HomeMy WebLinkAboutBLD1989-00593 BUILDING 'ERNIT APPLICATION p/ N /6 -4 134a9
Jetfprson County Building ikartment.P .O . Box 1220sPor Townsend. WA 98368.
LOCATION B Y ICR V j LI"• AG - S tie- 14, .
SPECIFIC LOCAT I Oti SITE ADDRESS N IJS 1W Pi-. G(c!1 04.)
POSTAL DISTRICT /SUBDIVISION Bay Via() //l Gt.Le
LEGAL DESCRIPTION LOI R ? BLOCK DIVISION TAX NUMBER (�//
PARCEL NUM ER E�./�ljj - 1 / 4 SECTION
PLANNING AREA SECTION TOWNSHIP NORTH RANGE / C • WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE/7/,
i '`/ X SINGLE FAMILY 1 NEW BUILDING MAIN FLOOR
40 ❑ MOBILE HOME ❑ ADDITION 2ND FLOOR -
❑ MODULAR HOME 0 ALTERATION BASEMENT
❑ DETACHED/ATTACHED 0 REPAIR .CAR-P ft-TDQ .-2-n oZ,--
0 GARAGE 0 REPLACEMENT GARAGE 5-in
_ 0 WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
CT ❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS
❑ COMMERCIAL MOBILE HOMES /� �1/D0
�r 0 INDUSTRIAL SIZE /-, $ 16 �l/ Al(
YEAR
0 HOTEL/MOTEL/DORMITORY MAKE a $ 1 a $8
NUMBER OF UNITS !iJ
❑ OTHER - SPECIFY ESTIMATED COST OF s J @ $8 L.��L/��
IMPROVEMENTS TOT 6FA ay,1�j2KET VALUE
UBC OCCUPANCY GROUP; $ $ (�( . L/yL
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS 0 COAL
❑ REINFORCED CONCRETE ❑ OIL R OTHER - SPECIFY-JAF /
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES / TOTAL LAND AREAY/,O
DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
/^., �{/ / g PUB L I C OR PR I VATE NUMBER OF EXISTING BEDROOMS
��` /V ❑ INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE
C..) APPROVED
1 ND 1 V I DUAL WELL NUMBER OF EXISTING BATHROOM --
( �i PUD TYPE OF WATER SUPPLY
`.- k PUBLIC '( NAME OF WATER SUPPLY) L4(bLO W Ca le-,
'` APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
Cr
PLANNING DEPT , WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
--3 APPROVED DATE BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF - WAY WIDTH �j0
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER
Re_SWrCQS (70M -Pa)/aa', ( S'u2 y37.0.lq
?-4--. LuDL-oco :-/R3(05
GON S
T Ckyyk�/
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
SIGN AK OF A APPLICATION DATE k33
CEIPT NUMBER CHECK NUMBER OR CASH
/, , / / y c ..,, t -
PPROVED BY PE MIT FEES
A P P + ,N `:' E 0 qqtoo BASE FEE INSPECTION
OCT I _ �,�� BLDG SURCHARGE / / PLAN CHECK
JEfFf.RS09 pUp `,�Y \ ENERGY SURCHARGE d C.../gc,� TOTAL
PLANNING&BLDG DEPT P ` I�/
911 NUMBER REFUND DATE DAT ISSUED
BUILDING OFFICIAL l D1 f`R cl
M+ /111 LL ` o
1332
N 54.00 '42' C
49. 000 •
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JEFFERSO i COUNTY
PLANNING&3l.OG DEPT
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