HomeMy WebLinkAboutBLD1987-00402r
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BUILDING PERMIT APPLICAT
Jefferson County Bur ng Department• County Courthouse •Port TWasend,Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF � iAID FEET
NE r�
S W FROM INTERSECTION OF ROAD AND lilt --ROAD
other specific location or/andrlr ..e ��. �1T1 I�
^LEGyq L�D ESC�i1 PTl OI1(:'
f \\��``�}JJ--����``��''JJ�� �� Lot Block �~P Subdivi
1
t� �Q Tax Number 1h Section Section ownship aR nge
II.TYPE AND COST OF BUILDING -
TYPE 9F IMPROVEMENT BUILDING TYPE MOBILITY •
New building
❑Single Family ❑New County Resident
❑A dition ❑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 IXI Mobile Home •
❑Moving (relocation) ❑Other—Specify ❑YES ❑NO
❑Foundation only
OWNERSHIP USE
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) ° "y
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. •
a. Electrical If use of existing building is being changed,enter proposed use.
b. Plumbing G �. 1 C) '�/ <��-�"
--� '- c. Heating,air conditioning C / (�
d. Other (elevator,etc.) T
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• TOTAL COST OF IMPROVEMENT $ } f
/ (�\
III.SELECTED CHARACTERISTICS OF BUILDING \ v
PRINCIPAL TYPE OF FRAME DIMENSIONS
-V' TYPE OF SEWAGE DISP `�
Masonry (wall bearing) \ �1 •Number of Stories
tNej ❑ 9 ❑Public or Private •---
❑Wood Frame -----, `� •Total square feet of floor area,
Individu eptic tank,etc.) all floors,based on exterior
❑Structural steel dimensions
TYPE- TER SUPPLY
Reinforced concrete •Total land area,sq.ft.
/ Other—Specif
Public dr private company
� � � ❑Tnd idual (well,cistern) PA SPACES
NUMBER OF STREET
!J Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
CI Gas Outdoors
�❑Oil ", RESIDENTIAL BUILDINGS ONLY
t Electricity Number of bedrooms
///❑ oal TYPE OF MECHANICAL
Ot r— Number of
Full
WOpec - bathrooms
O, _ey' Partial , (1 )"
IV. IDENTIFICATION- •
Name Mailing Address—Nurvt er,street,city„an State ZIP code Tel.No.
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2.
Owner .�
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Contractor State License No.
3
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
i7ature of applicant Add,� Applica on dat
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/6 _< ...YC-2
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BAY I J h
i / 6
JEFF HEALTH DEPARTMENT
APPROV B ' PERMITISSUED TE RECEIPT NUMBER
3 ` s'57 -- f /57
BUILDING OFFICIAL c<✓
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