HomeMy WebLinkAboutBLD1987-00430 BUILDING PERMIT APPLICATI
Jefferson County Bullg Department• County Courthouse •Port To . rd, Wash.98368 • 385-1310
N E
I. LOCATION: geographic name S W SIDE OF ROAD FEET
NE
S W FROM INTERSECTION OF ROAD AND B5 1Y)ca-t-I h ROAD
other specific location or landmark: P 1
LEGAL DESCRIPTION:
ot,ca G j * Lot Block
�9 Subdivision
�30 I Li
tt 2"���yy
1 01 I 1- > Tax Number %a Section Section Township Range
r II.TYPE AND COST OF BUILDING -
r.
TYPE OF IMPROVEMENT BUILDING TYPE MOBILITY
` ❑New building Single Family ❑New County Resident
L J pgAddition ❑\Multi-Family
/� \ Is this structure to serve the residential
number of units
❑Alteration or commercial needs of those employed
❑Repair,replacement ElHotel,Motel, Dormitory at either the U.S.Navy's Trident or
number of units Indian Island Facilities?
❑Wrecking
❑Mobile Home
❑Moving (relocation)
❑Other—Specify ❑YES ❑NO
❑Foundation only
0
I0r USE
OWNERSHIP
❑Full-time Residence
❑Private (individual,corporation,
nonprofit institution,etc.) ❑Second Home: Recreation Cabin,etc.
❑Public (Federal,State or local gov't.) UBC OCCUPANCY GROUP: -3 ❑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 x 13 - I OH ` 0 t Gii.5- I R,a()
c. Heating,air conditioning I( X/ 2(n _ 4 I 1 o ttl
�
d. Other (elevator,etc.) !\ l T
0 • TOTAL COST OF IMPROVEMENT $ I.
.. , III.SELECTED CHARACTERISTICS OF BUILDING -
PRINCIPAL TYPE OF FRAME TYPE OF SEWAGE DISPOSAL DIMENSIONS
Masonry (wall bearing) �x(s� •Number of Stories
❑ 9 ❑Public or Private •Total square feet of floor area,00d Frame Individua (septic tank etc.) all floors,based on exterior
❑Structural steel / dimensions
TYPE OF WATER SUPPLY
❑Reinforced concrete •Total land area,sq.ft.
❑Public or private company
❑Other—Specify p— NUMBER OF OFF-STREET
--i Individua (well, istern) PARKING SPACES
e%(St
Enclosed
PRINCIPAL TYPE OF HEATING FUEL TYPE OF FIREPLACE
❑Gas Outdoors
/" ❑Oil ', RESIDENTIAL BUILDINGS ONLY
Electricity `—J.. Number of bedrooms
(4 ❑Coal TYPE OF MECHANICAL
7 ❑Other—Specify F Number of Full
,.
bathrooms
Partial
IV. IDENTIFICATION- •
Name Mailing Address—Number,street,city and State ZIP code Tel.No.
1. ehorle.S gSxI 1+111. 8S Tr,-1-i h la PT- ga,(0to ? 5
Owner LCn hd 0 l) 50S, II
2.
Contractor State License No.
3.
Architect
The finer of this building and the undersigned agree to conform to all applicable laws.
nature of ap nt Address Application date
c.....t_, st..........„ 4D14......._ 1 //)7/8
PLANNING AREA FIRE DISTRICT SCHOOL DISTRICT WATER DISTRICT
APPROVED BY ^t0 //c7A-7
JEFFER H DEPARTMENT
APPROVED PERMIT FEEpUEDATtIqBY � RECEIPT NUMBER
5'' 35O
BUILDING OFFICIAL gQ l v 1. -
32
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