HomeMy WebLinkAboutBLD1989-00601 BU ING , 'ERMIT APPLICATION
Jefferson County Buildin311!)epartmentoP .O . Box 1220104 Townsend, WA 98368
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1,,OCAT I ON
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SPECIFIC LOCATION SITE ADDRESS J
POSTAL DISTRICT ../SUBDIVISION
LEGAL DESCRIPTION LOT BL0.7 , , DIVISION TAX NUMBER
PARCEL NUMBER ,i ,8_:_-5 CC , 1 / 4 SECTION
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PLANNING AREA SECTION / / TOWNSHIP e- NORTH RANGE WM
BUILDING INFORMATION
BUILDING TYPE \yPE OF IMPROVEMENT / QUARE FOOTAGE
O SINGLE FAMILY 0 \NEW BUILDING / IN FLOOR
0 MOBILE HOME 0 A DITION 2N FLOOR
O MODULAR HOME 0 AL ERATION BASEMENT
/
0 DETACHED/ATTACHED 0 REP IR CARPORT
jeARAGE 0 REPLA EMENT GARAGE
learwOODSTOVE 0 WRECK! G/DEMOLITTON COMMERCIAL
O E
MULTI - FAMILY 0 RELOCATI N/, OVING INDUSTRIA
NUMBER OF UNITS
0
MOBILE, HOME COMMRCIAL
SIZE 1/1 a $ 0
O INDUSTRIAL
A @ $20
O HOTEL/MOTEL/DORMITORY YEAR \
° •
NUMBER OF UNITS MAKE $ 10
O OTHER - SPECIFY
\
@ $10 1
ESTIMATED COST OF \
IMPROVEMENTS IT AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP
/ _ . --- ---
SELECTED CHARACTERISTICS OF BUI/LDING
PRINCIPLE TYPE OF FRAME PR /ICIPLE TYPE OF HEATING FUEL
O WOOD FRAME 0 ELECTRICITY 0 COLLECTIVE SOLAR
D MANUFACTURED 0--WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS 0 COAL
O REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
p MASONRY ( WALL BEARING ) DIMENSIONS -
. .. ,
O OTHER - NUMBER OF STORIES TOTAL LAND AREA . 1
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DEPARTMENTAL REVIEW
1
------- H DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED-BEDROOMS .
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0 PUBLIC OR PRIVATE NUMBER OF-EXISTING BEDROOMS
O INDIVIDUAL ( SEPTIC ) NUMI3ER OF PROPOSED BATHROOM
APPROVED DATE - , .---
O INDIVIDUAL WELL ---NUMBER OF EXISTING ammRoDm
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PUD ROF WATER SUPPL;X--'-
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O P U B ( N A M E .9 W A T E R S U P P L.Y.)..........
APPROVED DATE
Li PRIVATE ( ME OF WATER .22=1.2
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PLANNING DEPT . WITH7HORELINEJURISDICTION
0 YE- NAME OF ADJACENT, WATER BODY
_„....-- 0 NO -•-...
APPROVED DAT,F,/' BANK HEIGHT SETBACK
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PUBLIC} KS KS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
__-- APPROVED DATE ROAD ACCESS PERMIT REQUIRED D YES 0 NO
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IDENTIFICATION
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NAME MAILING ADDRESS ZIP TEL NO
OWNER
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THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE OF APPLICANT
, A*Ail41 cekyci, , 4APPLICAT DATE-.,RE 0EIPT
07t ER CHECK UMBER
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73 R CASH
C /7
APPRO BY PXRMIT
FEE/
BASE FEE INSPECTION
APPROVED -;27.- a B L.DG SURCHARGE PLAN CHECK
DEC 2 8 1989 ENERGY SURCHARGE --- --6 6
TOTAL
JEFFERSON COUNTY 911 NUMBER REFUND DATE .DA E ISS ED
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APPROVED
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DEC 2 8 1989 5 r'/Lf • ' ' -7/
AMMO COUNTY.
Pt OM/63&84.04 ilEPT
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