HomeMy WebLinkAboutBLD1987-00038 AiiiIIIIMIIIII
Jefferson County Buildiiikpartrnent • County 1 Co;rllouse • Port Tow ,(I,'Wash.98368 • 385-1310
N E A.
I. LOCATION: geographic name S W SIDE OF
N E ROAD FEET
S W FROM INTERSECTION OF ROAD AND I O L fte In (e e- Rd
ROAD
other specific location or landmark: NI
LEGAL DESCRIPTION: o
Ic.T
farce I ` Lot ---oak— f), ,h - -a 0 ' � ---C) ; �0
�y / Subdivision
—I '7 7 700 Tax Number �--
II.TYPE AND COST OF BUILDING - ��Se`�1On Section Township Range
TYPE OF IMPROVEMENT
BUILDING TYPE MOBILITY
ew building •
❑Single Family
Addition ❑New County Resident
❑Multi-Family
❑Alteration number of units Is this structure to serve the residential
DI Hotel,Motel, Dormitory or commercial needs of those employed
at either the US.Na Trident or
❑Repair,replacement
number of units
❑Wrecking Indian Island Facilities?
obile Home
❑Moving (relocation)
❑Other—Specify
❑Foundation only ❑YES ❑NO
OWNERSHIP USE
❑Private (individual,corporation, ❑Full-time Residence
❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
COST (Omit cents)
• Cost of improvement Nonresidential— Describe in detail proposed use of buildings,e.g-,food
Tot inimpr d m not included $ processing plant,machine shop,laundry building at hospital,elementary
in the above cost school,secondary school,college,parochial school,parking garage for
department store,rental office building,office building at industrial plant.
a. Electrical If use of existing building is being changed,enter ro
b. Plumbing proposed use.
X
c. Heating,air conditioning
1�1
d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ r 1 4
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Public or Private .
❑Wood Frame � Total square feet of floor area,
►: ndividual (septic tank,etc.) ---
all floors,based on exterior
❑Structural steel
dimensions.._.
❑Reinforced concrete TYPE OF WATER SUPPLY
*Total land area,sq.ft.
1 Other—Specify ❑Public or private company
1 ti� ,'J ; '. Individual-(well cistern) NUMBER OF OFF-STREET
PARKING SPACES
PRINCIPAL TYPE OF HEATING FUEL Enclosed
TYPE OF FIREPLACE
❑Gas
Outdoors
❑Oil
lectricity RESIDENTIAL BUILDINGS ONLY
Number of bedroomsMill- I
g4
Coal TYPE OF MECHANICAL
Other—Specify Number of FullMillAl
i '' i
�j;/i`-, bathrooms
Partial
IV. IDENTIFICATION- -
•
Name Mailing Address—Number,street,city and State
® n • O_ ZIP code Tel.No.
I. N d}}
Owner
aiimitiannimumEEM
immissimirab --;
2. G-z%Gi�r�
Contracto rate License lo. illial2 J
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applicant
Address
Application date
• ,: )O' I
•
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT
WATER DISTRICT
APPROVED BY /1/
't.. -% J
JEFFERSON COUNTY HEALTH P TMENT
APPROVED BY: PERMIT FEE
5 /U� ISSUE DATE
lJ RECE NT NUMBER
' kll -7
BUILD( c---
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of A Ia ,S TO ttp sic own:
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