HomeMy WebLinkAboutBLD1989-00594 BUILDING 'ERMIT APPLICATION N /6- ����
Vson
County Building •partment.P .O . Box 1220'Po Townsend. WA 98368
CATJON TTViCW VI1GC, - Sif 11.
ECIFIC LOCATIO SITE ADDRESS --L��POSTAL DISTRICT /SUBD1V1S1ON2 �f �GAL DESCRIPTION LOTv�j BLOCK DIVISION TAX NUMBER
PARCEL NUMBER EoZ.-1,42 - �y 1 / 4 SECTION
PLANNING AREA SECTION /(7 TOWNSHIP r (5 NORTH RANGE / C . WM
(� BUILDING INFORMATION
�' V BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE J-
t0 J SINGLE FAMILY , NEW BUILDING MAIN FLOOR /7/&'
0 MOBILE HOME ❑ ADDITION 2ND FLOOR
0 MODULAR HOME 0 ALTERATION BASEMENT -p `
0 DETACHED/ATTACHED ❑ REPAIR LA14-129Rgpee �-2.(1 --
GARAGE 0 REPLACEMENT GARAGE -fr)&
C' ❑ WOODSTOVE ❑WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
-'',' )
NUMBER OF UNITS
C` ' MOBILE HOMES / �,
❑ COMMERCIAL SIZE /7/w 0 S 3 5 �/_
oC I CI'0n
❑ INDUSTRIAL $ 16
YEAR
❑ HOTEL/MOTEL/DORMITORY �{'
NUMBER OF UNITS MAKE c2R 2A ] @ S 8 2.r ,5
❑ OTHER - SPECIFY ESTIMATED COST OF 5 ale), a $8 27ta g
IMPROVEMENTS TOT .,;F I 7 RKET VALUE
UBC OCCUPANCY GROU $/ _ $ (�( L/�
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
g WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
•
❑ MANUFACTURED U WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE 0 OIL R OTHER - SPECIFY 6/I.P&CQ�
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER
NUMBER OF STORIES TOTAL LAND AREA&7 n
'�- DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ,
F..;, K PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS����APPROVED DATE 0 I ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM o2
❑ INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM—
PUD TYPE OF WATER SUPPLY / n �
( ) L--4(1)Lo c c� 11� (1 (�-
KX3PUBLIC ' NAME OF WATER SUPPLY
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
c *___ww�-a�ses.._��r�w�
y PLANNING DEPT . WITHIN SHORELINE JURISDICTION
_� ❑ YES NAME OF ADJACENT WATER BODY.
-C (� NO
APPROVED DATE /\ BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH 30
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
�{j-���NAAME��('(��c(��J�/1�C /,,n /�/� �1 MAILING ADDRESS '�f(-� ZIP TEL NO
O W N E R t `��^- ' V y c r cY 1d (0 0/Y 1 RO l.0 d.e i 1. &.f,��.. • L
f�
_ p-4--- (emu D L o U3 -L8310\
CONT CL .P)
E _a3 9
ARCH
' - ,
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNAL' OF AN APPLIC TION DATE RECEIPT NUMBER ICHECK NUMBER OR CASH
PPROV •D BY PE MIT FEES
APPFlpVEDBASE FEE INSPECTION
\\0C ;`,,jj�` 9'_,, BLDG SURCHARGE PLAN CHECK
J.. ERSiT'GMAT ENERGY SURCHARGE qqssZ)
TOTAL
PLANNING &BLDG DEPT
911 NUMBER REFUND DATE DAT 1 UED
BUILDING OFFICIAL I
g�
•
t.
A.p� A2... 1, �63. o
tk 5 9•p15
5
•
9 .
•
•
i`
.f 1 �.
•
CO
Oil 1' J l ` /,r �'� ,` �[V
\\
V •. C• •
\.
•
Cr) .---.."'--- \:1 r tll •
`n y 3' \, f 1•
+f
1 O C 1' �%/�r Ol t71
•
1.
r.•. J` ')
'.I -• '
CO
�► .r t'\\,/
F1.
t
...�x.••1 �'•1
'•'''-1;\ ,
1 A1
tr.....,..f .0..........,1‘ . ,
11
tfil
. 3tl
•
•
•
h
ca
0.10.48 ,52•
. .
L"33.031 . .,
.,..._,
al .
`•
•
L o r ,z,Z • .zi4Y Ulu lk1
U1LLfiJC
, / ,
(---,-1„: /,,,,
-), .
,.
hri- 1461Lom
APFfay\ ED
JEFFERSON COUNTY
PLANNING&SLOG DEPT
-
tc:'--(.2- '-' 1" — '1--- < - ' jC-- Y-°----___ •-•-'t
t c::,_t- Hil_____ :..r.; P......4
veljc
3 1 —2_1 tIG r
--).
if:
(' '''.. __rq .,,„,
ot_c_
/
'cri -
FY/2-5/v — &41—,t1 -G