HomeMy WebLinkAboutBLD1989-00604I , ,
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Biii_DING ,-TRMIT APPLICATION
Jefferson Count )? BuildingDepartment0 .0 . Box 12204101rt Townsend, WA 98368 .
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LOCATION -- .
ay/7r?)
SPECIFIC LOCATION SITE ADDRESS
POSTAL DISTRICT
LEGAL DESCRIPTION LOT BLOCK DIVIAION TAX NUMBER3
/-4ARCEL NUMBER 4737-73-75 / 1 / 4 SECTION
PLANNING AREA i„---BECTIoN -I TOWNSHIPB11 ) NORTH RANGE c' ,z WM
BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
O SINGLE FAMILY 0 NEW BUILDING MAIN FLOOR
O MOnILE HOME 0 ADDITION 2ND FLOOR
O MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE 0 REPLACEMENT GARAGE
O WOODSTOVE 0 WRECKING/DEMOLITION COMMERCIAL
O MULTI - FAMILY V"PELocATION/MOVING
..,/INDUSTRIAL
NumBER OF UNITS
MOBILE HOMES
O COMMERCIAL
SIZE
O INDUSTRIAL
YEAR 0 $ 16
O HOTEL/MOTEL/DORMITORY
MAKE ../77elb $8
NUMBER OF UNITS .
O OTHER -, SPECIFY @ $8
EsTIMA D COST OF
UBC OCCUPANCY GROU
1 IMP VEMENTS T, TAL FAIR MARKET VALUE
$
-....
SELECTED CHARACTERISTICS OF BUILDING
PRCIPLE TYPE OF FRAME PRI IPLE TYPE OF HEATING FUEL
cl; WOOD FRAME ELECTRICITY 0 COLLECTIVE SOLAR
O MANUFACTURED W,W6ODSTOVE 0 PASSIVE SOLAR
0 STRUCTURAL STEEL. 0 GAS 0 COAL
c\- 0 REINFORCED CONCRETE 0 OIL 0 OTHER - SPECIFY
0 MASONRY ( WALL BEARING )
DIMENSIONS
i
0 OTHER - NUMBgB—OP—S-TOKIES TOTAL LAND AREA
(1 -------
DEPARTMENTAL REVIEW
0--- HEALTH DEpARTMENT TYPE J'YPE0FSEWAGEDISPOSAL NUMBER OF PROPOSED BEDROOMS
pri):u C
I VAT E NUMBER OF EXI STING BEDROOMS 1
113 1 v I DUAL ( SEPT I C ) NUMBER OF pROPub ED BATHROOM
,----, APPROVED DATE
INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM
mm.0.-
-.7--4 PUD TYPE OF WATER SUPPLY
0 PUBLIC ( NAME OF WATER SUPPLY)
APPROVED DATE 0 PRIVATE ( NAME OF WATER SUPPLI1
PLANNING DEPT . WITHIN SHORELINE JURISDICTION
0 YES NAME OF ADJACENT WATER BODY
pAql --
APPROVED DATE BANK HE SETBACK
PUBLIC VIORKS DEPT ROAD RIGHT-OF-WAY WIDTH
NAME OF PUBLIC ROAD
NAME el- PRIvATE ROAD --- _
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
---
IDENTIFICATION
— — — — —
NAME MAILING ADrPESS ZIP TEL NO
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77/*411
CONT
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ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS,
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/ SICATURE OF PLI7/ANT , APPLWnIATE RECFF.12nBER CHEg MBER OR CASH
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APPROVED BY PERMIT , gs
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A Po CeP - V 11 P ' BASE FEE ,,,-- •,___) -1N-SPECTION -
AU 2 1 19 9
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BLDG SURCHARGE PLAN CHECK
- --- — ENERGY SURCHARGE $ ../r
OF77V 'MT' TOTAL
ir911 NUMBER REFUND DATE DA*117 I st/77.7
BUILDING OFFICIAL 634R ) 81
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HEALTH DEPT.
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