HomeMy WebLinkAboutBLD1987-00401 BUILDING PERMIT APPLICATI RECEIVED
Jefferson County Buu ng Department•• County Courthouse ••Port To ,send, Wash.983t FEE§ IViS WNTY
N E NOV 13 1987
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF R/O,D AND /y _ RTMEIaAD
other specific location or landmark:
to LEGAL DESCRIPTION: S-Z 1,8 k� Y
Lots Block Subdi ision
patC CA-- - 9‘j 2 Q o 8(A 3 cl 3& / c.J
Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING -
1&) TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY •
``✓✓'' ❑New building LSingle Family ❑New County Resident
c ❑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 ❑Mobile Home
oving (relocation) ❑Other-Specify ❑YES ❑NO
oundation only
OWNERSHIP �lQ LpGo�-�j t 4:.e- C USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) 0Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: 12-73 ❑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
4►.. 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.
.4449' b. Plumbing
c. Heating,air conditioning
d. Other (elevator,etc.) q ,rc,
\ • TOTAL COST OF IMPROVEMENT $•1414* 1.
III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
e •Number of Stories (
❑Masonry (wall bearing) ❑Public or Private
•Total square feet of floor area,
Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
Structural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft.
❑Other-Specify ❑Public or private company _
NUMBER OF OFF-STREET
-+. ❑Individual (well,cistern) PARKING SPACES
v4,..D Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Di ', RESIDENTIAL BUILDINGS ONLY .-7.7 r f
LElectricity o Number of bedrooms -'
❑Coal TYPE OF MECHANICAL
.."
Full...►
(Other-Specify (i// Number of
bathrooms 1
• Partial
IV. IDENTIFICATION - •
Name Mailing Address-Number,street,city and State ZIP code Tel.No.
t. 1610- ".�•uJf 3 I /AN,c-0.-rQ �873.39 ss/y
Owner
2. -
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Sig applicant Address Ap lication date
/1/4)L41414:, 1, ' _ 3i A76';14'',7 S--r--- ,7 /itinv
8-9
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY ,�
\(J e -rEk
' 45�(� 73)87
JEFFERSON H TH DEPARTMENT rr
APPROVED BY: PERMIT FEE ISSUE DATE
RECEIPT NUMBER
25��
�7 � � ° I1a 3 ) I
BUILDING OFFICIAL SJu n� / 3/9--
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