HomeMy WebLinkAboutBLD1987-00361 UILDING PERMIT APPLICATION '
Jefferson County Building S tment• County4ourtho se •Port Townsen Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF OADN AND
�•,Y'�` ROAD
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other specific location or landmark: � W/Vim.) i '
Octey rIT.j.EitON:
� , V
Lot Block Sub i ' n r
3 5
! O ci l! Tax Number '%Section Sect Township 'Ran
II.TYPE ANDVCOS T OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY '
❑New building ❑Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units
❑Alteration 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?
❑Wrecking ❑ obile Home
❑Moving (relocation) Other—Specify
❑YES ONO
❑Foundation only
V VI V USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation, ❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: /- 3 ❑Second Home: Future conversion to
permanent residence
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement P $ 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. •
i--
a. Electrical If use of existing building is being than ed,enter proposed use.
b. Plumbing
c. Heating,air conditioning -
d. Other (elevator,etc.) •
• TOTAL COST OF IMPROVEMENT $ (,
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) •Number of Stories
LI 9 ❑Public or Private •Total square feet of floor area,
❑Wood Frame _ ❑Individual (septic tank,etc.) all floors,based on exterior
❑Structural fleet dimensions
❑ n`forced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
Other—Specify El Public or private company NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
Cl Gas Outdoors
❑oil '‘ RESIDENTIAL BUILDINGS ONLY
❑Electricity ; Number of bedrooms
4____, Qtoal TYPE OF MECHANICAL
Number of Full
❑Other—Specify i bathrooms
Partial
IV. IDENTIFICATION - •
Name Mai ing Address—Number,street,city and State ZIP code Tel.No.
1. �f A
Owner
�/�� V I I1€r
e l�� I k
2.
Contractor State License No.
3
Architect
The ner of this building and the undersigned agree to conform to all applicable laws.
iOature f plican Address Ap licat n date /c7'
al)-\C(. Pl- / hiv` r/
ul
PLANNING AREA F RE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY 6/
JEFFERSON C DEPARTMENT
APPROVED BY PE IMIT F ) IS UE DATE RECEIPT NUMBER
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BUILDING OFFICIAL
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