HomeMy WebLinkAboutBLD1988-00337 BUILDING PERMIT APPLICATIOlAk
Jefferson County Buifa)epartment• County Courthouse • Port To d, Wash.98368 • 385-9141
N E .I
I. LOCATION: geographic name S W SIDE OF q (( ROAD FEET
S W �J lI FROM INTERSECTION OF ROAD AND 1"7 1 T— 'd d n 1 f�((.S ROAD
other specific location or landmark: 'P-T--
LEGAL D SCR PTION:
O _ Lot Block Subdivision
001 ��� oir� r°� O ICE
Tax Number / Section Section Township Range
II.TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
ew building ❑Single Family
❑New County Resident
❑Addition ❑Multi-Family
Is this structure to serve the residential
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the U.S.Nav
❑Repair,replacement number of units Y's Trident or
Indian Island Facilities?
❑Wrecking Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: - ❑Second Home: Future conversion to
permanent residence
k< 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.
(�'°-:^_r�- Q a. Electrical If use of existing building is being changed,enter proposed use.
IC b. Plumbing X ) I B e)
c. Heating,air conditioning ( )
cr—
.......,.. d. Other (elevator,etc.) .
• TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
/ PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
❑Public or Private DIMENSIONS
��J ❑Masonry (wall bearing) •Number of Stories
•Total square feet of floor area,
❑Wood FramejndividuaY(septic tan ,etc.) all floors,based on exterior
❑Structural steel ` dimensions
TYPE OF WATER SUPPLY Total land area,sq.ft.
Other—Specify ❑Public or private companyVV
O
n U-P-az citurec OIndividu (well, intern) NUMBER OF PARKING SPACCESESSTREET
•
,
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
El Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
,4lectricity Number of bedrooms
/❑Coal TYPE OF MECHANICAL
El —Specify Number of Full
bathrooms
Partial
IV. IDENTIFICATION-
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. C P . mac,-<(°n Zl e Dn Fox 8ct)14 , ! 9 a (c)E (ocr8
Owner
2.
Contractor State License No.
3.
Architect ..
v
The owner of this building and the undersigned agree to conform to all applicable laws.
Si at re a lice AZ Application date
e.. ..40.1.,....42,0,
/ / / .4?./0-\ -e (Y0//37A8
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY ! 1 /c f(l C( //c//
JEF ��- I UMNTY/ HEALTH DEPARTMENT "lJ �
APPROOVVEDr6 V D PERMIT FEE ISSUE DATE RECEIPT NUMBER
�({ /988 0 So 6// /d
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