HomeMy WebLinkAboutBLD1987-00387 N L ►v
I. LOCATION: propraphic name allS W SIDE OFM� W. ROAD FEET
N E 1-I A Can o I LOCH 0 ROAD
5 w FROM INTERSECTION OF ROAD AND
d�,
other specific location or landmark: �r
-LEGAL DESCRIPTION: /``�",(/ar5 \((JLJJO‘ '11 / 4),.CAUZIK
Lbt Block Subdivision
' 7 � � LLAD
f31 �v1 �7 Tax Number Y.Section Section Township
II.TYPE AND COST OF BUILDING -
�� TYPE OF IMPROVEMENT BUILDING TYPE ' MOBILITY
•
0-----
0 New building 0 Single Family 0 New County Resident
Addition 0 Multi-Family Is this structure to serve the residential
number of units or commercial needs of those employed
❑Alteration Hotel,Motel, Dormitory at either the US.Navy's Trident or
Q Repair,replacement number of units Indian Island Facilities?
Q Wrecking 0 Mobile Home
Q Moving(relocation) Other—Specify O YES ONO
CIFoundation only
l.I)oor,S-f-C)Te _
USE
OWNERSHIP• 0 Full-time Residence
Private(individual,corporation, Q Second Home:Recreation Cabin,etc.
nonprofit institution,etc.)
0 Public(Federal,State or local gov't.) 2-3 Q Second Home:Future conversion to UBC OCCUPANCY GROUP: permanent residence
COST (Omit cents) Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement 5
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.
If use of existing building is being changed,enter proposed use.
�` a. Electrical
{�+,w b. Plurrbing
1 L.'
c. Heating,air conditioning
j d. Other(elevator,etc.)
• TOTAL COST OF IMPROVEMENT $ g
x 1 III.SELECTED CHARACTERISTICS OF BUILDING -
• DIMENSIONS mi
t .1 PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL 'Number of Stories
Q Masonry(wall bearing) 0 Public or Private *Total square feet of floor area,
O Wood Frame Q Individual (septic tank,etc.) all floors,based on exterior
dimensions
0Structural steel
TYPE OF WATER SUP P' *Total land area,sq.ft.
❑Reinforced con e Q Public or privet 'company
1 Q Other—Speci - NUMBER OF OFFSTR
0 Individual ( II,cistern) PARKING SPACES
Enclosed
����~� PRINCIPAL PE OF HEATING FUEL TYPE OF FI PLACE Outdoors_,1. Q Gas i
Q RESIDE IAL BUILDINGS ONLY
Nu er of bedrooms
Electricity TYP OF MECHANICAL
Q Coal • Full Number of 1
:
❑Other—Specify bathrooms Faille! E
IV. IDENTIFICATION- - .
•
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
Owner `� 3 l t:
8iSnern_
t
2.
State License No. i
Contractor
Architect
The owner of this building and the undersigned agree to conform to all applicable laws. j
Address Application date
S< tore of apiplron :-
„do
;2.414
(Y-LP.i))/BD _
-
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
[•.J
JEF C:XUNTY HEALTH DEPA}7Ti.lENTFERSI .....\....
V
APPROVED PERMIT FEE tSSUE DATE •
RECEIPT NUMBER
? 0��5 ,00 g--.9.c . o •
�M
BUILDING OFFICIAL rl , 50
a � 50 o Tie P,,•:trry - P,;rr To.+nstnd
88 l 220 l
WASHINGTON STATE FIRE MARSI$AL C••• i
FIRE INVESTIGATION REPOfi"1`
0243
11 09 26 88 1
INCIDENT I *Yk' I
C.""'" SISNEROS, JEANNE s ,��>i�1� •
\
0� Poi°'eO'H ock [c°"" JEFFERSON 1i.1]
A""''`°"'N"211 Alcohol Loop Road . ':-.' "1
• PRINCIPLES I Asdr«. T"...437-9585 L2 j
Owner
A SISNEROS, JEANNE' 131
T.n.nl ,.r.oew•t.S am e
All
Ate... 101 Rainier Road, Nordland T385-5462
°
7 HALL, JENNIFER TelepreorneAddress 335-3831 15
D 7 WURTSMITH. DALE i Add. J.C.S.O. 7".0. 1_6I
E Address Telephone j 7
F T«.pAa. e
Ad...
G
VMn... •—P Adl ettt— ek.or
M.r tU..rd w V t w— Oche r
L�EApprt .t>I. 7--Pap,. •—J—PeraWio.r •—Veet.ns— Cues. !--AMww."
INSURANCE I • I�"" ' 9 1
H234074 i {
`""°""i'lutual Of Enumel aw Stock U«• oee. 0tt,« t0{
s°r"" A.u,0 •eaO..t. 35,000 $ $ Om Other 1 ,
�_U, Contents Moen •
LEst L f •
Ls /(J,Ul�l� r.Nonw» 12
Fin.' Aea... Oakharbor !
i►+ ;A°"" Richardson Insurance Co. IT.'""" j12
1 'AdjN'.r `"'" "°°"'s 5113 Pacific Highway East, Fife f
13
1 FASNACHT, GARY Add
ress Telephone 1
'Few
LOSS I T.'.0.0.
1 15'.
I Dept.. Addr.AddressK FO kwNlp.la �
AresaabM 116
1 Property endeseE
WSW Few
�17
tr«t sow.I i Model Sahel it (16
Yr 1 WP
II 'cow N+d+•O—krrrrt Yr 1
�� St license + 091
V.hieN Mror+.0
Yr MIg Model
Caw I 20
Fencing. °meo.dan .
Telephone ,2 1
Pepe. Address
PD InwHrp.ta
L t IC.N . 122i
1 Fn.e.g. p..pcsnro.
INVESTIGATION I From �23
T.r linen I In Person N.e.n.d.T
iaroake.twn—ae.. T . L R!�ff I/�� y STFIt AR- t1,C.,�Sr�p ,
(�-`�f1-nr� l'+ n4nn 0 t. Time TM Men le Person •► STEiYART 124.
1 A.. MI CHEAU 09.-28-88 @ 081.5 XX i
i � N..TNN Evidence S.te.d D.r.. Time
Pewees Taken D 25
1"E'
'rig-26-88 (a 1410 AMW(X1 ►" 09-26-88 0 1530) Yes mxhaIX
•, izs
Larded, (enter .ppkeMM.Meters/
1F"'°"'9' Fire in single family dwelling. Occupants were in Reno at time of fire., Burn �27
28
patterns indicative of a flammable liquid accelerant, Wood stove way to the 2g
immediate area of origin. 13C
131
;3:
3'
Jy !3,
cc FD I Po I P AO" t Admit 1Ot/..' STATUS Cw..O 1
Si.Nit/7tiv•31.-
'
Jefferson County Fire Protection
District No. 1
Chimacum, Washington 98325
P.O. Box 537
SO
Jai 0 9
December 12, 1988
Larry A. Micheau
Deputy State Fire Marshall
Fire Protection Ser. Div.
9th and Columbia Bldg.
Olympia, Wa. 98504-451
Dear Mr. Micheau,
As of the above date the Chimacum Fire Department has
not received a report concerning the fire,
September 26, 1988 at :
Jeanne Sisneros
211 Alcbhbl:.:Loop -Road
Hadlock, Wa.
If and when the investigation is finalized I would
appreciate a copy of this report at your convenience.
PtiF
chard(Dick) ,muff
Fire Chief
J.C.F.P.D.#1
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