HomeMy WebLinkAboutBLD1977-00217v!ry --t
Jeffe?son Co-unty ,r{)::ffiTj:,i::\':::)n,,UILD
NE
S W SIDE OF
98368 . 385-1310 tox
/4/BOAD o FEET
ROAD
l. LOCATION: geographic name
NE
-S sw FRoM
LkoYlvoth/,J"'m1,
w/PJROAD AND
/4.,F
INTERSECTION OF
landmark 0ata- fla
LEGAL DESCR!PT!ON:
Block Subdivision
/te/2q IE
% Section Townshi Ra
II. TYPE AND COST OF BUILDING .
MOBILITY
n N"* County Resident
ls this structure to serve the residential
or commercial needs of those employed
at either the U.S. Navy's Trident or
lndian lsland Facilities?
E ves (*o
I
TYPE OF IMPROVEMENT
firu"* buildins
! Addition
I Alteration
E Repair, replacement
I Wrecking
! Moving (relocation)
E Foundation only
BUILDING TYPE
Isingle Family
E Multi-Family
number of
! Hotet, Motel, Dormitory
Eo,her -fy
number of units
I Mobite Home
UBC OCCUPANCY GROUP:-
f] Futt-time Residence
psecond Home: Recreation Cabin, etc.
tssecono Home: Future conversion to1 l\
permanent residence(fr9s lQft )
USE
!,Private (individual, corporation,
nonprof it institution. etc.l
E Prulic (Federal, State or local gov't.)
OWNERSHIP
(Omit cents)
$ElDoo
./,oo 5,I ooo
l, ooo
Nonresidential - Describe in detail proposed use of buildings, e.9., food
processing plant, machine shop, laundry building at hospital, elementary
school, secondary school, college, parochial school, parking garage for
department store, rental office building, office building at industrial plant.
lf use of existing building is being changed, enter proposed use.
Cost of improvement.. ,.. ....
To be installed but not included
in the above cost
a. Electrical.
b. Plumbing.
c. Heating,airconditioning ......
d. Other (elevator, etc.I. . .
. TOTALCOSTOF IMPROVEMENT
cosT
$ /6ooo
I!I. SELECTED CHARACTERISTICS OF BUILD!NG -
/TYPE OF SEWAGE DISPOSAL
E Puutic or Private
f,tndiviouat (septic tank, etc.)t7+5
loSrlog*
DIMENSIONS
. Number of Stories
.Total square feet of floor area,
all floors, based on exterior
dimensions.
.Total land area, sq. ft.
PRINCIPAL TYPE OF FRAME
I MasonrY (wall bearing)
fiwood rrame
! Structural steel
! Reinforced concrete
F;;",-.*,,,, i)//u ' t,
TYPE OF WATER SUPPLY
E Puulic or private company
}dtnairiouat (well, cisternl o
NUMBER OF OFF-STREET
PARKING SPACES
Enclosed
Outdoors ITYPE OF FIREPLACE
trrt,^Lli"
2-
o
TYPE OF MECHANlCAL
RESIDENTIAL BUI LDINGS ONLY
Number of bedrooms
Full..
Partial
Number of
bathrooms
PRINC]PAL TYPE OF HEATING FUEL
DG"t
E oit
EEt"",ri"i,,
D coat
Eo,n"r. - Specify l,i,o")
IV. IDENTIFICATION.
ZIP code r{. uoNameMailinSAddress - Number, street, city and State
l lrfrfi 06 4)
s4l-7{/c
1
Owner ilr^,, N,tlilJu,
lreao AA\rrSS
Mtd-LiEeTI56NH
I QSrrc
2.
contractor Se//-6;4e Q,a
Al, ,g*,,"4 rt|o*+r-
942'7sta
3.
Architect /xJ44i./1, il *,&drl^i?* lr0^"0 B,;e4 m*Aal &4f*(
The owner of this building and tl{e undersigned agree to conform to all applicable laws.
F a.
Address
73a
Sionature of aoolicant-'iilX
^Lr///"-
SCHOOL DISTRICTPLANNING AREA RICT WATER DISTRI
OLYMPIC HEALTH DISTRICT
APPROVED BY
PERMIT NUMBER
\Q to
PERMIT FEE
7eD9
ISSUE DATE ,
Q_r,1 _H
APPROVED BY
ILDING OFFICIAL
The.printery - portTownserd ?e"*n\-f €;X-f<.{\Le_L T<5 ?
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