HomeMy WebLinkAboutBLD1987-00392 BUILDING PERMIT APPLICATION
Jefferson County Building Wrtment• County Courthouse •Port Townser /ash.98368 • 385-9141
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET(
S W FROM INTERSECTION OF ROAD AND
other specific location or landmark: C.-L6t)
/L G DEScIPTION: c�.l J /U� .��j J' JT—
(r Lot Block �� Sub visi
Cal1000��� C,� ` ,) 1 -/
Ca f 0 S- l 005 Tax Number h Section Section Township Range
II.TYPE AND COST 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
❑Alteration number of units or commercial needs of those employed
❑Hotel,Motel,DormitoryNavy's Trident or
❑Repair,replacement at either the U.S.number of units Indian Island Facilities?
❑Wrecking
❑Mo 'le Home
❑Moving (relocation)
Other-Specify ❑YES ❑NO
❑Foundation only
P
OWNERSHIP
i USE
❑Full-time Residence) ❑Private (individual,corporation, •
nonprofit institution,etc.) ElSecond Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP-3 ❑Second Home: Future conversion to
t, 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.
1 a. Electrical If use of existing building is being changed,enter proposed use. •
b. Plumbing
c. Heating,air conditioning
r. d. Other (elevator,etc.)
• TOTAL COST OF IMPROVEMENT $
J III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
❑Public or Private DIMENSIONS
❑Masonry (wall bearing) •Number of Stories
❑Wood Frame •Total square feet of floor area,
❑Individual (septic tank,etc.) all floors,based on exterior •
ID Structural steel dimensions
TYPE OF WATER SUPPLY Total land area,sq.ft. /�
❑Reinforced concrete •
❑Public or private company ��� I
Other-Specify
NUMBER OF OFF-STREET "f
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIRE -LACE
❑Gas Outdoors
s
❑Oil RESIDENTI'4L BUILDINGS ONLY
❑Electricity Numjer of bedrooms
El Coal TYPE OF MECHANICAL
/
❑Other-Specify Number of Full
bathrooms
• Partial
IV. IDENTIFICATION- .
•
Name, Mailin Address Numb r,stjaet,city and ate IP code Tel.No.
1.
Owner
( �Al Pia a i )
z.
Contractor State License No.
. 3
Architect
•
The owner of this building and the undersigned agree to conform to all applicable laws.
Signatur o5'pplicant // / Address -
C r----T-Th -- 1/- -7/77 V
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PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY ., -
Gve 4.1-
JEFFER •N COUNTY HEALTH DEPARTMENT
APP%V,E Di: PERMIT E ISS E DA -
�' F' � �--�y RECEIPT NUMBER
DEC 1 88 ion7 ' IC'll / p
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