HomeMy WebLinkAboutBLD1987-00413 ,
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Jefferson County Buildir��artment• County Courthouse • Port Town ,✓ash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF- ROAD FEET
f NE `:��r_.
S W FROM INTERSECTION OF ROAD AND '�� 1Ill CTitcrft/j) ROAD
' S other specific location or landmark: /
.+EGAL D SC IPTION:
".gyp e , Lot Block �,�_ Subdivision � ��
C, r
Tax Number Y.Section Section Towns ip Range
tr—; II.TYPE AND COST OF BUILDING -
'
/`� TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY '
New building ingle Family ❑New County Resident
",.._,% dition ulti-Family Is this structure to serve the residential
❑Alteration number of units 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—Specify ❑YES ❑NO
❑Foundation only
USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
kN f"ar ❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: ❑Second Home: Future conversion to
`` �f I 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 Austria!plant.
z_N
�`\j a. Electrical If use of,existing building is being changed,enter proposed use.
6� I'lb. Plumbing YI ry p ,,,\ i / �O Vi � ---� " c �y�.�
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c. Heating,air conditioning e ' q>3 e 3 A
d. Other (elevator,etc.) j 6Z ... `3ty; kg,,, ,-_-:
_ l
r
' • TOTAL COST OF IMPROVEMENT $ -+/le
�� — 1 Qq f A,'
III.SELECTED CHARACTERISTICS OF BUILDING - , \ 13 7 ! 0 0 Fill(
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DI :O. \\ IIIMENSIONS
❑; asonry (wall bearing) ❑Public or Private •Number of Stories
, _ •Total square feet of floor area,
r Wood Frame )lndividua (septic tan etc.) all floors,based on exterior
•
III uctural steel dimensions
TYPE OF WATER SUPPLY
II:Reinforced concrete •Total land area,sq.ft.
❑Public or p ' - e company
❑Other—Specify NUMBER OF OFF-STREET
NIndividu.le istern) PARKING SPACES
Enclosed
PRINCIPA 1 (rE�,�H ,FUEL TYPE OF FIREPLACE
❑Gas i Thy,��l Outdoors
❑Oil � a RESIDENTIAL BUILDINGS ONLY
❑Electricity Number of bedrooms
❑Coal • TYPE OF MECHANICAL
Number of Full
t ther—S rfy bathrooms
)00 \ N-e__. Partial
IV. IDENTIFICATION- 1 d /T� . tr
Name �- g Address—Number,street,city and State ZIP code Tel.No.
1. C�iIles t'I O 0 i a., /0 3a -
Owner c T,/1 l��Vv Ci 7���
2. �^�
Contractor State License No.
3.
Architect
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature ap�'cant ( Address q A lication date
\� ( }� ����J�'�r S /�JV l V.o . S filb4PQ__ ,r ``
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY
GLCan e ms\ 0 (7 37
JEFFERSON FIEAI 77i DEPARTM NT �� ✓�V\
APPROVED BY: PERMIT EE ISSUE DATE RECE I PT NUM BE R
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Pr r J ►ne-+14- 4 .6 '/ RECEIVED
i-•4 Er:ic 7 JUL 2 4'87
l w--rlt't[si, t!St.trt4re 7-/9-97 JEFF. COUNTY
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