HomeMy WebLinkAboutBLD1987-00411 BUILDING PERMIT APPLICATION
Jefferson County BuildiSepartment• County Cor -thouse • Port Towlid, Wash.98368 • 385-1310
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I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE •
S W FROM INTERSECTION OF rROAD AND �'"ROAD
specific location l ndmark: + &- i j di 1�
other spec cor a Y
EGAL DESCRIPTION:
Fa h e e Lot Block Subdivi
0° I O S 3 -/�
/ K Tax Number '4 Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY '
` hlew building ❑Single Family ❑New County Resident
❑Addition ❑Multi-Family Is this structure to serve the residential
number of units❑Alteration or commercial needs of those employed
❑Hotel,Motel, Dormitory at either the US.Navy's Trident or
❑Repair,replacement number of units Indian Island Facilities?
❑Wrecking ❑Mobile Home
❑Moving (relocation) Other S cify ❑YES ONO
❑Foundation only
USE
OWNERSHIP ❑Full-time Residence
❑Private (individual,corporation,
❑Second Home: Recreation Cabin,etc.
nonprofit institution,etc.)
f ❑Public (Federal,State or local goVt.) UBC OCCUPANCY GROUP: M----I ❑Second Home: Future conversion to
permanent residence
(Omit cents)
COSTNonresidential- 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
c. Heating,air conditioning 7 I , OV /--t /
Wit- l
d. Other (elevator,etc.)
`1 • TOTAL COST OF IMPROVEMENT $
III.SELECTED CHARACTERISTICS OF BUILDING -
DIMENSIONS
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL
`„_ El Masonry (wall bearing) •Number of Stories
(�fi ❑Public or Private •Total square feet of floor area,
1 Wood Frame ❑Individual (septic tank,etc.) all floors,based on exterior
dimensions
❑Structural steel
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft �/5D.p._
❑Public or private company [[ JJ
"'- ❑Other-Specify NUMBER OF OFF-STREET
❑Individual (well,cistern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
❑Oil RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal TYPE OF MECHANICAL Full
Number of
❑Other-Specify bathrooms
Partial
IV. IDENTIFICATION- -
•
Name Mailin Address-Number,street,city and State ZIP code Tel.No.
'�/
Owner S (%y�r "��� Lrt (.2 !l c
2. c Y 0
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Si n e of applicant
Address Applicatio date-
, —a,C-4(.4-'4,-4 (---13 -- c7
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVER BY 6 /- �5- �7 �<�
pSPG�_
JEFF TH DEPARTMENT -
APPROVED BY: PE I FEE ISSUE DATE RECEIPT NUMBER
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APPROVED
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