HomeMy WebLinkAboutBLD1987-00393 L..i l . , .,i . ._. i .;t—i is: i i L.f'. ,.. s
Jefferson County Building lertrnent • County Courthouse • Port TownsciVash, 98368 • 385-1310
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I: LOCATION: geographic name S W SIDE OF...• ROAD FEET
N E 1H'
S W FROM INTERSECTION OF ROAD AND + `C1 (�� w • ROAD
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-other specific location or landmark: pT
LEGAL DESCRIPTION: /�''�� 0 i G 6 ,
IJnci () f 3^ .0`-''�1� t Block Subdivision
'l I`/7.733k` 5 Tax Number Y.Section Section To nssniip 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
number of units or commercial needs of those employed
N ❑Alteration ❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
C\-,
❑Wrecking. 4Mobile Home
❑Moving(relocation) Other—Specify ❑YES ONO
❑Foundation only
O
^', USE
OWNERSHIP
�� Full-time Residence
jaerivate (individual,corporation,
nonprofit institution,etc.) i ❑Second Home: Recreation Gavin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 1 1 ❑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.
a. Electrical if use of existing building is being changed,enter proposed use.
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b. Plumbing ,e /
c. Heating,air conditioning t� --. / 9
d. Other (elevator,etc) v, 16.__X
.:, eel-it/0a
• TOTAL COST OF IMPROVEMENT $
n III.SELECTED CHARACTERISTICS OF BUILDING -
Cr* PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISP ,, DIMENSIONS
`�V Jy ❑Masonry (wall bearing) •Number of Stories f •
❑ ublic or Private
•Total square feet of floor area,
❑Wood Frame Individual septic tan etc.) all floors,based on exterior /0 ��`
❑Structural steel dimensions �/ J
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. 7.!f1�(' "
Public or private company J
,ci
Other—Spe y NUMBER OF OFF-STREET
�_ �t`/ $ t!, ❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
0- ❑Gas Outdoors
\J ❑Oil RESIDENTIAL BUILDINGS ONLY
• 7 /Electricity Number of bedrooms
i TYPE OF MECHANICAL
❑Coal Full
Number of
❑Other—Specify bathrooms
Partial
IV- IDENTIFICATION- •
-
Name Mailing Address— Number,street,city and State ZIP code Tel.No.
1. Qf fti c,J GU. ,a61/ /---(a� C
1 j-v,e- (� r 9 %% -On �3
rOwner `,yl `l (�i
2. r
Contractor State License No.
3.
Architect '
The owner of this building and the undersigned agree to conform to all applicable laws.
li4ignat of applicant Addr s //�� ��� Appli ion dye
3 PLANNING AREA N FIRE DISTRICT 44 ' �SCHOOL DISTRICT - - WATER DISTRICT
APPROVFQ BAr e
1-1 CO oK 'd CI 7 / -7
JEFFER COUNTY HEALTH DEPARTMENT
APPROVED Y.\4 f '\ PERMIT\FEE ISSUE DATE RECEIPT NUMBER
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BUILDING OFFICIAL V
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