HomeMy WebLinkAboutBLD1987-00419 110
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I. LOCATION: peopraphic name __. S W SIDE OF ROAD FEET
•
N E •
ilaA ik ROAD
S W FROM INTERSECTION OF ROAD AND,/
'.l0h'��1.��
other specific location or landmark: Q
LEGAL DESCRIPTION: 5_ V \O 2 A ri�Q I
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1� Lot Block A Subdivision
-I-t 0 I 1 5 1 Tax Number Y.Section Section Township Range
II.TYPE AND COST OF BUILDING-
TYPE OF IMPROVEMENT BUILDING TYPE
PUBLIC WORKS APPROVAL
New building Single Family
❑ dition ❑Mu of units Multi-Family Road Access Permit No.
❑Alteration
number
0 Hotel,Motel, Dormitory Utility Permit No.❑Repair,replacement number of units
❑Wrecking 0 Mobile Home Emergency Services No.
❑Moving(relocation) 0 Other—Specify
❑Foundation only Street Width A:
B:
C . Additional Permits Required:
` -- OWNERSHIP
0 Private (individual,corporation,
,t'
nonprofitetc.)
❑Public(Federal,State or local gov't.) UBC OCCUPANCY GROUP:
COST (Omit cenaJ Nonresidential— Describe in detail proposed use of buildings,e.g.,food
• Cost of improvement S 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
/ooff existing buildingis being changed,enter proposed we.
b. Plumbing / 7 7 // lQif/YL e- -/,/.�. Q
c. Heating,air conditioning /Cf q� /�, 4_ _ 7 e Q„- 3 9'Q,/
.,, d. Other(elevator,etc) I �'—/Q' �`��^��Si' )- r``�� 7
r'
-~ • TOTAL COST OF IMPROVEMENT S g / �1
I III.SELECTED CHARACTERISTICS OF BUILDING (/ `7
PRINCIPAL TYPE OF FRAME T OfPIyN)6E DISPOSAL
DIMENSIONS • -�-
❑Masonry(wall bearing) Public or Private •Number of Stories
•Total square feet of floor area,
Wood Frame 0 Individual (septic tank,etc.) all floors,based on exterior
❑ tructural steel dimensions
❑Reinforced concrete TYPE OF WATER SUPPLY •Total land area,sq.ft. `�
Public or private company
❑Other—Specify NUMBER OF OFF-STREET
Individual (well,astern) PARKING SPACES
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
0 Gas Outdoors
0• l RESIDENTIAL BUILDINGS ONLY
lectricity �- Number of bedrooms
TYPE OF MECHANICAL
1111 Coal Full
O Other—Specify Num r of
baathrothro oms [
I
Partial -..6,'� /j��
(�
IV. IDENTIFICATION 1��
Name P J r 60)6 I : ZIP code "el.No.
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Yr("1 ". --.--30- p L. q, .- (,,;‹ gR---,45
State License No.
Contractor1.
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Architect _ Poll-Le, a 1 �75C
The owner of this building and the undersigned agree to conform to all applicable laws.
Signature of applica Address Application date I
.i- -" /cam- I() --, Abft---e...... 7-/6'Nam_, i.._
PLANNING ARE FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT r
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APPROVED 8
S e PPF:wt--OVEDs� 3` �St7/ a,,,bawknk. APPROVED BY
t ,c Mr� ► ►✓��iaw�L► •
JE 1 ATH DE SHOP.EL 1 NE DEPT.�--7.3O.''? PLANNING DE'�T. '
APP I L
P RMIT FEE ISSUE DATE RECEIPT NUMBER
SS i5v`g 3)50 6 ly UILDINGOFFICIAL ` IJ87
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RECORD OF SURVEY
of -a portion of G OVT LOT 2 section 9 , township 28 north, range I east , w M.
jeffe rson county, washington.
for MERLAND MOSESON M Tcv,��ME�'Y�=
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auditor's certificate
numb r fee
surveyor's certificate
TAA, 5 A port townsend, wa.
,
99368 38 5 -063 3
filed for recordthis day
of , 198_•, at
this map correctly represents a survey made by me or
�U rvQy
m. in book
of surveys at page__
under my direction In conformance with the requirements
as datQs
at the request of ALAN
S CARMAN.
,of the SURVEY RECORDING ACT at thel request of
awn c'k'C° MR. ME�e�^N�' L MesF saN
sheet dr
of /' Bc H in 198
` fie: 0eL, /, /J6F,=—R? 1,v county auditor by deputy al n s. carman, certifi
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