HomeMy WebLinkAboutBLD1989-00606 i_0_DING '„ 'ERMIT APPLICATION 0
Jefferson County Building Department* 122O* ort Townsend. WA 98368
P .� . Box
LOCATION ,
SPECIFIC LOCATION SITE ADDRESS A C J / yl22 I ./, '
POSTAL DISTRICT PZ-----` %UBD IvVISION
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NUMBER �777 /Cl GO/)� 1 / 4 SECTION
PLANNING AREA SECTION +' TOWNSHIP NORTH RANGE_i WM
BUILDING INFORMATION _
BUbING TYPE TYPE" OF IMPROVEMENT SQUARE FOOTAGE/ ,
[ /
SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR /CD
❑ MOI:1I LE HOME ❑ ADDITION 2ND FLOOR I/ ) /.,
❑ MODULAR HOME ❑ ALTERATION BASEMENT
❑ DETACHED/ATTACHED ❑ REPAIR CARPORT
GARAGE [] REPLACEMENT GARAGE
❑ WOODSTOVE ❑ WRECKING/DEMOLITION ( COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES l�Q
❑ COMMERCIAL SIZE / �7�@ $ 35 �()
❑ INDUSTRIAL YEAR /
❑ HOTEL/MOTEL/DORMITORY MAKE
NUMBER OF UNITS____ w $1 8
❑ OTHER SPECIFY ESTIMATED COST OF 0 c@i $8
R
IMPRO EMENTS TOTAL F MARKET VALUE
UBC OCCUPANCY GROU $ $ `=D(t2/fin
SELECTED CHARACTERISTICS OF BUILDING
PRI IPLE TYPE OF FRAME PRIM PLE TYPE OF HEATING FUEL
WOOD FRAME ELECTRICITY ❑ COLLECTIVE SOLAR
❑ MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
❑ STRUCTURAL STEEL 0 GAS ❑ COAL
❑ REINFORCED CONCRETE ❑ OIL ❑ OTHER - SPECIFY
. 0 MASONRY ( WALL BEARING ) DIMENSIONS•
❑ OTHER - NUMBER OF STORIES TOTAL LAND AREA
DEPARTMENTAL REVIEW _
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS 2 )
/Sl�ji l � 0 PU 1 C OR PRIVATE NUMBER OF EX EXISTING BEDROOMS
I6_ ` ND I V I DUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM-7__ __-/
APPROVED DATE
0 INDIVIDUAL WELL NUMBER OF EX I S'T 1 NG BATHROOM
PUD TYPE OF WATER SUPPLY
❑ PUBLIC ( NAME OF WATER SUPPLY) _,,,y„
APPROVED DATE L PRIVATE ( NAME OF WATER SUPPLY � L ,-
PLANNING DEPT WIT SHORELINE JURISDICTION
0 V-- \;04\-. - --",..\) , G\\\%,\ YES NAME OF ADJACENT WATER BODY
CU-�nh ❑ NO .'
APPROVED DATE BANK HEIGHT SETBACK W
'PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
NAME OF PUBLIC ROAD
NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED ❑ YES ❑ NO
IDENTIFICATION
NAME MAILING ADDRESS ZIP TEL NO
OWNER I
1, 1.
\, Cohde
n' `'1'� � • ' �T i 1 •.�y g '' I 78
t
ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
1 S I GN TUR OF APPLICANT Aç ) rION DATE RECW c1BER CHECkCU�7% R OR CASH
APPRO ED BY PERMIT� Eggs,
IlD BASE FEE INSPECTION
P' \ c �S� BLDG SURCHARGE PLAN CHECK
JUN 1 5583 �—�.. 6 ENERGY SURCHARGE .$ &-2/
TOTAL
JEFFERSON COUNTY 9 1 I NUMBER REFUND DATE D E i 1.EP ,
PLANNING &9LDG DE°' / e,e„)_a 1
BUILDING OFFICIAL � (�,;;!! �
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