HomeMy WebLinkAboutBLD1988-00352 BUILDING PERMIT APPLICATION
Jefferson County Builditeepartment• County Coty-thouse •Port Towns, Wash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF/ ROAD AND a L CL' b
I lLLf3 ROAD
other specific location or landmark: t fi S) t ad itlEt
LEGAL DESCRIPTION: A.)
PO i W Lot Block Subdivn
' I 700 OS�
7 ( Tax Number %Section Section Township Range
II.I TYPE AND COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
❑New building D4ingle Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
R
❑Hotel,Motel, Dormitory at either the U.S.Navy's Trident or
\epair,replacement number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
m 1 iO4,_) a dad c '0n q—
______, `
t^dk•FSE
OWNERSHIP 'rn 1 i ( 0�
y' ❑Private (individual,corporation, 11i ❑
Full-time Residence
nonprofit institution,etc.) n ❑Second Home: Recreation Cabin,etc.
1� ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ..) 3 ❑Second Home: Future conversion to
permanent residence
'S%} 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
Icy-
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.
b. Plumbing _It7(09'@ 3C &0 Sl_/(V
01..3 Heating,air conditioning / (
d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $Q0 AD
III.SELECTED CHARACTERISTICS OF BUILDING -
ENSIGNS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DIS
Masonry (wall bearing/) •Number of Stories
❑ 9 ❑Public or Private •Total square feet of floor area,
‘Ntgl,,,Vood Frame -s Individu (septidtanl etc.) all floors,based on exterior
Structural steel J� dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY
•Total land area,sq.ft. /�
ElPublic or private company I( Li CO-�7'7"
❑Other—Specify T_/ NUMBER OF OFF-STREET
L2N„ndividu(ell,cistern) PARKING SPACES
✓R
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
E(55oal
❑IOil RESIDENTIAL BUILDINGS ONLY
lectricity Number of bedrooms
p J1
TYPE OF MECHANICAL �G t"� XJ Full �`'
ther—Sp ify Number of i /a l,►":
bathrooms Illf
Partial I
IV. IDENTIFICATION - •
Name Mailing Address—Number,street,city and State ZIP cod Tel.No.
1. crivak.d 14 i9 _) 1/2 Q inss?S 7/3S-
Owner
5"..i. p)../.31
/3:44. 13 8 l9' K3�• --7/51
ontractor State License No. Ft q CeDC---1C--
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant Addre
Appl catio 'date
1.,,,,, --12//142(0 7/i. ,r,A7
9/c.-
o.
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
P._„c b--r---c It a -s 7)/JEFFER IdCOUNTY HE L,TH DETMENT
-
APPRA Y: m.e
PERMIT FEE ISSUE DATE RECEIPT NUMBER
i'v1^->13 1988 3, ---c) 5 i(q 6 ---
BUILDING OFFICIv I S V.
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