HomeMy WebLinkAboutBLD1989-00610 •DING 4'1ERMIT APPLICATION
Jefferson County Building Department*P .O . Box 1220irt Townsend, WA 9836r1
LOCATION 1 V' 1 n( T4-(1 I n \I P(.11
SPECIFIC LOCATION SITE ADDRESS `"2Z:"1 7CD �1n A )('r`
POSTAL DISTRICT tf /SUBDIVISIO4
LEGAL DESCRIPTION LOT BLOCK DIVISION TAX NUMBER
PARCEL NU ER 1 / 4 SECTION
PLANNING AREA
I SECTION TOWNSHIP PC? ORTH RANGE hAj WM
;;, BUILDING INFORMATION
BUILDING TYPE TYPE OF IMPROVEMENT SQUARE FOOTAGE
1 0 SINGLE FAMILY ❑ NEW BUILDING MAIN FLOOR
tW MOl 1 LE HOME 0 ADDITION 2ND FLOOR
1
! � ❑ MODULAR HOME 0 ALTERATION BASEMENT
O DETACHED/ATTACHED 0 REPAIR CARPORT
GARAGE ❑ REPLACEMENT GARAGE
0 WOODSTOVE ❑ WRECKING/DEMOLITION COMMERCIAL
❑ MULTI - FAMILY ❑ RELOCATION/MOVING INDUSTRIAL
NUMBER OF UNITS MOBILE HOMES
�'
❑ COMMERCIAL SIZE 1 1L{ X / ( ,../ 5
❑ INDUSTRIAL YEAR IC? '7� 0 .. $ 1 6
❑ HOTEL/MOTEL/DORMITORY MAKE C11rii'1t").tF>h 1 1`r"{10 M @ $B
NUMBER OF UNITS I
O OTHER - SPECIFY tESTIMATED COST OF a@ $8
IMPROVEMENTS T AL FAIR MARKET VALUE
UBC OCCUPANCY GROUP $
SELECTED CHARACTERISTICS OF BUILDING
PRINCIPLE TYPE OF FRAME PRINCIPLE TYPE OF HEATING FUEL
❑ WOOD FRAMEpr,ELECTRICITY ❑ COLLECTIVE SOLAR
' D MANUFACTURED ❑ WOODSTOVE 0 PASSIVE SOLAR
O STRUCTURAL STEEL 0 GAS ❑ COAL
O REINFORCED CONCRETE 0 OIL ❑ OTHER - SPECIFY
O MASONRY ( WALL BEARING ) DIMENSIONS
0 OTHER NUMBER OF STORIES_____ TOTAL LAND AREA
sN,� DEPARTMENTAL REVIEW
HEALTH DEPARTMENT TYPE OF SEWAGE DISPOSAL NUMBER OF PROPOSED BEDROOMS
Q. 0 PUBLIC OR PRIVATE NUMBER OF EXISTING BEDROOMS
)*(INDIVIDUAL ( SEPTIC ) NUMBER OF PROPOSED BATHROOM
APPROVED DATE 0 INDIVIDUAL WELL NUMBER OF EXISTING BATHROOM��r
IUD TYPE OF WATER SUPPLY
i 0 PUBLIC ( NAME OF WATER SUPPLY
�+..I APPROVED DATE ❑ PRIVATE ( NAME OF WATER SUPPLY) _i®
S.V PLANNING DEPT . WITHIN SHORELINE JURISDICTION
1C --. 0 k)\ 0 YES NAME OF ADJACENT WATER BODY
�` ❑ NO
APPROVED DATE BANK HEIGHT SETBACK,,.:9
PUBLIC WORKS DEPT ROAD RIGHT-OF -WAY WIDTH
q� NAME OF PUBLIC ROAD
nI NAME OF PRIVATE ROAD
APPROVED DATE ROAD ACCESS PERMIT REQUIRED 0 YES 0 NO
IDENTIFICATION
- NAME MAILING NG ADDRESS ZIP TEL
NO
OWNER Rl%�hv. �
S> � ' t °P 2// k -121 Li-
~ sh _
4hh0ki _
;�` y�COS U, �; ' '--r R� �- ---- .
��� Ems. N
�v ARCH
THE OWNER OF THIS BUILDING AND THE UNDERSIGNED AGREE TO CONFORM TO ALL APPLICABLE LAWS.
SIGNATURE bF APPLICANT APPLICATION DATE RECEIPT NUMBER CHECK NUMBER OR CASH
f //� , ,/ �✓ - l o
1f �P p �� PERMIT FEES
t `�,�7 ,CSC.) BASE FEE I NSPECT I ON
...43
.. 7 1909 23 , ) BLDG SURCHARGE PLAN CHECK
JEFFERSON COUNTY ENERGY SURCHARGE is
PLANNING&OLDS OW $ TOTAL
9 I I NUMBER ? REFUND DATE DATE SS ,41.^
BUILDING OFFICIAL 2" 7 . Y
\,...
AP PR " ED
FEB 7 V.'
JEFFERSON COUHTY
PLANNING&RI.DG DEPT
1 /"5 1 fi?c,
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