HomeMy WebLinkAboutBLD1989-00595 L3UIL ING 'ERMIT APPLICATION )/ --,( /,�j-4-
.1et4ferson County Building •partment*P .O . Box 1220.Po• Townsend . WA 98368
•LOCATION 'Bil- VICw VI Li- 6 - Sir• Ka
SPECIFIC LOCAT I O SITE ADDRESS Vf! /IYD 0 5 E IJ�nZ,'VE /''7-•�L W
POSTAL �DISTRICT
I STR I CT /SUBD I V I S I ON L/7 /J //!-Eta
LEGAL DESCRIPTION LOT ! BL uCK / SECTION
DIVISION TAX NUMBER ((///
#' , PLANNING AREA SECTION N/�nER TOWNSHIP r /S NORTH RANGE / C . WI1
As BUILDING INFORMATION
C3 BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE��
X SINGLE FAMILY R(_ NEW BUILDING MAIN FLOOR
❑ MOBILE HOME /❑ ADDITION 2ND FLOOR
❑ MODULAR HOME 0 ALTERATION BASEMENT
—J
•••--- ❑ DETACHED/ATTACHED ❑ REPAIR R-IN4p _a(1p .--r
,r,c) GARAGE 0 REPLACEMENT GARAGE j(t')GC7
\'s3 0 WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY 0 RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES ,//�� /1/
❑ COMMERCIAL 7/ $3 5 t/ C(00
SIZE /--r�-�--+�� r
❑ INDUSTRIAL YEAR 0 @ $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE 02 Ra1u @ $8 A.F.2c52
NUMBER OF UNITS
❑ OTHER - SPECIFY ESTIMATED COST OF 5 d1,04, al $8 5
J IMPROVEMENTS TOTAL�FA /Mjjj2KET VALUE
UBC OCCUPANCY GROU ; s (�� (��jjLL//�f
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
( WOOD FRAME u ELECTRICITY 0 COLLECTIVE SOLAR
❑ MANUFACTURED WOODSTOVE ❑ PASSIVE SOLAR
0 STRUCTURAL STEEL ❑ GAS 0 COAL
❑ REINFORCED CONCRETE 0 OIL p OTHER - SPEC I FY- Ace.tGQ-i
❑ MASONRY ( WALL BEARING ) DIMENSIONS /
Ni ❑ OTHER - NUMBER OF STORIES ( TOTAL LAND AREA/
, DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS ,
yg PUBL 1 C OR PRIVATE NUMBER OF EXISTING BEDROOMS —
( ❑ 1 ND 1 V 1 DUAL ( SEPT 1 C ) NUMBER OF PROPOSED BATHROOM o�
Cr APPROVED DATE ❑ I ND I V I DUAL WELL NUMBER OF EXISTING BATHROOM —
PUD TYPE OF WATER SUPPLY / ,' , \ ( Qw �
V PUBLIC •( NAME OF WATER SUPPLY) �---KJ��Owa1 p�-g-'
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
a0■i■...r0..r■cs■s■e..
IPLANNING DEPT . WITHIN SHORELINE JURISDICTION
� � 0 YES NAME OF ADJACENT WATER BODY
C� (S� NO
APPROVED DATE /� BANK HEIGHT SETBACK
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH n /
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
NAME
MAILING ADDRESS ZIP TEL NO
OWNERMcv 111QSo rccS (0oM pw ,« . 9,' . Co . 2,/ z737(OO
111 � i • LuDL ,3L•
r
CONT Sam
Tf_ NtS 3 / 1
ARCH
C��Ii�
rHE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNA OF C N C TION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
'. � lAPPLI �
PROVE.j Y PERMIT/ FEES� 1�
AP " ? E D �/ F�,COD BASE FEE INSPECTION
SE 7 �9B q, < L/
JJ�, BLDG SURCHARGE PLAN CHECK
9•L ENERGY SURCHARGE C ~/0 L,? TOTAL
JEFFERSUN COUNTY P
PLANNING a BLDG DEPT IREFUND
ATE DAT` 11 NUMBERI i ,� / ,
BUILDING OFFICIAL7
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