HomeMy WebLinkAboutBLD1987-00365 Jefferson County Buildin.partment • County Courthouse • Port Towrill, Wash. 98368 • 385-1310
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I. LOCATION: geographic name SW SIDE OF i ROAD ` FEET
N E 0 --Q /
S W FROM INTERSECTION OF ROAD AND /(�C,( ROAD
other specific location or landmark: ' / 1 -1� �
LEGAL 4ESCRIPTION: N�TJ' " `!
� Lot Block Sub •vi n
gl D Da_ 20� (.)x Number __y� (2),)
3(� ` Tax Number V.Section Secti o nship Range
II.TYPE AND
COST OF BUILDING -
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY '
/J�Cf New building ❑Single Family Cl New County Resident
`�❑Addition ❑Multi-Family Is this structure to serve the residential
number of units❑Alteration or commercial needs of those employed
❑Hotel,Motel,Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
❑Wrecking AlO,►..i obile Home
❑Moving (relocation) Y-414 her—Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP ❑Full-time Residence
❑Private (individual,corporation,
❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.) 7%-2.„
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
permanent residence
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.
`"w'_° a. Electrical If use of existing building is being changed,enter proposed use.
n
` b. Plumbing / / )6(0W
ra, c. Heating,air conditioning l 9 o rl
.� d. Other (elevator,etc.) L.—C� 0Q • I
• TOTAL COST OF IMPROVEMENT $
a,
III.SELECTED CHARACTERISTICS OF BUILDING -
Cc-- ghAS
ENSIGNS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPL
•Number of Stories
,,,- ❑Masonry (wall bearing) ❑Public or Private
s •Total square feet of floor area,
❑Wood Frame ndividu I (septic tank, tc.) all floors,based on exterior
�^^• El Structural steel VV dimensions
c C '-
-) ❑ einforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. Cs
❑Public or private company J
Other—Specav• NUMBER OF OFF-STREET
lJ�� ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
Number of bedrooms
6,ra Electricity
Coal TYPE OF MECHANICAL
' EliNumber of Futl
Other—Spe ify bathrooms
WO Oe—i.w .,O Partial
7�((J�l C
IV. IDENTIFICATION- -
•
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
SaeA(�--- S POiwC 3 2 Co �^ Gc)'7
Owner � A ??
_ �� / J.JCT I
2.
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si ature of applicant Address Applyation da
ict--t-i-, . U-1-4-ol—
9/C7V/.'t--7
PLANNING AREA % FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY �(G � iieao--1
lg7
JEFF COUNTY HEAL DEPARTMEN /
T
APPROV B E: PERMIT FEE ISSUE DATE RECEIPT NUMBER
7 �L/ V
‘, r ,S72—, ---D-. 1\--V
BUILDING OFFICIAL 30- 7-7
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NORTHWESTERN TERRITORIES, INC.
Engineers • Land Surveyors • Planners
+� Construction Coordination • Materials Testing