HomeMy WebLinkAboutBLD1989-00587 110LDING ERMIT APPLICATION Ask
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Jefferson County Building Department -P .O . Box 1220Wort Townsend, WA 98368 '
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OCAT 0 : A
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT o/SUBDIVISION
6- 1-c,
LEGAL DESCRIPTION LOT /6 BLOCK 2 DIVISION TAX NUMBER
PARCEL NUMBER ;t5LQ. FOC / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE / VI) WM
BUILDING INFORMATION
BUILDING TYPE TYPE' OF FMrPOVEMENT ."----------- -1SQUARE FOOTAGE
O SINGLE FAMILY M7NEW BUILDING MAIN FLOOR
O MOBILE HOME 0 ADDITION 1..t.4k6Tizs)p. 2ND FLOOR
O MODULAR HOME 0 ALTERATI N BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT 1GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION 1COMMERCIAL
O MULTI - FAMILY 0 RELOCATION/MOVING NDUSTRIAL
NUMBER OF UNITS
MOBILE HOMES
O COMMERCIAL ..,,'
-----A a $35
SIZE
O INDUSTRIAL ----
YEAR @ $ 16
O HOTEL/MOTEL/DORMITORY
V U M B E R OF UOITS----
---- —
OTHER - SPECAFY 0 @ $5
ESTIMAT D COST OF
IMPR vEMENTS ;EP,T. MARKET VALUE
WUBC OCCUPANCY GROUPft7:t $
--.) -
SELECTED CHARACTERISTICS OF BUILDING ---
,--.
t C\
() PRI,NCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
---_.-----
_„---,----
\-.) ErWOOD FRAME
O MANUFACTURED 0 ELECTRICITY 0 COLLECTIVE S0IT
0 WOODSTOVE 0 PASSIVE SO,L-A-IR
--- .
0 STRUCTURAL STEEL 0 GAS 0 COAE,_,-------
O REINFORCED CONCRETE , 0 OIL ja-eiiiER - SPECIFY
0 MASONRY ( WALL REiY DITIFNS _-,-----
. 0 OTHER - OF STORIES TOTAL LAND AREA
1Z -- - --------- , ,
DEPARTMENTAL REVIEW •
HEALTH DEPA TMENT TYPE OF SEWAGE DISPOSAL NUMBER or PROPOSED BEDROOMS----
C., (.._ 0-4 0 , UB L I C OR PR I VAT E NUMBER OF EXI ST I NG—BEDROOMS
\C'' , I\-
HI I N D I V I D LI A L, ( S E P T I C ) NUMBER OF---1-170----PO.S ED BATHROOM
APPROVED DATE
,--EI INolviruAL WF:LL f• R OF EX I ST I NG BA T HF200M
PUD TYyE OF WATER SUPPLY
• -•:) MI/PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE Li PRIVATE ( NAME OF WATER SUPPLY)
PLANNING DEPT . WITHIN SHORELINE ..7URISDICTION
ci 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 PRIVn.TE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES D NO
---- - - ,
IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO
OWNER 'rLCOQW vc cEo/7yLe, ) .--3-37 --,.35--
... .
CONT
TT-A-I E L r'cL717,77-7"D '
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
VSIGNATU F AP CANT __„L. IZLICAT, ON ATE] R4IPT NUABER ICHM5 R OR CASH
1....\: ..
Alrf": °VEX) By PERMIT rE7L.s
p r
pt. 'Its .,,, f ,_ _ _ BASE FEE INSPECTION
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----- ---6° ,
Palik BLDG SURCHARGE — PLAN CHECK
I T 1 I tri 0
N
EERG Y SURCHARGE
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-o, TOTAL
JEFFEN$ON C
PLANA/NG, 000
,...._—__BUILDING OFFICIAL I I NW El ER REFUND DATE DATE ISSUED
DI OLOG DEpT
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