HomeMy WebLinkAboutBLD1988-00328 BUILDING PERMIT APPLICATION '
Jefferson County 8uilditpartment• County Courthouse •Port Towns, Wash.98368 • 385-9 141
N E
I. LOCATION: geographic name SW SIDE OF ROAD FEET
N E iJ S W FROM INTERSECTION OF ����R�O�,AD AND �� , ROAD
other specific location or landmark: r%�i���l� 4i"CAQ' (xJ�C_.G �
ythEGAD CRIPTION: 0 /— 1---.
(t,_- L Lot Blbck Sub
d'vi i
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, ..\ _feet
VD yC Vy-ti,czTax Number '%Section Section Township Rang
II. TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
IC›./1,e_vv building Ingle Family ❑New County Resident
❑Addition ulti-Family Is this structure to serve the residential
El Alteration number of units or commercial needs of those employed
❑Repair,replacement ❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
`R,�j ❑Wrecking
'✓v ❑Mobile Home
ctj ❑Moving (relocation) ❑Other—Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,`
�`/� nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
`'�l ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: fir ❑Second Home: Future conversion to
Cad, i permanent residence
X/ COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement $ processing plant,machine shop,laundry building at hospital,elementary
To be installed but not included school,secondary school,college,parochial school,parking garage for
in the above cost department store,rental office building,office building at industrial plant.
a. Electrical If Use of existing building is being changed,enter proposed use.
r`
b. Plumbing Mats
l- -15g --. s-0
c. Heating,air conditioning 6 to � X T/ ( c Co([
- 4c1j -
d. Other (elevator,etc.) C. •T6
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearin ► •Number of Stories
❑ 9 ❑Public or Private •Total square feet of floor area,
Wood tr Frame ( {�Indivi al (septic tank etc.) all floors,based on exterior
�❑Structural steel ✓✓ `` dimensions
❑Reinforced concrete TYPE OFT 'Total PP •Total land area,sq.ft.
XP u.lic o riv e corn an
❑Other—Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
' lectricity'�[J �(fL, Number of bedrooms _
• ❑foal TYPE OF MECHANICAL
(,�r�( Number of Full
Ot er—Specify.
bathrooms
Partial
IV. IDE IFICATION - •
Name Mailing Address— Numbe street,city and State ZIP cod Tel.No.
1. 116m - W(�rl LOD7 5 l/ 7711 D PL_ a(-/G-07s7
Owner
cevr, Y37_0291
.c75-5 1 r i --e... ?vs/b <3 73
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2.
Contractor tll�'S lCe 'K�3o7Q, N1
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g r 1 I7/n��wl. l /
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
"y<nature of
appll ant /_ as •..I' ation ate
/�S1/�atLJ /►�t�t— - a,i NIP-
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRI T WATER DISTRICT
APPROVED BYIMVSY4J-- GV/ yJEFF ••••OI CO H L H EPARNNT `!
t .fir PIRMIT FEE 15 E DATE RECEIPT NUMBER
Qh... •. -- 3.,-5 9/43/
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