
. BASE FEE
AP
BLDG SURCHARGE
(Att;
Cr 4 1989 ----- \
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--_ —
ENERGY SURCHARor .,....,:t _ PLAN CHECK
INSPECTION
..- TOTAL
---- -
ROM 4 tit OG DEti . 91 : NUMBER nErumo DATE , DATE ISSUED
BUILDING OFFICIAL /C/4
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