HomeMy WebLinkAboutBLD1989-00600 L DINGf 'ERMIT APPLICATION ima
,. ffiers on CountyBuilding Department*P .O . Box 1220.'!rrt Townsend. WA 98368
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e
A LOCATION
SPECIFIC LOCATION SITE ADDRESS (
POSTAL DISTRICT
LEGAL DESCRIPTION LOT R /SUBDIVISION iSnn �) /"
BLOCK DIVISION TAX NUMBER
PARCEL NH BER 1 O 2 'i y C> 1 / A SECTION
PLANNING AREASECTIONTOWNSHIPA � NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
❑ SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
❑ MOPILE HOME ❑ ADDITION 2ND FLOOR „a,
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE)f U , 10 x_A()
❑ WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL 3
4 - ❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
' NUMBER OF UNITS
MOBILE HOMES
'44-- ❑ COMMERCIAL SIZE 0 a $35
❑ INDUSTRIAL YEAR 0 a $ 16
❑ HOTEL/MOTEL/DORMITORY MAKE W,!. VI @ $8 �''-ilt) r)
i': NUMBER OF UNITS
OTHER - SPECIFY, $8
ESTIMATED COST OF
,`_5-1-nr'<4r'-) .5i-\P(� IMPROVEMENTS TOTAL FAIR,_MARKET VALUE
UBC OCCUPANCY GROUP AIO $ $ ,",) > (('<
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF HEATING FUEL
PRINCIPLE TYPE OF FRAME
` ❑ WOOD FRAME ❑ ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE ❑ PASS1- -E—SOLAR
❑ STRUCTURAL STEEL ❑ GAS "r COAL
❑ REINFORCED CONCRETE ❑ _0__1_1.--- 0 OTHER - SPECIFY
❑ MASONRY ( WALL BEARING ) DIMENSIONS
❑ OTHER - NUMBER OF STORIES R TOTAL LAND AREA
DEPARTMENTAL REVIEW
HEAL H DE ARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
/T
r ❑ PUBL I C OR PRIVATE NUMBER OF EXISTING BEDROOMS
❑ 1 ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DAT ❑ I ND I VI DUAL WELL NUMBER OF EXISTING BATHROOM
�. PUD TYPE OF WATER SUPPLY
\ ❑ PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
❑ YES NAME OF ADJACENT WATER BODY
''�q ❑ NO
APPROVED DATE BANK HEIGHT SETBACK
Y '--- PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
'i APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION ..
+�
NAME� MAILING ADDRESS ZIP TEL NO
j ( { f
OWNER p i� le i_ �.c. ���.�1 V �I����InL�'� / � .,i-��
CONT C , \-P
S or, L -L'-Ft.L.NSE NO 1
ARCH
I
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATU E OF APPLICA APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
APP1� V D BY PERMIT FEES
A P p E `c`- W 0C) BASE FEE INSPECTION
VE �C' BLDG SURCHARGE PLAN CHECK
922 f989 -__
ENERGY SURCHARGE $ l` 5 , ,� ( ) TOTAL
JEFFERSON COUNTY
PLANNING&BLDG DEFT 9 1 1 NUMBER ' REFUND
DATE ATE SIC
BUILDING OFFICIAL 0
4
APPROVED
AEfffRSDM COUNTY
Pi's ONG A KOS V_PY
3 \ tA —
_ 1.44. S9
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